Costochondritis: Symptoms, Diagnosis, and Treatment

Experiencing chest pain of any kind can be alarming since it houses both your heart and your lungs. However, there are many different causes of chest pain, including more minor and benign musculoskeletal issues. Costochondritis, which is a kind of chest inflammation, could be one potential explanation behind your pain. Here’s what you should know about costochondritis, including how to distinguish it from cardiac arrest, plus some tips on managing the pain.

Anytime you have tenderness or pain in your chest, it can be worrisome. Even though costochondritis usually goes away on its own, it's always best to see a medical professional to rule out other causes of chest pain.

What is costochondritis?

Costochondritis is a type of chest pain linked to inflammation of the costal cartilage, which is the place in your chest wall where your ribs meet your sternum.

Costochondritis comes from the English words “costo," meaning anatomy or ribs, "chondral," referring to cartilage, and "itis," meaning inflammation.

How common is costochondritis?

Costochondritis is a fairly common type of chest pain. In fact, one survey found that about 30% of people who went to the emergency room with chest pain were found to have costochondritis.

It can also be more common in certain populations: for example, women are more likely to experience costochondritis than men. Costochondritis is also a common cause of chest pain in adolescents.

Is it costochondritis or cardiac arrest?

Experiencing costochondritis can be alarming because the pain in your chest may feel like you’re suffering from cardiac arrest, which is an unexpected loss of heart activity due to an irregular heart rhythm.

In costochondritis, the pain worsens with specific movements and positions, whereas cardiac pain is not affected by movement or position. Occasionally, costochondritis pain occurs with a deep breath, cough, or sneeze. Both cardiac and costochondritis pain can be dull or sharp.

The best way to determine the difference between chest pain of cardiac origin vs. costochondritis (or other musculoskeletal disorders) is to place pressure on the area where the pain originates. If pressure on that site causes the same pain, it is called reproducible, which usually means the cause of the pain is musculoskeletal.

Alternatively, they can often be distinguished by the symptoms.

Costochondritis symptoms

Costochondritis is a musculoskeletal issue that affects your chest wall and therefore does not have any direct relation to your cardiovascular system. Some common symptoms of costochondritis include chest pain that:

• Can be described as either sharp or achy
• Feels tender when pressing the affected chest area
• Starts on the left side of your chest wall
• Extends to other areas of the chest, as well as arms, shoulders, back, or belly
• Gets worse with deep breathing, coughing, or other chest movements

Pain from costochondritis often goes away on its own, usually after a couple of weeks. In addition, all other vital signs should be normal in someone experiencing costochondritis.

Cardiac arrest symptoms

On the other hand, a cardiac arrest is a cardiovascular event in which your heart completely stops all activity due to irregular heart rhythms.

One of the most common symptoms of cardiac arrest is chest pain, but it is also often accompanied by other serious symptoms like:

• Shortness of breath
• Sudden weakness or fatigue
• Heart palpitations
• Eventual loss of consciousness/collapse

Call emergency medical services immediately if you suspect that you or someone you love is experiencing cardiac arrest. The lack of blood and oxygen to your brain can cause death or permanent brain damage very quickly if left unaddressed, so it’s important to get help immediately.

What causes costochondritis?

The causes of costochondritis aren’t well understood. However, some potential causes linked to costochondritis include:

• Trauma or injury to your chest wall
• Tumors in the chest area
• Overuse of your arms
• Arthritis
• Respiratory, bacterial, or fungal infections

Tietze Syndrome vs costochondritis: are they related?

The term “costochondritis” is sometimes used interchangeably with Tietze syndrome. However, it’s important to make a distinction between the two.

Tietze syndrome is an inflammatory condition linked to swelling at the costochondral junction — similar to costochondritis. Symptoms of both costochondritis and Tietze syndrome will look similar, with the main similarity being the localized pain and tenderness in the chest area.

However, unlike costochondritis, Tietze syndrome is a much rarer condition that can come on with seemingly no warning. People with Tietze syndrome may experience sudden and acute chest pain with no history of trauma and may otherwise be healthy. Unfortunately, Tietze syndrome may also leave patients with chest swelling up to one year after the initial incident, even after the pain has dissipated.

