Overview

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, costosternal syndrome or costosternal chondrodynia. Sometimes, swelling accompanies the pain (Tietze syndrome).

Costochondritis usually has no apparent cause. Treatment focuses on easing your pain while you wait for the condition to improve on its own, which can take several weeks or longer.

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

Symptoms

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
• Worsens when you take a deep breath or cough

When to see a doctor

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

Causes

Costochondritis usually has no clear cause. Occasionally, however, costochondritis may be caused by:

• Injury. A blow to the chest is one example.
• Physical strain. Heavy lifting, strenuous exercise and severe coughing have been linked to costochondritis.
• Arthritis. Costochondritis might be linked to specific problems, such as osteoarthritis, rheumatoid arthritis or ankylosing spondylitis.
• Joint infection. Viruses, bacteria and fungi — such as tuberculosis, syphilis and aspergillosis — can infect the rib joint.
• Tumors. Noncancerous and cancerous tumors can cause costochondritis. Cancer might travel to the joint from another part of the body, such as the breast, thyroid or lung.

Risk factors

Costochondritis occurs most often in women and in people older than 40.

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

Diagnosis

During the physical exam, your doctor will feel along your breastbone for areas of tenderness or swelling. The doctor may also move your rib cage or your arms in certain ways to try to trigger your symptoms.

The pain of costochondritis can be very similar to the pain associated with heart disease, lung disease, gastrointestinal problems and osteoarthritis. While there is no laboratory or imaging test to confirm a diagnosis of costochondritis, your doctor might order certain tests — such as an electrocardiograph, X-ray, CT or MRI — to rule out other conditions.

Treatment

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

Medications

Your doctor might recommend:

• Nonsteroidal anti-inflammatory drugs. Although certain medications, such as ibuprofen (Motrin IB) or naproxen sodium (Aleve) are available over the counter, your doctor might prescribe stronger varieties of these nonsteroidal anti-inflammatory medications. Side effects might include damage to your stomach lining and kidneys.
• Narcotics. If your pain is severe, your doctor might prescribe medications containing codeine, such as hydrocodone/acetaminophen (Vicodin, Norco) or oxycodone/acetaminophen (Tylox, Roxicet, Percocet). Narcotics can be habit-forming.
• Antidepressants. Tricyclic antidepressants, such as amitriptyline, are often used to control chronic pain — especially if it's keeping you awake at night.
• Anti-seizure drugs. The epilepsy medication gabapentin (Neurontin) also has proved successful in controlling chronic pain.

Therapy

Physical therapy treatments might include:

• Stretching exercises. Gentle stretching exercises for the chest muscles may 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 your brain.

Surgical and other procedures

If conservative measures don't work, your doctor might suggest injecting numbing medication and a corticosteroid directly into the painful joint.

Lifestyle and home remedies

It can be frustrating to know that there's little your doctor can do to treat your costochondritis. But self-care measures might make you feel more comfortable. They include:

• Over-the-counter nonsteroidal anti-inflammatory drugs pain relievers. Ask your doctor about using ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others).
• 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 activities that make your pain worse.

Preparing for an appointment

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

What you can do

• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Write down your key medical information, including other conditions and any history of injury to the painful joint.
• Write down key personal information, including any major changes or stressors in your life.
• Make a list of all your medications, vitamins or supplements.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.
• Write down questions to ask your doctor.

Questions to ask your doctor

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

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

• When did you first begin experiencing these symptoms? Have they worsened over time?
• Where is your pain located?
• Does exercise or physical exertion make your symptoms worse?
• Does anything else seem to make your pain worse or better?
• Are you having any difficulty breathing?
• Have you had any recent respiratory infections?
• Have you had any recent injuries to your chest?
• Have you been diagnosed with any other medical conditions?
• Have you recently experienced a significant amount of stress or change?
• Are you aware of any history of heart problems in your family?