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Pediatric Costochondritis Workup

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

Laboratory Studies

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

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  • 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 the clinical diagnosis of costochondritis. Occasional localized peripheral calcifications may be noted on chest radiography. In the absence of confounding physical findings, the diagnostic yield of a chest radiograph is minimal.
  • In the unusual circumstance that imaging is required, CT scanning is probably the best choice because it can demonstrate swelling or low attenuation signal of the costal cartilage.[18] Ultrasonography may also demonstrate swelling but is highly user dependent and thus generally 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.[19]
  • MRI can be utilized as an alternate imaging study in rare circumstances. While the costochondral cartilage can be well defined with this modality, there are no known studies utilizing MRI in this role. Furthermore, younger children may need to be sedated in order to obtain images thus increasing overall risk of this study in the younger age group.
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Procedures

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  • 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.[20]
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

References
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  2. National Ambulatory Medical Care Survey. 1998;

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

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

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  6. Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiology in the Young. 2013. 23:361-367.

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

  8. Disla E, Rhim HR, Reddy A, et al. Costochondritis: a prospective analysis in an emergency department setting. Arch Int Med. 1994. 154 (21):2466-2469.

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  10. [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.

  11. Son MBF, Sundel RP. Musculoskeletal Causes of Pediatric Chest Pain. Pediatr Clin N Am. 2010. 57:1385-1995.

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

  13. Drossner DM, Hirsh DA, Sturm JJ, et al. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med. 2011. 29:632-638.

  14. Saleeb SF, Wing YV, Li BA, Shira Z, Warren BA, Lock JE. Effectiveness of Screening for Life-Threatening Chest Pain in Children. Pediatrics. 2011. 128:e1062-e1068.

  15. Lipsitz JD, Hsu DT, Apfel HD, et al. Psychiatric Disorders in Youth with Medically Unexplained Chest Pain versus Innocent Heart Murmur. J of Pediatr. 2012. 160:320-324.

  16. Lee JL, Gilleland J, Campbell RM, et al. Internalizing Symptoms and Functional Disability in Children with Noncardiac Chest Pain and Innocent Heart Murmurs. J Pediatr Psychol. 2013. 38(3):255-264.

  17. Loiselle KA, Lee JL, Gilleland J, et al. Factors Associated with Healthcare among Children with Noncardiac Chest Pain and Innocent Heart Murmurs. J Pediatr Psychol. 2012. 37(7):817-825.

  18. Malghem J, Vande Berg B, Lecouvert F, et al. Costal cartilage fractures as revealed on CT and sonography. Am J Roentgenol. 2001. 176:429-432.

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

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

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

  22. Selbst SM. Approach to the child with chest pain. Pediatr Clin N Am. 2010. 57:1221-1234.

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

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Sternocostal and interchondral articulations. Anterior view.
 
 
 
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