eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Costochondritis

Author: Joseph P Garry, MD, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise & 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: Nov 8, 2007

Introduction

Background

Chest pain is a common reason parents seek medical attention for their children. Annually, physicians evaluate approximately 650,000 cases of chest pain in patients aged 10-21 years, a number that may reflect overwhelming concern about chest pain as a manifestation of cardiac disease and cancer in older patients.

Costochondritis is a common cause of chest pain in children and adolescents. The condition is characterized as an inflammatory process of one or more of the costochondral cartilages that causes localized tenderness and pain of the anterior chest wall. Most cases of costochondritis are idiopathic. The remaining cases may result from costochondral irritation due to direct trauma, aggressive exercise that caused a strain, or a prior upper respiratory tract infection with cough that caused repeated stretching and strain at the costochondral junction.

Costochondritis is a relatively benign and usually self-limited condition. Patients are often evaluated initially in the emergency department (ED) or, with acute conditions, in their primary care physician's office.

The term Tietze syndrome implies swelling; costochondritis refers to pain alone.

Pathophysiology

The exact pathophysiology of cartilage and capsular involvement is unknown because costochondritis does not warrant surgical intervention or tissue biopsy. Theoretically, the cartilage involved in costochondritis is either inflamed or torn. Either condition presumably leads to inflammation with subsequent stimulation of pain receptors.

Frequency

United States

Several studies of chest pain in pediatric patients report costochondritis prevalences of 14-30%; a single study reported rates as high as 79%. The overall incidence rate is approximately 4% of children and adolescents.

Mortality/Morbidity

No reports have associated mortality with costochondritis, and no mortality is expected.

Race

A study indicates Hispanics may have an increased prevalence of costochondritis, but most studies do not mention race as a factor.

Sex

Studies of chest pain in children showed that females are diagnosed with costochondritis more often than males by a 2:1 ratio.

Age

No data support an association between age and costochondritis; the condition is well described in children of all ages, including infants.

Clinical

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:

• 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 months); musculoskeletal strain; trauma to chest wall

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. Patients with Tietze syndrome, however, 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.
• 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.

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)¹
• Preceding upper respiratory tract infection with cough (which can cause repeated stretching and strain at the costochondral junction)

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