What Is Costochondritis?

Costochondritis is a condition characterized by pain in the chest wall due to inflammation of the costal cartilage, which connects the rib to the breastbone. It most often affects people who are over 40 years of age and is more common among people assigned female at birth.

The exact cause that leads to costochondritis is unclear. Common risk factors include severe coughing, physical overexertion, trauma to the chest, a recent history of viral infection, and surgeries involving the anterior chest wall.

Pain and tenderness in the region where the ribs join the breastbone are the most common symptoms. Costochondritis will likely go away on its own over time and with rest, so treatments are usually only used for pain management. However, severe cases may require more intensive treatment. Several medications and home remedies are available for reducing pain and improving the quality of life for people with costochondritis. 

Symptoms of Costochondritis

Chest pain is the most common symptom of costochondritis. The onset of pain can be gradual or sudden. 

 Symptoms of costochondritis include:

• Sharp or dull pain in the chest wall that might spread to the stomach or back
• Worsening of pain with deep breaths and certain upper body movements
• Tenderness in the region where the ribs join the breastbone

Pain from costochondritis does not generally co-occur with swelling, heat, or redness.

Chest pain can arise due to other conditions such as heart disease, lung conditions, or rib fractures. People must immediately consult their healthcare providers if they are experiencing severe and acute chest pain.

Causes

Most often, the cause of costochondritis is not known. A strain in the chest region can occur due to a wide variety of factors. A few factors that can increase your risk of costochondritis are:

• Physical exertion due to heavy lifting or strenuous exercises
• Undergoing surgeries that involve the anterior chest wall
• Severe coughing, which is especially common in those with lung conditions like asthma or chronic obstructive pulmonary disease (COPD)
• Blunt trauma to the chest due to accidents or falling
• Recent history of viral respiratory infection
• Certain types of arthritis, such as osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis
• Infections, especially due to recently using intravenous (IV) drugs
• Benign or cancerous tumors in the chest

Diagnosis

No specific test is available for the diagnosis of costochondritis. Your healthcare provider will likely ask about your medical history and perform a physical examination to diagnose costochondritis. They also check for signs of tenderness in the region where the ribs meet the breastbone.

Generally, diagnosis of costochondritis involves a process of elimination. Since chest pain is a symptom associated with many conditions, it is important to rule out more severe and potentially life-threatening causes. A few tests can be used to eliminate other causes of chest pain. These include:

• Lab tests: Lab tests such as blood or urine tests are not essential for the diagnosis of costochondritis. However, they can help to determine if the chest pain is for some other conditions such as pneumonia or acute coronary syndrome.
• X-ray: Chest X-rays cannot be used to determine if you have costochondritis. However, they can help to rule out lung conditions such as spontaneous pneumothorax, pneumonia, or others.
• Electrocardiogram (ECG): An ECG can help to determine if chest pain is occurring due to heart disease or other conditions affecting the heart.

Treatments for Costochondritis

Most of the treatment options for costochondritis focus on reducing pain. Several home remedies and medications are available to improve pain from costochondritis.

Medications

Medications are available both by prescription and over-the-counter (OTC). Generally, OTC medications can help with pain reduction until you have time to heal. If your pain does not feel adequately managed using OTC medications, talk to your healthcare provider about other options, including prescriptions. Medication options for managing pain caused by costochondritis include:

• Prescription-strength or OTC nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen)
• OTC cough suppressants for those with severe cough
• Tricyclic antidepressants such as Elavil (amitriptyline), must be used with caution due to potential side effects 
• Local steroid injections at the region of pain
• Topical lidocaine or capsaicin patches or cream for pain
• Muscle relaxants such as Flexeril or Amrix (both cyclobenzaprine) can sometimes help to reduce pain

Surgery is sometimes used in very severe cases of costochondritis when all the other treatment options fail.

Home Remedies

A few of the home remedies that can be useful to reduce pain from costochondritis are:

• Applying hot or cold compresses in the chest region around the pain
• Performing certain stretching exercises, including range of motion (ROM) and postural correction exercises
• Avoiding activities that overuse chest muscles, such as lifting heavy weights or rowing
• Undergoing physical therapy
• Undergoing acupuncture alone or in addition to other traditional treatments

Prevention

No specific prevention approaches are available for costochondritis since the causes are often not clear. Some of the causes are preventable while others are not.

It can be helpful to ease into new activities, giving your body time to adjust to new movements. Practice caution when exercising to avoid overexertion and give yourself adequate time to heal, when needed.

Complications

Costochondritis most often does not cause any permanent and long-term complications. The pain and inflammation usually goes away on its own with appropriate treatment.

In a few cases, the pain can be persistent and recurring even with treatment. This can be due to performing certain exercises or engaging in activities involving the upper body, especially after the symptoms of costochondritis have already set in. In such scenarios, you may need to undergo long-term treatments such as physical therapy to be able to perform your daily activities.

Chest pain associated with costochondritis can also indicate other, more serious conditions. Visit the emergency department if you are experiencing severe chest pain, especially if it’s accompanied by any of the following:

• Difficulty in breathing
• High fever
• Worsening pain even after taking medications
• Any signs of infection such as swelling, pus, or redness around the ribs
• Extreme pain even while breathing 
  

A Quick Review

Costochondritis is a condition that arises due to the inflammation of the costal cartilage that joins the ribs to the breastbone. It leads to mild or severe chest pain along with tenderness in the region. Several factors can cause costochondritis, although the exact cause is not yet clear.

Chest pain can also arise from other serious health conditions such as pneumonia or heart disease. Testing can be used to rule out other potential causes. Several treatment options are available to reduce pain from costochondritis. People experiencing other symptoms such as high fever, nausea, dizziness, or shortness of breath along with pain must seek medical care since it may be indicative of other serious conditions.