Define Costochondritis and its symptoms, causes, triggers, test and treatments

What is costochondritis?

It is a condition characterized by pain in chest wall which is caused by inflammation in the joints of the rib cage. In this condition, patient suffers from severe chest pain. Costochondritis is often confused with lung or heart disease and people suffering from it usually fear about occurrence of heart of lung problem.

But this is condition where a patient should not panic because it is not a life threatening condition and it gets better on its own. The blood vessels inside your heart or lungs are not responsible for the pain associated with costochondritis but due to the pain in ribs cage which protect your lungs. More specifically, it comes from one or more of the joints between your ribs and your breastbone (sternum). The pain in chest occurs due to inflammation of these joints.

What can cause inflammation in the chest?

How common is costochondritis?

Costochondritis seems to be quite common,   however, it cannot be described exactly because many people suffer from this condition but a very few consider it to get diagnosed by the doctor. Doctors reported that out of 5, one patient is suffering from chest pain related to muscles, ribs, and joints in the chest wall.

What is the outlook of costochondritis?

The outlook for costochondritis is generally very good. It usually disappears within 6 to 8 weeks in most cases which are mild. Mediations may also help in this. It disappears completely within one year in almost all cases. Costochondritis is less likely to recur.

How does the chest wall work?

For the complete understanding about the costochondritis, you must understand the way rib cage is put together. Our lungs are protected in a cage like structure named as rib cage. Although all bones are firm and solid structures due to which they are unable to move, but when our lungs moves (due to inhaling and exhaling), the rib cage also expands, every time you breathe in. But for this movement of the bones, you need cartilage. Cartilage is soft and strong glue likes material which is found in joints in the body. It helps in attaching the ribs to sternum (breastbone) and sternum to collar bones also called clavicles. The joints between the cartilage and the breastbone are called costosternal joints. Those between the breastbone and the collarbones are called the sternoclavicular joints. The name costochondritis is divided in two parts and is defined as ‘costo’ which means cartilage and –‘itis’ means inflammation. So, the inflammation is mainly found in costochondritis are costochondral, costosternal or sternoclavicular joints (or in combination).

The patient may feel extreme pain while moving, or bending or pressing down on the affected area.

What are the common causes of costochondritis?

The exact cause of Costochondritis is unknown, but basic problem can be considered as inflammation. You should be aware that the blood vessels inside your heart or lungs are not responsible for the pain associated with costochondritis but due to the pain in ribs cage which protect your lungs. More specifically, it comes from one or more of the joints between your ribs and your breastbone (sternum). The pain in chest occurs due to inflammation of these joints. Some problems that may cause inflammation are:

  • Chest infections of different types
  • Heavy physical efforts
  • Lifting heavy objects
  • Repeated bouts of coughing
  • Accidents that affect the chest area mainly such as falls
  • Arthritis

What are the symptoms of costochondritis?

The main symptom of costochondritis is chest pain at the front of the chest. The pain associated with Costochondritis is severe, stabbing, and sharp in nature. Continues movements, exertion, and deep breathing exacerbate the pain in the chest area.  When someone tries to put extra pressure on the chest or the affected area, patient may feel severe shooting pain. The pain associated with costochondritis is localized but can spread to the wider area. Patient can seek relief in the pain by changing the position and by shallow breathing.

How do you diagnose costochondritis?

Other symptoms include:

  1. A dull and sharp pain localized in front chest wall. However, it can radiate to your back or abdomen area, mostly in your left side.
  2. Cough and deep breathe associated pain.
  3. Fourth, fifth and sixth ribs are most common sites of pain which is exacerbated while you cough, move your trunk, or if you take deep breaths.
  4. A constant feature of costochondritis is reproducible tenderness when you press the costochondral joints (rib joints). The diagnosis of costochondritis is complicated without such tenderness.

Who develops costochondritis?

There is no particular person more at risk of costochondritis than any other.  It can occur at any stage of life and in younger people, teenagers, and young adults. It can also affect children. The people who are more risk are who use to do repetitive movements that strain the chest wall; mainly if they do not repeat such movements regularly. Women are more affected as compare to men. Other disease that can cause coschondritis are fibromyalgia which is a long term chronic disease that cause body pain throughout the body and cause fatigue.

When should I see a doctor if I have costochondritis?

You can find it difficult to see a doctor in case you have a chest pain and how urgently you may need it. If you just have a pulled muscle, you may also do not want to waste your time in visiting a doctor. And also if you are confused that if it is a symptom of heart attack  or any other life threatening problem you are unable to find a solution but need to visit a doctor. You should treat your chest pain as an emergency if you feel unwell, breathless, dizzy or sweaty or if your chest pain is very severe and spreading to jaw or to your left arm.

If you have a pain in your chest which gets severe when you move your chest wall and hurts when you press your chest, it is likely to be due to costochondritis. You do not need to see a doctor if the pain in your chest does not any pain killer or if it goes away on its own. If it gets better by taking over-the-counter medication, even then you should not need to see a doctor.  But if you came to know that you are suffering from costochondritis and still if you feel that your pain is getting worse, you should see a doctor. If you may not have a serious chest pain, if you are young and healthy otherwise.Costochondritis is an example of a condition that can cause chest wall pain that is not serious. Because the pain caused by costochondritis can be quite severe at times, many people with it become very anxious and worried that it may be due to something more serious.

