eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Costochondritis: Differential Diagnoses & Workup

Author: Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
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
Contributor Information and Disclosures

Updated: Jan 22, 2010

Differential Diagnoses

Anxiety Disorder: Panic Disorder
Pneumonia
Asthma
Pneumothorax
Cardiomyopathy, Hypertrophic
Pulmonary Infarction
Child Abuse & Neglect: Physical Abuse
Sickle Cell Anemia
Esophagitis
Somatoform Disorder: Pain
Fibromyalgia
Zoster
Gastroesophageal Reflux
Myocarditis, Viral
Pericarditis, Viral

Other Problems to Be Considered

Aneurysm
Gynecomastia
Muscle strain
Neurofibroma of an intercostal nerve
Psychogenic chest pain
Rib fracture
Slipping rib syndrome
Stress fracture

Workup

Laboratory Studies

  • Costochondritis has no confirmatory or diagnostic laboratory tests.

Imaging Studies

  • Imaging studies are unnecessary to confirm a diagnosis of costochondritis.
  • Chest radiography may exclude other possible causes of chest pain but offer no diagnostic value to costochondritis assessment. In the absence of confounding physical findings, the diagnostic yield of a chest radiograph is less than 2%.
  • In the unusual circumstance that imaging is required, CT scanning is probably the best choice because it can demonstrate swelling of the costal cartilage. Ultrasonography may also demonstrate swelling but is less useful. Bone scanning may demonstrate uptake at the area of concern; however, increased uptake at costochondral junctions that do not produce symptoms may also be present, making this modality less useful.

Procedures

  • Costochondral joint injection is indicated for patients with severe pain for whom oral analgesics are either ineffective or contraindicated. Costochondral joint injection may have a role in treating refractory cases of costochondritis. Using a 22-gauge needle, inject 2% lidocaine or a combination of corticosteroid and lidocaine. A total volume ranging from 1-3 mL may be injected depending on patient size.
  • Contraindications include an uncooperative patient, known hypersensitivity to the injectant, unclear diagnosis, or unstable cardiopulmonary disease. Use caution in patients with a severe coagulopathy. Complications include bleeding, infection, and pneumothorax.
  • Manipulation using a high velocity, low amplitude technique has been described to produce relief in costochondritis, but no larger studies have been done to confirm this.

More on Costochondritis

Overview: Costochondritis
Differential Diagnoses & Workup: Costochondritis
Treatment & Medication: Costochondritis
Follow-up: Costochondritis
Multimedia: Costochondritis
References
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References

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Further Reading

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Keywords

chest wall syndrome, costochondral syndrome, costosternal chondrodynia, Tietze syndrome, chest pain, costochondral joint, costochondritis, costochondral cartilage, treatment, symptoms, diagnosis

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Contributor Information and Disclosures

Author

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
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.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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.

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