Costochondritis is a painful condition of the chest wall. It is caused by inflammation in the joints between the cartilages that join the ribs to the breastbone (sternum). Although painful, it is not a serious condition. Usually it has no obvious cause and settles over time. Painkillers and anti-inflammatory medication can be used for relief of symptoms.
What is costochondritis?
Costochondritis is a painful condition of the chest wall. It causes chest pain. Fortunately, it is not a serious condition.
To understand costochondritis, you need to know a bit about the anatomy of the rib cage. The rib cage is a bony structure that protects the lungs. Bones are hard and solid, and they don't tend to bend or move. However, our lungs need to move, so we can breathe.
When we take a deep breath in, the diaphragm acts as a bellows. The diaphragm moves down and this sucks air through our mouth and nose, and into our lungs. Our rib cage expands too. In order for the ribs to expand, the ribs need something to allow movement. Cartilage allows this. Cartilage is a softer, flexible (but very strong) material found in joints around the body.
Cartilages attach the ribs to the breastbone (sternum) and the sternum to the collarbones (clavicles). The joints between the ribs and the cartilages are called the costochondral joints. Those between the cartilages and the breastbone are called costosternal joints. Those between the sternum and the clavicles are called the sternoclavicular joints.
The prefix 'costo' simply means related to the ribs. 'Chondr-' means related to the cartilage and '-itis' is the medical ending (suffix) that means inflammation.
In costochondritis, there is inflammation in either the costochondral, costosternal or sternoclavicular joints (or a combination). This causes pain and tenderness, that tends to be worse with movement and pressure.
Tietze's syndrome is similar to costochondritis. The two conditions are often (incorrectly) used interchangeably. Tietze's syndrome is, however, a different condition. It causes similar symptoms, is still due to inflammation, but tends to cause swelling at the costochondral, costosternal or sternoclavicular joints.
Bornholm disease is another similar condition. However, it is caused by a viral illness and leads to muscle aches and pains, as well as chest pain. Coxsackievirus B is the usual cause of Bornholm disease (although echovirus and Coxsackievirus A can be responsible). See separate leaflet called Bornholm Disease.
Important information regarding chest pain
There are many causes of chest pain. Chest pain is a symptom that you should discuss with your GP to try to establish the cause.
Note: chest pain can have serious causes. Any new, severe or persisting chest pain should be discussed with a doctor. This is particularly important if you are an adult and have a history of heart or lung disease. If the pain is particularly severe, especially if radiating to your arms or jaw, and you feel sick, sweaty or breathless, call 999 for an emergency ambulance. These can be symptoms of a heart attack.
If you are young, and generally healthy then non-serious chest wall pain is common. Costochondritis is an example of a condition that can cause chest wall pain that is not serious. Because the pain caused by costochondritis can be quite severe at times, many people with it become very anxious and worried that it may be due to something more serious.
What causes costochondritis?
Costochondritis is often idiopathic. This is a medical term, meaning 'of unknown cause'. So, in many cases, no cause is found.
Sometimes costochondritis can follow repeated minor chest injury or activities that one is unused to - perhaps decorating or moving furniture.
Who develops costochondritis?
There is no particular person more at risk of costochondritis than another. It does tend to affect younger people, especially teenagers and young adults. It can affect children. People performing repetitive movements that strain the chest wall, particularly if they are not used to it, might be considered more at risk of getting this condition. Some studies suggest women tend to be affected more commonly than men.
People with fibromyalgia tend to develop costochondritis more often than others. Fibromyalgia is a long-term (chronic) condition that causes widespread body pains and fatigue. (See separate leaflet called Fibromyalgia for more information.)
How common is costochondritis?
It is difficult to be precise about how many people develop costochondritis. It is a relatively common problem. Probably, many people with it do not report their symptoms to a doctor. And, as the condition is often short-lived, and settles on its own (spontaneously), the numbers are not known.
Some studies have estimated that between 1 and 3 in 10 people with chest pain have a musculoskeletal cause. This means the chest pain is related to the muscles or the ribs. Costochondritis is one cause of musculoskeletal chest pain.
What are the symptoms of costochondritis?
Costochondritis causes chest pain, felt at the front of the chest. Typically, it is sharp and stabbing in nature and can be quite severe. The pain is worse with movement, exertion and deep breathing. Pressure over the affected area also causes sharp pain. Some people may feel an aching pain. The pain is usually confined (localised) to a small area but it can spread (radiate) to a wider area. The pain tends to wax and wane, and can settle with a change of position and quiet, shallow breathing.
The most common sites of pain are close to the sternum, at the level of the 4th, 5th and 6th ribs.
Note: without tenderness, the cause of the chest pain is unlikely to be costochondritis. Remember to seek medical advice if you are unsure of the cause of your symptoms (see 'Important information regarding chest pain', above).
How is costochondritis diagnosed?
Costochondritis is usually diagnosed based on your symptoms and examination. It is important that other causes of chest pain should be ruled out.
Do I need any tests (investigations)?
No tests (investigations) are needed to confirm costochondritis. However, tests may be performed to rule out other causes of chest pain if the cause of the pain is unclear. Examples of such tests would include a heart trace (electrocardiogram, or ECG) or a chest X-ray.
What is the treatment for costochondritis?
Ibuprofen is an anti-inflammatory medication (also called a non-steroidal anti-inflammatory drug, or NSAID) that is often effective for costochondritis. Other NSAIDs are available on prescription. NSAIDs should not be taken on an empty stomach; neither should they be used by people taking anticoagulant medication (such as warfarin), nor by people with asthma (unless under supervision by a doctor). If you have a history of a stomach ulcer, or suffer regular indigestion or acid reflux, you should avoid NSAIDs. If you develop tummy (abdominal) pains, indigestion or being sick (vomiting) whilst taking NSAID medications such as ibuprofen:
- You should stop them immediately and seek medical advice.
For severe cases of costochondritis, not responding to painkillers and anti-inflammatory medication, injections of steroids or local anaesthetic medicines may be used.
In extreme cases, an intercostal nerve block can be performed (usually by a doctor specialising in acute pain and/or anaesthetics). This involves injection of a local anaesthetic medicine around the painful ribs, to block the nearby intercostal nerve. The intercostal nerves transmit the painful sensation in costochondritis. This sort of injection temporarily disrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In repeated (recurrent), severe cases of costochondritis, a series of these injections can be given to permanently destroy the nerve causing the pain.
Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:
- Heat pads
- Ice application
- Transcutaneous electrical nerve stimulation (TENS)
- Gentle stretching exercises
- Avoidance of sports or activities that worsen the pain
(See separate leaflet called TENS Machines for more information.)
What is the outlook (prognosis) for costochondritis?
The outlook (prognosis) for costochondritis is generally very good. Most cases are mild, short-lived (commonly no more than 6-8 weeks) and get better on their own. This happens with or without simple medications. In nearly all cases, the condition has completely gone within six months. However, in a very small number of cases it lasts longer. Costochondritis may return, but this is unlikely.
Dr Katrina Ford
Dr Colin Tidy
Dr John Cox