eMedicine Specialties > Emergency Medicine > Rheumatology

Costochondritis: Follow-up

Author: Lynn K Flowers, MD, MHA, FACEP, Assistant Professor, Department of Emergency Medicine, Emory School of Medicine; Clinical Faculty, Department of Emergency Medicine, Emory University Hospital
Contributor Information and Disclosures

Updated: Aug 25, 2009

Follow-up

Further Outpatient Care

  • NSAIDs for pain control
  • Local heat
  • Local infiltration of local anesthetic, steroid, or intercostal nerve block (reserved for refractory cases)
  • Biofeedback
  • Gentle stretching of the pectoralis muscles 2-3 times a day may be beneficial
  • Primary care follow-up with persistent symptoms

Deterrence/Prevention

  • Avoid repetitive misuse of muscles.
  • Modify improper posture or ergonomics of the home or work place.

Prognosis

  • The prognosis for patients with costochondritis is excellent.
  • After 1 year, about half of patients still may have discomfort; approximately one third report tenderness with palpation.

Patient Education

  • Reassure patients of the benign nature of the problem, and instruct them regarding avoidance of provoking activities.
  • Provide patients with a good understanding of the proper use and potential adverse effects of NSAIDs.
  • For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center and Muscle Disorders Center. Also, see eMedicine's patient education articles, Costochondritis and Chronic Pain.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose a myocardial ischemia or infarction
  • Failure to look for an intrathoracic pathology via chest radiography
  • Failure to palpate for local tenderness with assignment of the diagnosis of costochondritis
  • Failure to adequately control pain
  • Failure to realize that angina and costochondritis can coexist and treat accordingly
  • Failure to diagnose sternoarticular septic arthritis or osteomyelitis in patients who are intravenous substance users
  • Extensive and expensive negative workups
  • Consider costochondral infection in intravenous drug abusers
 


More on Costochondritis

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

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  3. 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].

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

  5. 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].

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

  7. 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].

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

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

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

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

  12. 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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Further Reading

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Keywords

costochondritis, costal chondritis, costochondral joints, costosternal joints, costal cartilage, chest pain, fibrositis, Tietze syndrome

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Contributor Information and Disclosures

Author

Lynn K Flowers, MD, MHA, FACEP, Assistant Professor, Department of Emergency Medicine, Emory School of Medicine; Clinical Faculty, Department of Emergency Medicine, Emory University Hospital
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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

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, Emergency Medicine, University Hospitals, Case Medical Center
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.

 
 
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