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.

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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

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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

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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

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Diagnosis

Differential diagnosis

• Tietze syndrome
  • Costochondritis typically affects the 3^rd ,4^th ,5^th costosternal joints in contrast to Tietze’s syndrome, which usually affects the 2^nd or 3^rd costosternal joint

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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