Costochondritis Clinical Presentation

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

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 one 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.

Physical examination can help differentiate costochondritis from Tietze syndrome. Although Tietze syndrome also produces costochondral tenderness, it is acute rather than chronic and it is additionally characterized by nonsuppurative edema (usually of the second and third costochondral junctions), heat, and erythema, all of which are absent in costochondritis. [4, 5]

A comprehensive physical examination should include assessment of the lateral ribs and the cervical and thoracic spine, as hypomobility in those areas may be a factor in the development of costochondritis. In such cases, upper thoracic mobilization and manipulation for the treatment of rib dysfunction may be incorporated into the treatment plan. [5]

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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. [6, 7] Costochondritis, among others, is a common cause of atypical chest pain (chest pain not caused by myocardial ischemia) in athletes. [8, 5, 9] Case reports have described costochondritis in vitamin D–deficient patients that resolved with vitamin D supplementation. [10]

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