What is costochondritis?
Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions.
Costochondritis is sometimes known as chest wall pain syndrome, costosternal syndrome or costosternal chondrodynia. Sometimes, swelling accompanies the pain (Tietze syndrome).
What causes costochondritis is unclear. Treatment focuses on easing the pain while waiting for the condition to improve on its own, which can take several weeks or more.
Symptoms
The pain associated with costochondritis usually:
- Occurs on the left side of your breastbone
- Is sharp, aching or pressure-like
- Affects more than one rib
- Can radiate to arms and shoulders
- Worsens when taking a deep breath, coughing, sneezing or with any chest wall movement
Diagnosis
During the physical exam, a health care provider will feel along your breastbone for tenderness or swelling. The provider might also move your rib cage or your arms in certain ways to try to trigger symptoms.
The pain of costochondritis can be similar to the pain associated with heart disease, lung disease, gastrointestinal problems and osteoarthritis. There is no laboratory or imaging test to confirm a diagnosis of costochondritis. But a health care provider might order certain tests, such as an electrocardiogram and chest X-ray, to rule out other conditions.
Treatment
Costochondritis usually goes away on its own, although it might last for several weeks or longer. Treatment focuses on pain relief.
Medications
Your health care provider might recommend:
- Nonsteroidal anti-inflammatory drugs. You can buy some types of these drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), over the counter. Stronger versions are available by prescription. Side effects can include damage to the stomach lining and kidneys.
- Narcotics. If pain is severe, a provider might prescribe a narcotic medication such as tramadol (Ultram). Narcotics can be habit-forming.
- Antidepressants. Tricyclic antidepressants, such as amitriptyline, are often used to control chronic pain — especially if the pain interferes with sleep.
- Anti-seizure drugs. The epilepsy medication gabapentin (Gralise, Neurontin) has also proved successful in controlling chronic pain.
Therapies
Physical therapy treatments might include:
- Stretching exercises. Gentle stretching exercises for the chest muscles might be helpful.
- Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. The current might interrupt or mask pain signals, preventing them from reaching the brain.
- Surgery or other procedures- If conservative measures don't work, another option is to inject numbing medication and a corticosteroid directly into the painful joint.