Additionally, costochondritis mainly affects people over forty and can occur in more than one location. Tietze syndrome, on the other hand, usually affects those younger than forty and occurs in just one place. Furthermore, costochondritis affects ribs 2–5, while Tietze affects ribs 2–3.

How is costochondritis diagnosed?

There is no specific diagnostic tool for costochondritis. Instead, a doctor might order a number of different screening procedures that can help rule out other causes of chest pain.

If you present with chest wall pain, your doctor may run a number of surveys and tests to discover the cause. Some of the most common tests in a chest wall pain diagnosis include:

• Patient history evaluation. The history is taken to learn about recent illnesses, coughing, sneezing, or strenuous physical activity.
• Thorough physical exam. A physical exam with particular attention to the heart, lungs, and the painful area.
• Complete blood work. In addition, troponin, a cardiac biomarker, is a sensitive and specific test currently used to detect cardiac ischemia (heart attack).
• Electrocardiogram (EKG). It is valuable for checking the heart's electrical functioning, including rate and rhythm. When there is a lack of blood flow to certain areas of the heart (ischemia), it usually shows up on EKG.
• Plain x-rays of the chest and ribs. The chest x-ray (CXR) will show the heart, lungs, and ribs; however, a set of specialized rib x-rays may be done. Plain x-rays evaluate for bony abnormalities, including fracture, osteoarthritis, rheumatoid arthritis, osteoporosis (thinning of the bones), and sometimes joint inflammation can be visualized.
• Computed tomography (CT or CAT) scans. They evaluate soft tissue structures not seen on x-rays, including the muscles, tendons, and ligaments. The CT scans take cross-sectional images and produce three-dimensional (3D) views.
• Echocardiogram (cardiac echo or just echo). It is a special ultrasound that helps evaluate the heart's functioning in real time. It shows the contraction of the heart muscle and blood flow.

What is the treatment of costochondritis?

Pain from costochondritis generally goes away on its own after a week or so. However, you may also try to manage the pain with either medication and/or home remedies.

Medication

• OTC drugs. Over-the-counter pain-relieving drugs like acetaminophen (Tylenol) may be used to manage minor to moderate discomfort. Yet, it must be used with caution since excessive use can lead to a liver disease.
• Anti-depressant medication. Your doctor may also recommend antidepressants like amitriptyline (Elavil), often used for chronic pain management and especially if it interferes to sleep.
• Injection directly into the site. Your doctor may also suggest a corticosteroid shot directly into the inflamed site for severe pain that can't be managed with medication alone. Corticosteroids are used to manage inflammation and target the root of chest inflammation.
• NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) are specifically meant to target inflammation, making them a good OTC medication to treat the chest inflammation associated with costochondritis. Furthermore, NSAIDs help with swelling and chronic pain. However, caution must be used with all NSAIDs since they can cause gastrointestinal (GI) irritation, leading to stomach ulcers and bleeding.

Home remedies

• Physical therapy. If your chest wall pain stems from an injury, you may benefit from physical therapy that gently works the affected area. Also, it's useful if there is poor posture or body mechanics (functioning). Some exercises might include stretching, breathing and mobilizations. In addition, physical therapy can use modalities such as electrical stimulation and ultrasound to help relieve symptoms.
• Minimizing activities. On the other hand, physical activity that strains your chest may exacerbate the pain, so it’s a good idea to lay low for at least a week while dealing with costochondritis to allow the area a chance to heal.
• Hot and cold therapy. Some costochondritis patients benefit from alternating hot and cold therapies (i.e., heating pads and ice packs) applied directly to the affected area. Both heat and ice can help manage inflammation and subsequent pain. The old-fashioned theory is to use ice for the first 24 hours, then use heat, which still is valid for the first 24 hours. However, after the first 24 hours, some people still respond better to ice as opposed to heat, so the technique should be individualized.
• Rib belt. If you need help keeping the affected area immobilized to let it heal, you might benefit from using a rib belt (also known as a rib brace) sparingly when you need the extra support. However, it's important to use these with moderation and to make sure that you aren't wearing yours too tightly, since this can restrict your chest wall motion.