Pediatric Costochondritis Clinical Presentation

  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Lawrence K Jung, MD   more...
 
Updated: Jan 22, 2010
 

History

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

Presenting characteristics of chest pain associated with costochondritis include the following:[2]

  • 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
  • Radiation - Chest, upper abdomen, or back
  • Exacerbating factors - Coughing, sneezing, deep inspirations, movement of the upper torso and upper extremities
  • Relieving factors - Rest, application of ice, or use of heat
  • Preceding conditions - Upper respiratory tract infection or exercise (common in the preceding 3 mo); musculoskeletal strain; trauma to chest wall
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Physical

Vital signs should be assessed. Careful and complete pulmonary, cardiac, and abdominal examinations eliminate the possibility of an underlying disease process.

  • 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 an 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 seventh ribs (see the image below). 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.
  • Auscultation of the lungs, heart, and abdomen are normal.
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Causes

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)[3]
  • Preceding upper respiratory tract infection with cough (which can cause repeated stretching and strain at the costochondral junction)
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Contributor Information and Disclosures
Author

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family & Community Medicine, 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 College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Coauthor(s)

Barry L Myones, MD  Associate Professor, Departments of Pediatrics and Immunology, Pediatric Rheumatology Section, Baylor College of Medicine; Director of Research, Pediatric Rheumatology Center, Texas Children's Hospital

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, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James M Oleske, MD, MPH  François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary, Allergy, Immunology and Infectious Diseases, Department of Pediatrics, 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 Pediatrics, American Public Health Association, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

David D Sherry, MD  Director, Clinical Rheumatology, Attending Physician, Pain Management, The Children's Hospital of Philadelphia; Professor of Pediatrics, University of Pennsylvania

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

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

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, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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  2. [Guideline] Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct.

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  14. Mendelson G, Mendelson H, Horowitz SF et al. Can (99m)-technitium methylene diphosphonate bone scan objectively document costochondritis?. Chest. 1997;111(6):1600-1602.

  15. Mukamel M, Kornreich L, Horev G, Zeharia A, Mimouni M. Tietze's syndrome in children and infants. J Pediatr. Nov 1997;131(5):774-5. [Medline].

  16. Pantell RH, Goodman BW Jr. Adolescent chest pain: a prospective study. Pediatrics. Jun 1983;71(6):881-7. [Medline].

  17. Rowe BH, Dulberg CS, Peterson RG. Characteristics of children presenting with chest pain to a pediatric emergency department. CMAJ. Sep 1 1990;143(5):388-94. [Medline].

  18. Selbst SM. Chest pain in children. Am Fam Physician. Jan 1990;41(1):179-86. [Medline].

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  21. Semble EL, Wise CM. Chest pain: a rheumatologist's perspective. South Med J. Jan 1988;81(1):64-8. [Medline].

 
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Sternocostal and interchondral articulations. Anterior view.
 
 
 
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