What is Costochondritis & How is it Treated?: Causes, Symptoms, Diagnosis of Costochondritis

The connection between breastbone and the ribs is made by way of cartilages. At times, these cartilages get inflamed and cause pain in the chest. This is what is referred to as Costochondritis. The pain experienced due to Costochondritis occurs where the ribs and sternum meet. This place is medically termed as sternal articulation. An individual with Costochondritis will have a chief complaint of severe chest pain. This will prompt the individual to go to the emergency room.^[1] There a series of tests will be conducted to rule out other causes of chest pain and once done a diagnosis of Costochondritis is made. It is a benign medical condition which does affect the overall health of the individual in any way.^[1]

What exactly causes this inflammation of the cartilages is not exactly clear. However, the symptoms may be so severe that the affected individual may feel that he or she is having a myocardial infarction. There is no specific treatment for Costochondritis aside from a course of antiinflammatory medications.^[1]

There is no known cause for Costochondritis. However, people who have a history of a medical condition where they have severe bouts of coughing for long periods of time tend to have it more. Costochondritis can also be sometimes caused due to heavy lifting or strenuous exercises which affect the chest wall and cause the cartilages to get inflamed. People who lift heavy objects like porters or people who carry heavy backpacks also at times develop Costochondritis.^[2]

Costochondritis at times also affects females who have abnormally large breasts as it puts excess pressure on the chest wall. People with a prior history of a trauma or injury to the chest also may develop Costochondritis sometime in the future. People who have undergone surgery to the chest or surrounding areas like a cardiac bypass are also at risk for developing Costochondritis. In case if there is no identifiable cause for this condition then it is termed as idiopathic Costochondritis.^[2]

The primary presenting feature of Costochondritis is severe chest pain that will be stabbing in nature. There will also be associated burning sensation in the chest. There will also be pain along the second and the fifth rib region. Costochondritis is seen mostly in people above the age of 40. Studies estimate that around 40% of people who go to the emergency room for chest pain are ultimately diagnosed with Costochondritis.^[2]

The pain caused by Costochondritis will worsen with periods of coughing or strenuous activity. Lifting objects above the head will also worsen the symptoms. The pain will usually be on the left side of the chest even though at times the right side may also have pain at times.^[2]

A variation of Costochondritis is termed as Tietze syndrome. In this condition, the symptoms are similar to Costochondritis but in addition there is also swelling of the rib cartilage. The ribs affected most by Tietze syndrome is the second and the third ribs. The pain caused by Costochondritis tends to subside within a few days after taking medications; however, with Tietze syndrome the swelling of the rib cartilage continues for a prolonged periods of time. It is a completely benign and rare condition and tends to occur mostly in people with Costochondritis.^[2]

As an individual with Costochondritis will always present with left sided chest pain, the diagnosis is made after ruling out other potentially serious causes. To begin with, the physician will take a detailed history of the patient as to when the symptoms started or any risk factors for any cardiac condition like uncontrolled hypertension. An EKG will also be taken to rule out any potential cardiac abnormality.^[2]

There are also certain other medical conditions which have symptoms similar to Costochondritis. These conditions include shoulder arthritis, infection involving the chest wall, and fibromyalgia. Once all these conditions are ruled out, the physician will perform a detailed physical examination of the affected region to look for any areas of tenderness around the ribs. Once all relevant conditions are ruled out then a diagnosis of Costochondritis is arrived at.^[2]

The best way to treat Costochondritis is by way of antiinflammatory and pain medications. The physicians will also ask the patient to avoid any strenuous activities and allow the inflammation to calm down. Ibuprofen and Tylenol are the best medications that are given for treatment of Costochondritis. It is recommended that aspirin which is also quite effective in treatment of Costochondritis should not be given to people under the age of 17 for potential risk of developing Reye Syndrome.^[2]

If medications are deemed ineffective in treating Costochondritis then the physician may resort to corticosteroid shots as a means of calming down inflammation and for pain relief. Additionally, the physician will recommend applying warm compresses to the rib area to calm down inflammation and to control pain. To control the cough which worsens the symptoms, the physician will recommend taking cough medications or syrups.^[2]

These treatments should suffice for an effective treatment of Costochondritis. However, if relief is not obtained by these measures then a thorough checkup with a physician is required for more aggressive measures to treat Costochondritis.^[2]

References:

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