Costochondritis

  • Author: Lynn K Flowers, MD, MHA, ABAARM, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Jul 28, 2016
 

Background

In contrast to myocardial ischemia or infarction, costochondritis is a benign cause of chest pain and is an important consideration in the differential diagnosis.[1, 2] Although the term costochondritis often is used interchangeably with fibrositis and Tietze syndrome, these are distinct diagnoses. For discussion of costochondritis in children, see Pediatric Costochondritis.

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Pathophysiology

Costochondritis is an inflammatory process of the costochondral or costosternal joints that causes localized pain and tenderness. Any of the 7 costochondral junctions may be affected, and more than 1 site is affected in 90% of cases. The second to fifth costochondral junctions most commonly are involved.

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Epidemiology

Frequency

United States

The exact prevalence of a musculoskeletal etiology for chest pain is not known, although overall prevalence of a musculoskeletal etiology for chest pain was approximately 10% in one study. In a 1994 emergency department study, 30% of patients with chest pain had costochondritis.[3]

Mortality/Morbidity

The condition's course generally is self-limited, but the patient often experiences recurrent or persistent symptoms.

Sex

In Disla's costochondritis study, women comprised 69% of patients with costochondritis versus 31% in the control group.[3]

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Contributor Information and Disclosures
Author

Lynn K Flowers, MD, MHA, ABAARM, FACEP Physician Partner, ApolloMD; Chief Medical Officer, Flowers Medical Group

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; 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, 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 Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Jindal A, Singhi S. Acute chest pain. Indian J Pediatr. 2011 Oct. 78(10):1262-7. [Medline].

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

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

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

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

  6. 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. 2002 Oct. 22 Spec No:S119-35. [Medline].

  7. Crawford SJ, Swan CD, Boutlis CS, Reid AB. Candida costochondritis associated with recent intravenous drug use. IDCases. 2016. 4:59-61. [Medline]. [Full Text].

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

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

  10. Oh RC, Johnson JD. Chest pain and costochondritis associated with vitamin d deficiency: a report of two cases. Case Rep Med. 2012. 2012:375730. [Medline]. [Full Text].

  11. [Guideline] Woodard PK, White RD, Abbara S, Araoz PA, Cury RC, Dorbala S, et al. ACR Appropriateness Criteria chronic chest pain-low to intermediate probability of coronary artery disease. J Am Coll Radiol. 2013 May. 10(5):329-34. [Medline].

  12. Mendelson G, Mendelson H, Horowitz SF, Goldfarb CR, Zumoff B. Can (99m)technetium methylene diphosphonate bone scans objectively document costochondritis?. Chest. 1997 Jun. 111(6):1600-2. [Medline].

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