Costochondritis is an inflammation of the cartilage that connects a rib to the sternum (breastbone). The pain caused by costochondritis may resemble that of a heart attack or other heart conditions.
Costochondritis is sometimes referred to as «chest wall pain,» «costosternal syndrome,» or «costosternal chondrodynia.» Sometimes the pain is accompanied by swelling (Tietze syndrome).
Costochondritis usually has no apparent cause. Treatment focuses on relieving pain while you wait for the condition to get better on its own, which can take several weeks or more.
Costochondritis usually goes away on its own, although it may last for several weeks or longer. Treatment focuses on pain relief.
Possible causes
Although there is no specific cause for costochondritis, there may be movements or situations that involve the trunk, which can favor this inflammation, such as:
Tightness in the chest, such as that produced by the seat belt when braking sharply, for example;
- Bad posture;
- Trauma or injury to the thoracic region;
- Strenuous physical activity;
- Deep breathing;
- sneezing;
- Cough;
- Arthritis;
- Fibromyalgia.
In more severe cases, costochondritis may be associated with chest tumors, in which there is difficulty breathing and swallowing, weight loss, fatigue, snoring, and chest pain.
In the later stages of pregnancy, women may feel chest discomfort, which can worsen with exertion and cause shortness of breath. This occurs due to compression of the lungs by the enlarged uterus.
Diagnosis
During the physical exam, the doctor will check the breastbone for areas of tenderness or swelling. Your doctor may also move your rib cage or arms in a certain way to try to trigger your symptoms.
Costochondritis pain can be very similar to pain associated with heart disease, lung disease, gastrointestinal problems, and osteoarthritis. Although there is no lab test or imaging test to confirm a diagnosis of costochondritis, your doctor may order certain tests, such as an EKG, X-ray, CT scan, or MRI to rule out other conditions.
differential diagnosis
Costchondritis enters the differential diagnosis with several other pathologies, among which the most important are:
Rib fracture – In this case there is an actual injury to the bone; the history will show significant chest trauma and the pain is very intense and long lasting. In the elderly due to osteoporosis can occur even without noticeable chest trauma.
Heart attack: the pain is intense (less marked in the case of diabetic neuropathy) and radiates to the left shoulder and arm. It is essential to always rule out a heart attack before thinking about costochondritis.
Tietze syndrome: is a benign pain syndrome that presents with chest pain located at the level of the first 4-5 ribs. It is now recognized as a severe form of chronic costochondritis. The essential element that allows to differentiate it from costochondritis is the presence of swelling and swelling at the level of the articular cartilages, completely absent in costochondritis, in addition to the location of the pain:
Costochondritis usually affects the third, fourth, and fifth coststernal joints. Tietze syndrome is usually the second or third coststernal joint.
Treatment
Costochondritis usually goes away on its own, although it may last for several weeks or longer.
Treatment focuses on pain relief.
Medicines
Acetaminophen or paracetamol
Acetaminophen is an alternative when pain is mild or moderate.
Non-steroidal anti-inflammatory drugs (NSAIDs).
Although certain medications such as ibuprofen (Motrin IB) or naproxen sodium (Aleve) are available at the supermarket, your doctor may prescribe stronger varieties of these NSAIDs.
Note that NSAIDs are not suitable for people with certain health conditions, including:
Asthma
stomach ulcers
Arterial hypertension
Kidney or heart problems
To reduce side effects, treatment should be limited to the dose and days recommended by the doctor.
narcotics
If your pain is severe, your doctor might prescribe medications that contain codeine, such as:
Hydrocodone with acetaminophen (Vicodin, Norco)
Oxycodone with 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 keeps you up at night.
anti-seizure medications
The epilepsy medication gabapentin (Neurontin) has also been shown to be successful in controlling chronic pain.
Physical therapy
Physiotherapy treatments may include:
Stretching exercises
Gentle stretching exercises for the chest muscles can be helpful.
nerve stimulation
In a procedure called transcutaneous electrical nerve stimulation, a device sends a weak electrical current through sticky patches on the skin near the area of pain.
The current could interrupt or mask pain signals, preventing them from reaching your brain.
Prevention
There are no effective methods of costochondritis prevention. However, if the characteristic pain appears, it is advisable to do stretching exercises, especially of the chest muscles. Also, avoid activities that make the pain worse.