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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Bone, Muscle and Joint Disorders Costochondritis

Costochondritis

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Costochondritis is a condition that causes chest pain due to inflammation of the cartilage and bones in the chest wall. Also called Tietze's syndrome, costochondritis occurs when there is inflammation at the junction of the rib bone and breastbone (sternum). At this junction, there is cartilage joining these bones. This cartilage can become irritated and inflamed. Depending on the extent of the inflammation, costochondritis can be quite painful.

 

Costochondritis is a condition that causes chest pain due to inflammation of the cartilage and bones in the chest wall. Also called Tietze's syndrome, costochondritis occurs when there is inflammation at the junction of the rib bone and breastbone (sternum). At this junction, there is cartilage joining these bones. This cartilage can become irritated and inflamed. Depending on the extent of the inflammation, costochondritis can be quite painful. The condition causes localized chest pain that one can reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is a relatively harmless condition and usually goes away without treatment. Any of the 7 costochondral junctions may be affected, and more than 1 site is affected in 90% of cases. The second to fifth costochondral junctions most commonly are involved.

Symptoms

  • Most common symptom is chest pain which may be –
  1. Exacerbated by trunk movement, deep inspiration, and/or exertion
  2. Lessens with decreased movement, quiet breathing, or change of position
  3. Sharp, nagging, aching or pressure like
  4. Usually quite localized but may extend or radiate extensively
  5. May be severe
  6. May wax and wane
  • Pain with palpation
  • Difficulty breathing
  • High fever
  • Signs of infection such as redness, pus, and increased swelling at the rib joints
  • Nausea
  • Sweating

Causes

  • Injury
  • Infection
  • Fibromyalgia
  • It may be a referred pain

Diagnosis

  • there may be signs of infection such as redness, swelling, pus, and drainage at the site of surgery.
  • A more sophisticated imaging study of the chest, a gallium scan, is used to check for infection. It will show increased uptake of the radioactive material gallium in an area of infection.
  • In cases of possible infection, the white blood cell count may be elevated.
  • Chest x-ray is done if pneumonia is a suspected cause of chest pain.
  • ECG and other tests will be done if a heart problem is being considered.

Treatment and Medications

  • Costochondritis responds to nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen.
  • local anesthetic and steroid injection may be used if the area is tender and if normal activities become very painful and the pain does not respond to medications.
  • Infectious costochondritis should be treated initially with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another two to three weeks to complete the therapy.
  • Surgical removal of the affected cartilage may be required if there is no response to medical therapy. 
  • Infectious costochondritis requires long-term, close follow-up.