Contents
Introduction
Costochondritis, also known as chest wall pain, costosternal syndrome, or costosternal chondrodynia is an acute and often temporary inflammation of the costal cartilage at the costosternal joint.
Aetiology
Physical trauma:
- Direct injury
- Strenuous lifting
- Severe bouts of coughing
- Chest binding
- Act of flattening breasts by the use of constrictive materials
Associated with:
- Scoliosis
- Ankylosing spondylitis
- Rheumatoid arthritis
- Osteoarthritis
- Tumour (benign or cancerous)
- Vitamin D deficiency (some cases)
- Relapsing polychondritis
Infection of the costosternal joint (rare):
- Common: Actinomyces, Staphylococcus aureus, Candida albicans, and Salmonella
- Rare: Escherichia coli in some cases
Pathophysiology
Pathogenesis remains unclear.
Proposed mechanisms of injury include:
- Neurogenic inflammation
- Muscular imbalance
- Increased muscular pull on the rib
- Mechanical dysfunction at the costotransverse joint of the rib
- Derangement of the mechanical structure of the costochondral junction
Clinical features
- Pain/tenderness to palpation
- On the sides of the sternum
- Affects multiple ribs
- Worsened with coughing, deep breathing, or physical activity
- Resolves within one year
Diagnosis
Differential diagnosis
- Tietze syndrome
- Costochondritis typically affects the 3rd ,4th ,5th costosternal joints in contrast to Tietze’s syndrome, which usually affects the 2nd or 3rd costosternal joint
Management
Physical therapy
- Ultrasonic, Transcutaneous electrical nerve stimulation (TENS or TNS) ± nerve stimulation
Medical management
- Nonsteroidal anti-inflammatory drugs (NSAIDs):
- Ibuprofen
- Analgesics:
- Acetaminophen
Severe cases:
- Opioid medications:
- Hydrocodone
- Oxycodone
- Tricyclic antidepressants:
- Amitriptyline
- Anti-epileptics:
- Gabapentin