Pediatric Costochondritis Workup

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

Laboratory Studies

  • Costochondritis has no confirmatory or diagnostic laboratory tests.
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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.
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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.
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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

  1. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. Sep 15 2009;80(6):617-20. [Medline].

  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.

  3. Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Med. 2005;35(6):537-55. [Medline].

  4. Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. Apr-Jun 2009;31(2):169-71. [Medline].

  5. Aeschlimann A, Kahn MF. Tietze's syndrome: a critical review. Clin Exp Rheumatol. Jul-Aug 1990;8(4):407-12. [Medline].

  6. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. May 2007;30(4):321-5. [Medline].

  7. Brown RT. Costochondritis in adolescents. J Adolesc Health Care. Mar 1981;1(3):198-201. [Medline].

  8. Brown RT. The adolescent with costochondritis. Compr Ther. Dec 1988;14(12):27-9. [Medline].

  9. Driscoll DJ, Glicklich LB, Gallen WJ. Chest pain in children: a prospective study. Pediatrics. May 1976;57(5):648-51. [Medline].

  10. Fam AG. Approach to musculoskeletal chest wall pain. Prim Care. Dec 1988;15(4):767-82. [Medline].

  11. Feinstein RA, Daniel WA Jr. Chronic chest pain in children and adolescents. Pediatr Ann. Oct 1986;15(10):685-6, 691-4. [Medline].

  12. Gregory PL, Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Med. 2002;32(4):235-50. [Medline].

  13. Harvard Womens Health Watch. Costochondritis: Not a heart attack but it feels like one. Harv Womens Health Watch. Mar 2003;10(7):6-7. [Medline].

  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].

  19. Selbst SM. Chest pain in children. Pediatrics. Jun 1985;75(6):1068-70. [Medline].

  20. Selbst SM, Ruddy RM, Clark BJ. Pediatric chest pain: a prospective study. Pediatrics. Sep 1988;82(3):319-23. [Medline].

  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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