Costochondritis

Updated: Feb 19, 2020
  • Author: Lynn K Flowers, MD, MHA, ABAARM, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Overview

Practice Essentials

Costochondritis is inflammation of the costal cartilage at the articulation of the ribs and sternum. [1] It is an important consideration in the differential diagnosis of chest pain, as in contrast to myocardial ischemia or infarction, it is a benign disorder. [2, 3]  Although the term costochondritis often is used interchangeably with fibrositis and Tietze syndrome, these are distinct diagnoses.

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. On physical exam, pain with palpation of affected costochondral joints is a constant finding. (See Presentation.)

The workup is directed toward excluding cardiac disorders and other causes of chest pain. The clinical scenario and the most likely differential diagnoses should guide the choice of tests, but an electrocardiogram and a chest radiograph are commonly ordered. (See Workup.)

Pain control is a principal objective of emergency care; NSAIDs may be useful. Patients should be reassured of the benign nature of the problem and instructed regarding avoidance of provoking activities. However, they should be made aware that after 1 year, discomfort may still be present in about half of cases, and tenderness with palpation in about one third. (See Treatment and Follow-up.)

For discussion of costochondritis in children, see Pediatric Costochondritis. For patient education information, see What Is 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 of costochondritis

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 of costochondritis

The condition's course generally is self-limited, but symptoms often recur or persist.

Sex-related variance in costochondritis

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

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