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.
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.
Etiology
The etiology of costochondritis is not well defined. Repetitive minor trauma has been proposed as the most likely cause. Costochondritis, among others, is a common cause of atypical chest pain (chest pain not caused by myocardial ischemia) in athletes. [4, 5, 6] Bacterial or fungal infections of these joints occur uncommonly, usually in patients who are intravenous drug users or who have had thoracic surgery. [7, 8] Case reports have described costochondritis in vitamin D–deficient patients that resolved with vitamin D supplementation. [9]
Epidemiology
The exact prevalence of a musculoskeletal etiology for chest pain is not known, although the overall prevalence of musculoskeletal chest pain was approximately 10% in one study. In a 1994 emergency department study, 30% of patients with chest pain had costochondritis. [3] In that study, women comprised 69% of patients with costochondritis versus 31% of patients with chest pain but without costochondritis. [3]
Prognosis
The prognosis for patients with costochondritis is excellent, as the condition's course generally is self-limited. However, symptoms often recur or persist: after 1 year, about half of patients still may have discomfort, and approximately one third report tenderness with palpation.
Patient Education
Reassure patients of the benign nature of the problem, and instruct them regarding avoidance of provoking activities. Provide patients with a good understanding of the proper use and potential adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs).
For patient education information, see Costochondritis: Causes, Symptoms, Pain Locations.
