Introduction
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. Although the term costochondritis often is used interchangeably with fibrositis and Tietze syndrome, these are distinct diagnoses.
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.
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 ED study, 30% of patients with chest pain had costochondritis.
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.1
Clinical
History
- The onset 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
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.
- Costochondritis has no palpable edema.
Causes
The etiology 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.
More on Costochondritis |
 Overview: Costochondritis |
| Differential Diagnoses & Workup: Costochondritis |
| Treatment & Medication: Costochondritis |
| Follow-up: Costochondritis |
| References |
| Next Page » |
References
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].
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].
Fam AG. Approach to musculoskeletal chest wall pain. Prim Care. Dec 1988;15(4):767-82. [Medline].
Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ. Sep 1 1985;133(5):379-89. [Medline].
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].
Physician's Desk Reference. Motrin. In: Physician's Desk Reference. 50th ed. Medical Economics Co: Montvale, NJ; 1996:2526-27.
Semble EL, Wise CM. Chest pain: a rheumatologist's perspective. South Med J. Jan 1988;81(1):64-8. [Medline].
Trentham DE, Le CH. Relapsing polychondritis. Ann Intern Med. Jul 15 1998;129(2):114-22. [Medline].
Wadhwa SS, Phan T, Terei O. Anterior chest wall pain in postpartum costochondritis. Clin Nucl Med. Jun 1999;24(6):404-6. [Medline].
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].
Further Reading
Keywords
costochondritis, costal chondritis, costochondral joints, costosternal joints, costal cartilage, chest pain, fibrositis, Tietze syndrome
