Pediatric Costochondritis Clinical Presentation

Updated: Aug 20, 2018
  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Lawrence K Jung, MD  more...
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Presentation

History

The key to the diagnosis of costochondritis, amid the differential diagnoses which include cardiac and pulmonary disorders, is a thorough history and physical examination.

Presenting characteristics of chest pain associated with costochondritis include the following: [10, 1, 11]

  • Onset - Typically insidious, occurring over several days or weeks; may be acute

  • Nature - Sharp and stabbing

  • Location - Anterior chest; pain usually unilateral, but may be bilateral; typically affecting the costochondral junctions 2-5

  • Radiation - Chest, back, or upper abdomen

  • Exacerbating factors - Coughing, sneezing, deep inspirations, movement of the upper torso and upper extremities (shoulders particularly)

  • Relieving factors - Rest, application of ice, or use of heat

  • Preceding conditions - Upper respiratory tract infection or exercise (common in the preceding 3 months); musculoskeletal strain; trauma to the chest wall

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Physical

Vital signs should be assessed. Careful and complete pulmonary, cardiac, and abdominal examination reduces the probability of an underlying disease process involving any of these organ systems.

  • Inspection: focuses on symmetry of the chest wall. Asymmetry may indicate trauma as a cause of chest pain.

  • Swelling is uncommon. However, patients with Tietze syndrome may have swelling over a single upper costochondral junction.

  • Ecchymosis would be expected only in trauma.

  • Respiratory effort is normal.

  • Palpation that reveals tenderness over the costochondral junction is diagnostic. The tenderness should be localized and is most common at the sternocostal cartilage of the second through the fifth ribs, however may affect the lower ribs (6-7) as well (see the image below). The key to palpation in costochondritis is that the tenderness at the costochondral junction which the patient experiences should reproduce the chest wall pain that the patient has been experiencing.

    Sternocostal and interchondral articulations. Ante Sternocostal and interchondral articulations. Anterior view.
  • Examination may be performed with firm, single-digit palpation of the area.

  • Crepitus is uncommon and may indicate a fracture associated with trauma.

  • Auscultation of the lungs, heart, and abdomen are normal.

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Causes

Most cases of costochondritis are idiopathic. The remaining cases may be the result of costochondral irritation caused by the following:

  • Direct trauma

  • Aggressive exercise resulting in a strain (eg, repeated twisting of the upper torso, stretching-pulling activities of the upper extremities) [12]

  • Preceding upper respiratory tract infection with cough (which can cause repeated stretching and strain at the costochondral junction)

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