Costochondritis

Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions.

Costochondritis is sometimes known as chest wall pain syndrome, costosternal syndrome or costosternal chondrodynia. Sometimes, swelling accompanies the pain (Tietze syndrome).

What causes costochondritis is unclear. Treatment focuses on easing the pain while waiting for the condition to improve on its own, which can take several weeks or more.

The pain associated with costochondritis usually:

• Occurs on the left side of your breastbone
• Is sharp, aching or pressure-like
• Affects more than one rib
• Can radiate to arms and shoulders
• Worsens when taking a deep breath, coughing, sneezing or with any chest wall movement

When to see a doctor

For chest pain, seek emergency medical attention to rule out life-threatening causes such as a heart attack.

Costochondritis usually has no clear cause. However, costochondritis might be associated with trauma, illness or physical strain, such as severe coughing.

Costochondritis occurs most often in women older than 40.

Tietze syndrome usually occurs in teenagers and young adults, and with equal frequency in men and women.

During the physical exam, a health care provider will feel along your breastbone for tenderness or swelling. The provider might also move your rib cage or your arms in certain ways to try to trigger symptoms.

The pain of costochondritis can be similar to the pain associated with heart disease, lung disease, gastrointestinal problems and osteoarthritis. There is no laboratory or imaging test to confirm a diagnosis of costochondritis. But a health care provider might order certain tests, such as an electrocardiogram and chest X-ray, to rule out other conditions.

Costochondritis usually goes away on its own, although it might last for several weeks or longer. Treatment focuses on pain relief.

Medications

Your health care provider might recommend:

• Nonsteroidal anti-inflammatory drugs. You can buy some types of these drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), over the counter. Stronger versions are available by prescription. Side effects can include damage to the stomach lining and kidneys.
• Narcotics. If pain is severe, a provider might prescribe a narcotic medication such as tramadol (Ultram). Narcotics can be habit-forming.
• Antidepressants. Tricyclic antidepressants, such as amitriptyline, are often used to control chronic pain — especially if the pain interferes with sleep.
• Anti-seizure drugs. The epilepsy medication gabapentin (Gralise, Neurontin) has also proved successful in controlling chronic pain.

Therapies

Physical therapy treatments might include:

• Stretching exercises. Gentle stretching exercises for the chest muscles might be helpful.
• Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. The current might interrupt or mask pain signals, preventing them from reaching the brain.

Surgery or other procedures

If conservative measures don't work, another option is to inject numbing medication and a corticosteroid directly into the painful joint.

It can be frustrating to know that there's little to do to treat costochondritis. But self-care measures, such as the following, might help.

• Nonprescription pain relievers. Acetaminophen (Tylenol, others) ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful.
• Topical pain relievers. These include creams, gels, patches and sprays. They may contain nonsteroidal anti-inflammatory drugs or numbing medications. Some varieties contain capsaicin, the substance that makes hot peppers spicy.
• Heat or ice. Try placing hot compresses or a heating pad on the painful area several times a day. Keep the heat on a low setting. Ice also might be helpful.
• Rest. Avoid or modify activities that might worsen pain.

You may be referred to a doctor who specializes in disorders of the joints (rheumatologist).

What you can do

Ask a relative or friend to accompany you, to help you remember what the provider says.

Make a list of:

• Symptoms, including any that may seem unrelated to the reason for the appointment, and when they began
• Key medical information, including other conditions you have and any injury to the painful joint
• Key personal information, including major life changes or stressors
• All medications, vitamins and supplements, including doses
• Questions to ask the health care provider

Questions to ask your doctor

• What's the most likely cause of my symptoms?
• What tests do I need?
• What self-care steps are likely to help?
• Do I need to restrict activities?
• What new signs or symptoms should I watch for?
• When can I expect my symptoms to resolve?
• I have other health conditions. How can I best manage them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, including:

• Have your symptoms worsened over time?
• Where is your pain?
• Does exercise or physical exertion make your symptoms worse?
• Does anything else make your pain worse or better?
• Are you having difficulty breathing?
• Have you had recent respiratory infections or injuries to your chest?
• Are you aware of a history of heart problems in your family?