What is costochondritis?

Costochondritis is a painful condition of the chest wall. It causes chest pain. Fortunately, it is not a serious condition, but other causes of chest pain can be more serious.

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 inside. 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, our rib cage expands too. In order for this to happen, 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 sternum (breastbone) and the sternum to the clavicles (collarbones). The joints between the ribs and the cartilages are called the costochondral joints, those between the cartilages and the breastbone are called costosternal joints and those between the sternum and the clavicles are called the costoclavicular joints.

The prefix 'costo' simply means related to the ribs. 'Chondr-' means related to the cartilage and '-itis' is the medical suffix (ending) that means inflammation.

In costochondritis, there is inflammation in either the costochondral, costosternal or costoclavicular 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 costoclavicular 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. Coxsackie B virus is the usual cause of Bornholm disease (although echovirus and Coxsackie A virus can be responsible). See our 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 it is radiating to your arms or jaw, you feel sick, sweaty or breathless, you should 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 gets 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 chronic (long-term) 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 get 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 spontaneously (on its own), 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 localised (confined) to a small area but it can radiate (spread) 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 are ruled out.

Do I need any investigations?

No investigations (tests) are needed to confirm costochondritis. However, investigations 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 an electrocardiogram (ECG - a heart trace) or a chest X-ray.

What is the treatment for costochondritis?

The treatments for costochondritis are analgesics (painkillers) and anti-inflammatory medications. Often, only simple analgesics such as paracetamol or codeine are needed.

Ibuprofen is an anti-inflammatory medication (also called a non-steroidal anti-inflammatory drug (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 abdominal pains, indigestion or 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 an doctor specialising in acute pain and/or anaesthetics). This involves injection of a local anaesthetic drug 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 recurrent, severe cases of costochondritis, a series of these injections can be given to permanently destroy the nerve causing the pain.

Non-drug measures can be tried for relief of pain in costochondritis. Examples of such techniques include heat pads, ice application, transcutaneous electrical nerve stimulation (TENS), acupuncture, gentle stretching exercises and avoidance of sports or activities that worsen the pain. (See separate leaflet called 'TENS Machines' for more information.)

What is the prognosis (outlook) for costochondritis?

The prognosis (outlook) 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 - with or without simple medications. In nearly all cases, the condition has completely gone within 6 months but in a very small number of cases it lasts longer. Costochondritis may return, but this is unlikely.