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Pediatric Costochondritis Clinical Presentation

  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Lawrence K Jung, MD  more...
Updated: Mar 09, 2015


The key to the diagnosis of costochondritis, amid the differential diagnoses which include cardiac and pulmonary disorders, is a thorough history and physical examination.

Presenting characteristics of chest pain associated with costochondritis include the following:[10, 1, 11]

  • Onset - Typically insidious, occurring over several days or weeks; may be acute
  • Nature - Sharp and stabbing
  • Location - Anterior chest; pain usually unilateral, but may be bilateral; typically affecting the costochondral junctions 2-5
  • Radiation - Chest, back, or upper abdomen
  • Exacerbating factors - Coughing, sneezing, deep inspirations, movement of the upper torso and upper extremities (shoulders particularly)
  • Relieving factors - Rest, application of ice, or use of heat
  • Preceding conditions - Upper respiratory tract infection or exercise (common in the preceding 3 months); musculoskeletal strain; trauma to the chest wall


Vital signs should be assessed. Careful and complete pulmonary, cardiac, and abdominal examination reduces the probability of an underlying disease process involving any of these organ systems.

  • Inspection: focuses on symmetry of the chest wall. Asymmetry may indicate trauma as a cause of chest pain.
  • Swelling is uncommon. However, patients with Tietze syndrome may have swelling over a single upper costochondral junction.
  • Ecchymosis would be expected only in trauma.
  • Respiratory effort is normal.
  • Palpation that reveals tenderness over the costochondral junction is diagnostic. The tenderness should be localized and is most common at the sternocostal cartilage of the second through the fifth ribs, however may affect the lower ribs (6-7) as well (see the image below). The key to palpation in costochondritis is that the tenderness at the costochondral junction which the patient experiences should reproduce the chest wall pain that the patient has been experiencing.
    Sternocostal and interchondral articulations. AnteSternocostal and interchondral articulations. Anterior view.
  • Examination may be performed with firm, single-digit palpation of the area.
  • Crepitus is uncommon and may indicate a fracture associated with trauma.
  • Auscultation of the lungs, heart, and abdomen are normal.


Most cases of costochondritis are idiopathic. The remaining cases may be the result of costochondral irritation caused by the following:

  • Direct trauma
  • Aggressive exercise resulting in a strain (eg, repeated twisting of the upper torso, stretching-pulling activities of the upper extremities)[12]
  • Preceding upper respiratory tract infection with cough (which can cause repeated stretching and strain at the costochondral junction)
Contributor Information and Disclosures

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.


Barry L Myones, MD Co-Chair, Task Force on Pediatric Antiphospholipid Syndrome

Barry L Myones, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American College of Rheumatology, American Heart Association, American Society for Microbiology, Clinical Immunology Society, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David D Sherry, MD Chief, Rheumatology Section, Director, Amplified Musculoskeletal Pain Program, The Children's Hospital of Philadelphia; Professor of Pediatrics, University of Pennsylvania School of Medicine

David D Sherry, MD is a member of the following medical societies: American College of Rheumatology, American Pain Society

Disclosure: Nothing to disclose.

Chief Editor

Lawrence K Jung, MD Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

James M Oleske, MD, MPH François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary, Allergy, Immunology and Infectious Diseases, Department of Pediatrics, Rutgers New Jersey Medical School; Professor, Department of Quantitative Methods, Rutgers New Jersey Medical School

James M Oleske, MD, MPH is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Allergy Asthma and Immunology, American Academy of Hospice and Palliative Medicine, American Association of Public Health Physicians, American College of Preventive Medicine, American Pain Society, Infectious Diseases Society of America, Infectious Diseases Society of New Jersey, Medical Society of New Jersey, Pediatric Infectious Diseases Society, Arab Board of Family Medicine, American Academy of Pain Management, National Association of Pediatric Nurse Practitioners, Association of Clinical Researchers and Educators, American Academy of HIV Medicine, American Thoracic Society, American Academy of Pediatrics, American Public Health Association, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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Sternocostal and interchondral articulations. Anterior view.
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