Costochondritis, also known as Tietze’s syndrome, is an inflammation of the cartilage in the rib cage. The condition usually affects the cartilage where the upper ribs attach to the breastbone (sternum), an area known as the costosternal joint.
Chest pain caused by costochondritis can range from mild to severe. Mild cases may only cause your chest to feel tender to touch or some pain when you push on the area of your chest cartilage. Severe cases may cause shooting pains down your limbs or unbearable chest pain that interferes with your life and doesn’t seem to go away. The condition often goes away within a few weeks, but some cases may require treatment.
People with costochondritis often experience chest pain in the upper and middle rib area on either side of the breastbone. The pain may radiate to the back or the abdomen. It may also get worse if you move, stretch, or breathe deeply.
These symptoms can indicate other conditions, including a heart attack. Seek immediate medical care if you experience persistent chest pain.
The exact cause of costochondritis in most people is unknown. But conditions that may cause it include:
- trauma to the chest, such as blunt impact from a car accident or fall
- physical strain from activities, such as heavy lifting and strenuous exercise
- certain viruses or respiratory conditions, such as tuberculosis and syphilis, that can cause joint inflammation
- certain types of arthritis
- tumors in the costosternal joint region
Women and people over age 40 are most commonly diagnosed with costochondritis. You may also be at a higher risk for this condition if you:
- participate in high-impact activities
- perform manual labor
- have allergies and are frequently exposed to irritants
Your risk increases if you have any of the following conditions:
- rheumatoid arthritis
- ankylosing spondylitis
- Reiter’s syndrome, also known as reactive arthritis
Improperly handling heavy loads can stress chest muscles. For instance, younger people should lift heavy bags and backpacks with care. Adults should perform manual labor with caution.
When to see your doctor
See your doctor right away if you have trouble breathing or are feeling intense chest pain.
Always seek immediate emergency care when you have abnormal and debilitating pain in your chest, as it can indicate something serious, such as a heart attack. Getting care as soon as possible limits the possibility of complications, especially if an underlying issue is causing your costochondritis.
Your doctor will perform a physical exam before making a diagnosis. They may also ask about your symptoms and your family’s medical history. During the physical exam, your doctor assesses pain levels by manipulating your rib cage. They may also look for signs of infection or inflammation.
Your doctor might order tests, such as X-rays and blood tests, to rule out other conditions that may be causing your symptoms. You might need an electrocardiograph or chest radiograph to make sure that you don’t have coronary artery disease or another heart condition.
Costochondritis can be treated in several ways.
Most cases of costochondritis are treated with over-the-counter medications. If your pain is mild to moderate, your doctor will probably recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve).
Your doctor may also prescribe:
- prescription-strength NSAIDs
- other painkillers, such as narcotics
- antianxiety medications
- tricyclic antidepressants, including amitriptyline
- oral steroids or injection of a steroid into the area involved
Your doctor may tell you to make permanent lifestyle changes if you have persistent or chronic costochondritis. Some types of exercise can aggravate this condition, including running and weightlifting. Manual labor can also have a negative effect.
Your doctor may also recommend:
- bed rest
- physical therapy
- hot or cold therapy using a heating pad and ice
Your doctor may use pain levels to evaluate your response to treatment. Once you’ve finished treatment, you can gradually build up to your previous activity levels. Daily stretching can help relieve some pain. Your doctor can also perform a procedure called transcutaneous electrical nerve stimulation (TENS), which uses small amounts of electricity to stop your nerves from sending signals of pain or aching to your brain.
Long-term pain caused by costochondritis can be debilitating if untreated. Normally, treatment of the inflammation and pain causes costochondritis to eventually go away on its own.
If you have chronic costochondritis, the pain may return, even with treatment, when you exercise or engage in certain activities. In these cases, you may need to seek long-term care to make sure that costochondritis doesn’t affect your quality of life and ability to take part in daily activities.
Pains associated with costochondritis can indicate other issues. Chest pains can often mean that you’re having heart issues, so see your doctor right away when you feel pain in your chest to make sure that you’re not having a heart attack or pneumonia.
The chest pain associated with costochondritis is a common symptom of fibromyalgia. With fibromyalgia, you may experience soreness in your chest in addition to:
- pain throughout your body
- fatigue and inability to rest due to pain
- difficulty focusing or concentrating
- feelings of depression
If you experience chest pains along with these other symptoms, talk to your doctor about getting tested for fibromyalgia. Understanding this condition can help you address the symptoms and ensure that it doesn’t interrupt your daily life.
This condition usually isn’t persistent. In many cases, costochondritis goes away on its own. Mild cases of costochondritis may disappear after a few days. Chronic cases can last for weeks or more, but most cases don't last any longer than a year.
To lower your chance of persistent and chronic costochondritis, carry and lift heavy loads properly. Try doing fewer high-impact exercises or manual labor. Call your doctor immediately if you experience chest pain while performing any of these activities.