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Musculoskeletal System ORGAN SYSTEMS

Costochondritis

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

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