Costochondritis

Definition

Costochondritis is an inflammation and associated tenderness of the cartilage (i.e., the costochondral joints) that attaches the front of the ribs to the breastbone.

Description

Costochondritis causes pain in the lower rib area or upper breastbone. Some patients fear they are having a heart attack. The most severe pain is usually between the breast and the upper abdomen. The pain may be greater when in sitting or reclining positions. Stress may aggravate this condition. Generally the third or fourth ribs are affected. However, any of the seven costochondral junctions may be affected, and more often than not more than one site is involved. The inflammation can involve cartilage areas on both sides of the sternum, but usually is on one side only. Costochondritis should be distinguished from Tietze Syndrome, which is an inflammation involving the same area of the chest, but also includes swelling.

Causes and symptoms

The causes of costochondritis are not well-understood and may be difficult to establish. The most likely causes include injury, repetitive minor trauma, and unusual excessive physical activity.

The primary symptom of costochondritis is severe chest wall pain, which may vary in intensity. The pain becomes worse with trunk movement, deep breathing, and/or exertion, and better with decreased movement, quiet breathing, or changing of position. It is usually localized but may radiate extensively from the chest area. The pain has been described as sharp, nagging, aching, or pressure-like.

Diagnosis

Diagnosis is based on pain upon palpation (gentle pressing) of the affected joints. Swelling is not associated with costochondritis. Diagnosis is also dependent on the exclusion of other causes, including heart attack or bacterial or fungal infections found in IV drug users or postoperative thoracic surgery patients.

Treatment

The goals of treatment are to reduce inflammation and to control pain. To accomplish these goals, nonsteroidal anti-inflammatory agents (NSAIDs) are used, with ibuprofen usually selected as the drug of choice. Other NSAIDS options are flurbiprofen, mefenamic acid, ketoprofen, and naproxen. Additional treatment recommendations include the use of local heat, biofeedback, and gentle stretching of the pectoralis muscles two to three times a day.

For more difficult cases, where the patient continues to exhibit pain and discomfort, cortisone injections are used as therapy.

Alternative treatment

Supplements that are used to reduce inflammation have been used to treat costochondritis. Examples of such supplements include ginger root, evening primrose oil, bromelain, vitamin E, omega-3 oils, and white willow bark. Glucosamine/chondroitin sulfate, which may aid in the healing of cartilage, has also been used. Other alternative therapies include acupuncture and massages.

Prognosis

The prognosis for recovery from costochondritis is good. For most patients, the condition lessens in six months to a year. However, after one year, about one-half of patients continue with some discomfort, while about one-third still report tenderness with palpation.

Prevention

Though the causes of costochondritis are not well known, avoidance of activities that may strain (e.g., the repetitive misuse of muscles) or cause trauma to the rib cage is recommended to prevent the occurrence of costochondritis. Modification of improper posture or ergonomics of the home or work place may also deter the development of this condition.

OTHER

Day, C. Costochondritis Web Site. 2001. <http://www.geocities.com/Hots/2338/#Frequently%20Asked%20Questions>.

Flowers, L. K., and B. D. Wippermann. "Costochondritis." eMedicine Journal: Emergency Medicine/Rheumatology. 23 Feb. 2001. <http://www.emedicine.com/emerg/topic116.htm>.

Judith Sims

KEY TERMS

Inflammation—Process whereby the immune system reacts to infection or other stimulus, characterized by pain, swelling, redness, and warmth of the affected part