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Costochondritis
Costochondritis is a painful condition of the chest wall. It is caused by inflammation in the joints
between the cartilages that join the ribs to the breastbone (sternum). Although painful, it is not a
serious condition. Usually it has no obvious cause and settles over time. Painkillers and antiinflammatory medication can be used for relief of symptoms.
What is costochondritis?
Costochondritis is a painful condition of the chest wall. It causes chest pain. Fortunately, it is not a serious
condition.
To understand costochondritis, you need to know a bit about the anatomy of the rib cage. The rib cage is a bony
structure that protects the lungs. Bones are hard and solid, and they don't tend to bend or move. However, our
lungs need to move, so we can breathe.
When we take a deep breath in, the diaphragm acts as a bellows. The diaphragm moves down and this sucks air
through our mouth and nose, and into our lungs. Our rib cage expands too. In order for the ribs to expand, the ribs
need something to allow movement. Cartilage allows this. Cartilage is a softer, flexible (but very strong) material
found in joints around the body.
Cartilages attach the ribs to the breastbone (sternum) and the sternum to the collarbones (clavicles). The joints
between the ribs and the cartilages are called the costochondral joints. Those between the cartilages and the
breastbone are called costosternal joints. Those between the sternum and the clavicles are called the
sternoclavicular joints.
The prefix 'costo' simply means related to the ribs. 'Chondr-' means related to the cartilage and '-itis' is the
medical ending (suffix) that means inflammation.
In costochondritis, there is inflammation in either the costochondral, costosternal or sternoclavicular joints (or a
combination). This causes pain and tenderness, that tends to be worse with movement and pressure.
Tietze's syndrome is similar to costochondritis. The two conditions are often (incorrectly) used interchangeably.
Tietze's syndrome is, however, a different condition. It causes similar symptoms, is still due to inflammation, but
tends to cause swelling at the costochondral, costosternal or sternoclavicular joints.
Bornholm disease is another similar condition. However, it is caused by a viral illness and leads to muscle
aches and pains, as well as chest pain. Coxsackievirus B is the usual cause of Bornholm disease (although
echovirus and Coxsackievirus A can be responsible). See separate leaflet called Bornholm Disease.
Important information regarding chest pain
There are many causes of chest pain. Chest pain is a symptom that you should discuss with your GP to try to
establish the cause.
Note: chest pain can have serious causes. Any new, severe or persisting chest pain should be discussed with a
doctor. This is particularly important if you are an adult and have a history of heart or lung disease. If the pain is
particularly severe, especially if radiating to your arms or jaw, and you feel sick, sweaty or breathless, call
999/112/911 for an emergency ambulance. These can be symptoms of a heart attack.
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If you are young, and generally healthy then non-serious chest wall pain is common. Costochondritis is an
example of a condition that can cause chest wall pain that is not serious. Because the pain caused by
costochondritis can be quite severe at times, many people with it become very anxious and worried that it may be
due to something more serious.
What causes costochondritis?
Costochondritis is often idiopathic. This is a medical term, meaning 'of unknown cause'. So, in many cases, no
cause is found.
Sometimes costochondritis can follow repeated minor chest injury or activities that one is unused to - perhaps
decorating or moving furniture.
Who develops costochondritis?
There is no particular person more at risk of costochondritis than another. It does tend to affect younger people,
especially teenagers and young adults. It can affect children. People performing repetitive movements that strain
the chest wall, particularly if they are not used to it, might be considered more at risk of getting this condition.
Some studies suggest women tend to be affected more commonly than men.
People with fibromyalgia tend to develop costochondritis more often than others. Fibromyalgia is a long-term
(chronic) condition that causes widespread body pains and fatigue. (See separate leaflet called Fibromyalgia for
more information.)
How common is costochondritis?
It is difficult to be precise about how many people develop costochondritis. It is a relatively common problem.
Probably, many people with it do not report their symptoms to a doctor. And, as the condition is often short-lived,
and settles on its own (spontaneously), the numbers are not known.
Some studies have estimated that between 1 and 3 in 10 people with chest pain have a musculoskeletal cause.
This means the chest pain is related to the muscles or the ribs. Costochondritis is one cause of musculoskeletal
chest pain.
What are the symptoms of costochondritis?
Costochondritis causes chest pain, felt at the front of the chest. Typically, it is sharp and stabbing in nature and
can be quite severe. The pain is worse with movement, exertion and deep breathing. Pressure over the affected
area also causes sharp pain. Some people may feel an aching pain. The pain is usually confined (localised) to a
small area but it can spread (radiate) to a wider area. The pain tends to wax and wane, and can settle with a
change of position and quiet, shallow breathing.
The most common sites of pain are close to the sternum, at the level of the 4th, 5th and 6th ribs.
Note: without tenderness, the cause of the chest pain is unlikely to be costochondritis. Remember to seek
medical advice if you are unsure of the cause of your symptoms (see 'Important information regarding chest
pain', above).
How is costochondritis diagnosed?
Costochondritis is usually diagnosed based on your symptoms and examination. It is important that other causes
of chest pain should be ruled out.
Do I need any tests (investigations)?
No tests (investigations) are needed to confirm costochondritis. However, tests may be performed to rule out
other causes of chest pain if the cause of the pain is unclear. Examples of such tests would include a heart trace
(electrocardiogram, or ECG) or a chest X-ray.
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What is the treatment for costochondritis?
The treatments for costochondritis are painkillers (analgesics) and anti-inflammatory medications. Often, only
simple analgesics such as paracetamol or codeine are needed.
Ibuprofen is an anti-inflammatory medication (also called a non-steroidal anti-inflammatory drug, or NSAID) that is
often effective for costochondritis. Other NSAIDs are available on prescription. NSAIDs should not be taken on an
empty stomach; neither should they be used by people taking anticoagulant medication (such as warfarin), nor by
people with asthma (unless under supervision by a doctor). If you have a history of a stomach ulcer, or suffer
regular indigestion or acid reflux, you should avoid NSAIDs. If you develop tummy (abdominal) pains, indigestion
or being sick (vomiting) whilst taking NSAID medications such as ibuprofen:
You should stop them immediately and seek medical advice.
For severe cases of costochondritis, not responding to painkillers and anti-inflammatory medication, injections of
steroids or local anaesthetic medicines may be used.
In extreme cases, an intercostal nerve block can be performed (usually by a doctor specialising in acute pain
and/or anaesthetics). This involves injection of a local anaesthetic medicine around the painful ribs, to block the
nearby intercostal nerve. The intercostal nerves transmit the painful sensation in costochondritis. This sort of
injection temporarily disrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In
repeated (recurrent), severe cases of costochondritis, a series of these injections can be given to permanently
destroy the nerve causing the pain.
Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:
Heat pads
Ice application
Transcutaneous electrical nerve stimulation (TENS)
Acupuncture
Gentle stretching exercises
Avoidance of sports or activities that worsen the pain
(See separate leaflet called TENS Machines for more information.)
What is the outlook (prognosis) for costochondritis?
The outlook (prognosis) for costochondritis is generally very good. Most cases are mild, short-lived (commonly
no more than 6-8 weeks) and get better on their own. This happens with or without simple medications. In nearly
all cases, the condition has completely gone within six months. However, in a very small number of cases it lasts
longer. Costochondritis may return, but this is unlikely.
Further reading & references
ProulxAM, Zryd TW; Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
For details see our conditions.
Original Author:
Dr Katrina Ford
Current Version:
Dr Colin Tidy
Peer Reviewer:
Dr John Cox
Document ID:
13605 (v2)
Last Checked:
11/02/2014
Next Review:
10/02/2017
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