Costochondritis Clinical Presentation

  • Author: Lynn K Flowers, MD, MHA, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 13, 2012
 

History

  • The onset of costochondritis is often insidious. Chest wall pain with a history of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture) is common. Pain may be described as follows:
    • Exacerbated by trunk movement, deep inspiration, and/or exertion
    • Lessens with decreased movement, quiet breathing, or change of position
    • Sharp, nagging, aching, or pressurelike
    • Usually quite localized but may extend or radiate extensively
    • May be severe
    • May wax and wane
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Physical

  • Pain with palpation of affected costochondral joints is a constant finding in costochondritis.
    • The second through the fifth costochondral junctions typically are involved. More than 1 junction is involved in more than 90% of patients.
    • Surprisingly, patients may not be aware of the chest wall tenderness until examination.
  • The diagnosis should be reconsidered in the absence of local tenderness to palpation.
    • Tietze syndrome is characterized by nonsuppurative edema.[3]
    • Costochondritis has no palpable edema.
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Causes

The etiology of costochondritis is not well defined. Repetitive minor trauma has been proposed as the most likely cause. Bacterial or fungal infections of these joints occur uncommonly, usually in patients who are intravenous drug users or who have had thoracic surgery.[4] Costochondritis, among others, is a common cause of atypical chest pain (chest pain not caused by myocardial ischemia) in athletes.[5, 6, 7]

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Contributor Information and Disclosures
Author

Lynn K Flowers, MD, MHA, FACEP  Physician Partner, ApolloMD, Atlanta, Georgia

Lynn K Flowers, MD, MHA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  2. Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. Nov 14 1994;154(21):2466-9. [Medline].

  3. Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ. Sep 1 1985;133(5):379-89. [Medline].

  4. Gotway MB, Marder SR, Hanks DK, Leung JW, Dawn SK, Gean AD, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics. Oct 2002;22 Spec No:S119-35. [Medline].

  5. Sik EC, Batt ME, Heslop LM. Atypical chest pain in athletes. Curr Sports Med Rep. Mar-Apr 2009;8(2):52-8. [Medline].

  6. Grindstaff TL, Beazell JR, Saliba EN, Ingersoll CD. Treatment of a female collegiate rower with costochondritis: a case report. J Man Manip Ther. Jun 2010;18(2):64-8. [Medline]. [Full Text].

  7. Cubos J, Cubos A, Di Stefano F. Chronic costochondritis in an adolescent competitive swimmer: a case report. J Can Chiropr Assoc. Dec 2010;54(4):271-5. [Medline]. [Full Text].

  8. Bayer AS, Chow AW, Louie JS, Guze LB. Sternoarticualr pyoarthrosis due to gram-negative bacilli. Report of eight cases. Arch Intern Med. Aug 1977;137(8):1036-40. [Medline].

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

  10. Ikehira H, Kinjo M, Nagase Y, Aoki T, Ito H. Acute pan-costochondritis demonstrated by gallium scintigraphy. Br J Radiol. Feb 1999;72(854):210-11. [Medline].

  11. Physician's Desk Reference. Motrin. In: Physician's Desk Reference. 50th ed. Medical Economics Co: Montvale, NJ; 1996:2526-27.

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

  13. Trentham DE, Le CH. Relapsing polychondritis. Ann Intern Med. Jul 15 1998;129(2):114-22. [Medline].

  14. Wadhwa SS, Phan T, Terei O. Anterior chest wall pain in postpartum costochondritis. Clin Nucl Med. Jun 1999;24(6):404-6. [Medline].

  15. Wolf E, Stern S. Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med. Feb 1976;136(2):189-91. [Medline].

 
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