Also known as chest wall pain, costosternal syndrome.

An acute and often temporary inflammation of the costal cartilage, the structure that connects each rib to the sternum at the costosternal joint.

A common cause of chest pain.

Often resolves on its own,

Can be a recurring condition that has little or no signs of onset.

Symptoms can be similar to the chest pain associated with a heart attack.

Chest pain is considered a medical emergency until life-threatening cardiac issues can be ruled out.

Severe cases of costal cartilage inflammation that also involve painful swelling are sometimes ref2242ed to as Tietze’s syndrome, a term sometimes used interchangeably with costochondritis.

Treatment involves a combination of rest, analgesics, or anti-inflammatory medications.

Patients with persistent discomfort may be managed with cortisone injections or surgery may be indicated if the condition is severe.

Individuals are instructed to avoid strenuous physical activity to prevent the onset of an attack.

Pain or tenderness to palpation usually occurs on the sides of the sternum.

It may affect multiple ribs, and is often worsened with coughing, deep breathing, or physical activity.

On physical examination, inspection and palpation assessing for swollen or tender areas, and can reproduce the pain of costochondritis by moving the patient’s rib cage or arms.

Costochondritis typically affects the third, fourth, and fifth costosternal joints in contrast to Tietze’s syndrome, which usually affects the second or third costosternal joint.

Pain from costochondritis typically resolves within one year.

In most cases no cause is identified.

May be the result of physical trauma, such as direct injury, strenuous lifting, or severe bouts of coughing. associated with scoliosis, ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, or a mass.

Rarely, it may be caused by infection of the costosternal joint: caused by Actinomyces, Staphylococcus aureus, Candida albicans, Salmonella, and Escherichia coli.

There is anecdotal evidence of costochondritic chest pain being associated with Vitamin D deficiency in some cases.

It also can be caused by relapsing polychondritis.

Proposed mechanisms of injury include inflammation, muscular imbalance, increased muscular pull on the rib, or mechanical dysfunction at the costotransverse joint.

Differential diagnosis includes:

Heart attack


Aortic aneurysm Gastrointestinal

Gastroesophageal reflux disease





Rib fracture

Ankylosing spondylitis

Bone metastases



Anxiety disorder

Panic disorder






Pulmonary embolism

Herpes zoster

Multiple myeloma

Treatments include physical therapy, including the use of ultrasound, TENS, with or without nerve stimulation, or with medication.

Treatment may involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs), or other pain relief medications.

Severe cases of costochondritis may call for the use of opioid medications, tricyclic antidepressants, or anti-epileptic drugs.

Oral or injected corticosteroids may be used for cases of costochondritis unresponsive to treatment by NSAIDs, however, such treatment has not been the subject of randomized controlled trials.

Rest from stressful physical activity is often advised.

It is a common condition and is responsible for 30% of emergency room chest-pain-related visits.

One-fifth of visits to the primary care physician are for musculoskeletal chest pain, of these13% are due to costochondritis.

Costochondritis cases are most often seen in people older than age 40.

Occurs more often in women than in men.

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