If you have other symptoms in addition to the pain, then see a doctor. Other symptoms may include cough, high temperature, blood in mucus, radiating pain to other parts of the body, an unusual rash, a feel of having thumping heart, dizziness, palpitations, difficulty in swallowing, and if you started a heartburn or indigestion. Also see your doctor if the pain gets worse as you exert yourself (for example, on walking up a hill) rather than as you twist your chest around. Pain on exertion is more likely to be due to angina.

How to diagnose costochondritis?

Physical examination to diagnose costochondritis

A constant finding of costochondriasis is pain with palpation of affected costochondral joints. Another constant feature of costochondritis is reproducible tenderness that produced upon pressing the ribs joints. Without the feature of tenderness the diagnosis of costochondriasis is unlikely. The second through the fifth costochondral junctions typically are involved. In approximately 90% of the patients, more than one junction is involved. Until examination, patient may not aware of the chest wall tenderness which is quite surprising. Whereas Tetze’s syndrome which is characterized by nonsuppurative edema. No palpable edema is noticed in costochondritis. Examination of the lateral ribs, cervical and thoracic spine should be part of the comprehensive evaluation of costochondritis.

Investigations of costochondritis

Costochondritis is essentially a clinical diagnosis however a failure to respond to the therapeutic trial of NSAIDs or local injection or clinical findings that put the patient at high risk of an alternate diagnosis (e.g., history of fever, malignancy, history of trauma or injury, and localized swelling and erythema) should prompt further investigations as indicated by the possible differential diagnosis. If an infective cause of costochondritis is suspected from history and risk factors, further testing with wound and/or blood cultures, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, blood and urine culture, plain radiography and CT of the chest, {or MR imaging) bone scintigraphy, ultrasound-guided needle aspiration of soft tissue mass, Gram staining and culture of aspirated fluid or MR imaging should be performed. Bone scan with technetium is not specific for costochondritis and may be positive in people without costochondritis. Many case studies suggest the value of gallium scan in the diagnosis of costochondritis.

What are the treatment options for costochondritis?

Treatment in the case of costochondritis is not always mandatory and needed. Sometimes doctors start treatment in order to be assuring about the serious cause of chest pain.  Anxiety is a common cause of the chest pain therefore the worry can worsen your pain.

What Is Costochondritis? Symptoms, Treatment, Causes & Relief
What Is Costochondritis? Symptoms, Treatment, Causes & Relief

Painkillers for treatment of costochondritis

Painkillers and anti-inflammatory medications are mainly given for the treatment of the costochondritis. Painkillers such as paracetamol and codeine are sufficient for relieving the pain. For reducing the inflammation and pain associated with inflammation, ibuprofen is sufficient; such medications are also called as non-steroidal anti-inflammatory medication.  Other NSAIDs are available on prescription, such as naproxen.

Intercostals nerve blockage for costochondritis

Costochondritis usually gets better with time in most of the people. If it last for more than 2 months, it is considered as unusual. If patient is not responding to anti-inflammatory and pain killer medications, steroids injections or local anesthetic medications are used for severe case of costochondritis. An intercostals nerve can also be blocked in case of extreme cases of costochondritis which is performed by a doctor. In this procedure, an injection of local anesthetic is given around painful ribs in order to block the nearby intercostals nerve. This is done in order to reduce the pain that radiates into other parts by this intercostals nerve. This sort of injection temporarily disrupts nerve impulses to stop the pain. For several weeks to months, the nerve may remain blocked. In recurrence cases of costochondritis, the injections are again given in order to damage the nerve permanently. Other non medicinal techniques that can be used for treating costochondritis are heat application, Ice pads, TENS (Transcutaneuos electrical nerve stimulation), acupuncture, gentle stretching exercises, complete prohibition of activities that increases the pain, physiotherapy, and chiropractic therapy.

What are the precautions for treatment of coschondritis?

For the sake of precautions of the treatment you should be sure about the pain origin and you shoukd assure that it should be not of cardiac origin. A doctor can identify the exact cause of the pain in your chest area. The symptoms such as exertion pain, radiation to neck, arms or abdomen, numbness, high fever, cough, loss of breathing, and the pain localized to uncommon areas such as axilla or mild thoracic spine may lead to diagnosis of non-musculoskeletal chest pain. You should adopt precautionary measures when it comes to other systemic illnesses such as pulmonary, esophageal, and psychiatric disorders along with chest pain.

What are some home remedies for costochondritis?

Costochondritis when diagnosed is not a life threatening problem and it gets away on its own. Sometimes even it does not need any medications. You can treat the costochondritis at home if the pain is not very severe. Some home remedies include:

  • Non-steroidal medications and over the counter pain killer medications such as ibuprofen, naproxen as and when needed. You may need such medications when pain caused by coughing, sneezing or laughing.
  • Ice or heat pack in order to reduce swelling and pain.
  • You should avoid unnecessary exercises or activities that may exacerbate the chest pain as such conditions can worsen the situation.

What is difference between Tietze’s syndrome and costochondritis?

Costochondritis is often known as Tietze’s syndrome but both are quite different from each other. Tietze syndrome usually comes on abruptly, with chest pain radiating to your arms or shoulder and lasting several weeks. Tietze syndrome is accompanied by a localized swelling at the painful area (the junction of the ribs and breastbone).

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