Costochondritis
Inflammation of the rib cartilage at the breastbone
Quick Facts
- Type: Musculoskeletal (chest wall) condition
- Location: Cartilage joining ribs to the breastbone
- Main symptom: Sharp chest pain that worsens with movement
- Outlook: Usually harmless and self-limiting
Overview
Costochondritis is inflammation of the cartilage that connects the ribs to the breastbone (sternum). This cartilage allows the rib cage to flex with breathing. When it becomes inflamed, it causes chest wall pain that is often sharp and can be quite worrying because it occurs in the chest.
Although the pain can mimic that of a heart problem, costochondritis itself is harmless and usually improves on its own over days to weeks. It is a common cause of chest pain in people who come to clinics and emergency departments. Because chest pain can have serious causes, however, it is important to have new or severe chest pain evaluated, especially the first time it occurs.
Symptoms
The pain of costochondritis has characteristic features:
- Sharp, aching, or pressure-like pain at the front of the chest, usually on the left side
- Pain over one or more spots where the ribs meet the breastbone, which are often tender to the touch
- Pain that worsens with deep breaths, coughing, or movement of the upper body
- Pain affecting more than one rib and that may spread to the back or abdomen
Importantly, costochondritis usually causes tenderness when you press on the chest, which is not typical of heart-related pain. Pain with sweating, breathlessness, or spreading to the arm or jaw should be treated as a possible heart problem.
Causes
The exact cause is often unclear, but costochondritis may follow:
- Strain or overuse: Heavy lifting, vigorous exercise, or repeated upper-body movements.
- Coughing: Forceful or prolonged coughing during a respiratory illness.
- Minor chest injury or impact.
- Infections, rarely, of the joint or surrounding tissue.
In many cases no specific cause is found, and the inflammation resolves on its own. A related condition called Tietze syndrome involves similar pain with visible swelling at the joint.
Risk Factors
- Recent heavy lifting or strenuous physical activity
- A recent respiratory infection with a lot of coughing
- Repetitive upper-body movements at work or in sports
- Minor trauma to the chest
Diagnosis
Costochondritis is diagnosed mainly by examination, after ruling out more serious causes of chest pain:
- Physical examination: Pressing on the rib-sternum joints reproduces the pain, which strongly suggests costochondritis.
- Tests to exclude other causes: An ECG, chest X-ray, or blood tests may be done, especially with first-time or concerning chest pain, to rule out heart or lung problems.
There is no specific test that confirms costochondritis; it is identified by its typical features and by excluding other conditions.
Treatment
Treatment focuses on relieving pain while the inflammation settles:
- Pain relief: Over-the-counter anti-inflammatory medicines such as ibuprofen, or acetaminophen, as appropriate.
- Heat or ice applied to the sore area.
- Rest and activity changes: Avoiding movements and exercises that worsen the pain until it improves.
- Gentle stretching as comfort allows.
For persistent or severe pain, a doctor may suggest stronger medication or, occasionally, a local injection. Most people recover within a few weeks, though it can sometimes linger longer.
Prevention
- Warm up and use good technique during exercise and lifting
- Avoid sudden increases in strenuous upper-body activity
- Treat coughs and respiratory illnesses to reduce prolonged forceful coughing
- Take breaks during repetitive upper-body tasks
When to See a Doctor
See a doctor for new chest pain, especially the first time, to confirm the cause. Seek emergency care immediately if chest pain is:
- Crushing or pressure-like and spreads to the arm, neck, or jaw
- Accompanied by shortness of breath, sweating, nausea, or lightheadedness
- Severe, or comes with a fast or irregular heartbeat
These features can signal a heart attack or other serious problem and should not be assumed to be costochondritis.
Frequently Asked Questions
Is costochondritis dangerous?
Costochondritis itself is harmless and usually clears up on its own within a few weeks. However, because chest pain can have serious causes, new or severe chest pain should be evaluated, especially the first time it occurs.
How can I tell costochondritis from a heart problem?
Costochondritis pain is usually sharp, worsens with movement or deep breaths, and is tender when you press on the chest. Heart-related pain is more often pressure-like, may spread to the arm or jaw, and comes with sweating or breathlessness. When in doubt, seek emergency care, as chest pain can be serious.
What causes costochondritis?
It is often linked to strain from heavy lifting or exercise, forceful coughing during an illness, or minor chest injury, though frequently no clear cause is found. The inflammation of the rib cartilage usually settles on its own.
How long does costochondritis last?
Most cases improve within a few weeks. Some people have pain that lingers longer or comes and goes, especially if the activity that triggered it continues. Anti-inflammatory medicines and rest help recovery.
How is costochondritis treated?
Treatment focuses on relieving pain with over-the-counter anti-inflammatory medicines, heat or ice, rest, and avoiding movements that worsen it. Persistent or severe cases may need stronger medication or, rarely, a local injection.
References
- Mayo Clinic. Costochondritis — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Costochondritis.
- American Academy of Family Physicians. Chest wall pain.