Costochondritis (Tietze's Syndrome)

Written by Seth Stoltzfus and Marijane Leonard | Published on July 18, 2012
Medically Reviewed by George Krucik, MD


Costochondritis causes chest pain that is related to inflammation of cartilage in your rib cage. More specifically, costochondritis often affects the cartilage where upper ribs attach to the sternum (breastbone). This area is referred to as the “costosternal joint.”

Pain may be mild or more severe depending on your condition.

Costochondritis is also known as Tietze’s syndrome.

Causes of Costochondritis

For many patients, the cause of costochondritis is unknown. However, some of the following may cause it:

  • different types of 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, syphilis, and aspergillosis, that can cause joint inflammation
  • certain types of arthritis
  • repetitive motion, including severe coughing
  • tumors in the costosternal joint

Who Is at a High Risk for Costochondritis?

Women and those over 40 are most commonly diagnosed with costochondritis. You may be at a higher risk for this condition if:

  • you participate in high-impact activities
  • you perform certain kinds of manual labor
  • you have allergies and are exposed to irritants

If you have any of the following conditions, you may also be at higher risk:

  • rheumatoid arthritis
  • ankylosing spondylitis
  • Reiter’s syndrome

Medical opinions differ as to the ages most at risk for costochondritis. In general, anyone who is exposed to some of the above situations can be at higher risk. Doctors warn against handling heavy loads in an inefficient way, as this can stress muscles in the chest area. For instance, younger people should be careful with heavy schoolbags, and adults will want to be careful if carrying out manual labor.

Symptoms of Costochondritis

A specific chest pain in the area of the fourth, fifth, and sixth ribs to the left of the sternum can indicate costochondritis. Pain may radiate to the back or down to the abdomen. It may also get worse if you move, stretch, or breathe deeply. However, these types of symptoms can also accompany other kinds of conditions, including heart attack. It is important to seek medical attention if you experience persistent chest pain.

Diagnosing Costochondritis

Your doctor will likely diagnose costochondritis based on the pain this inflammation produces. During a physical exam, your doctor will try to assess pain levels by manipulating the rib area and may also look for signs of infection or inflammation. He or she will also likely ask about personal and family medical history relating to chest pain.

In cases where doctors need to rule out other conditions, such as cardiovascular problems, X-rays and blood tests may be done.

Treatment for Costochondritis

There are a few different treatments for costochondritis.


Most cases of costochondritis are treated with over-the-counter drugs. If your condition is mild to moderate, your doctor will probably recommend treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Aspirin) or naproxen (Aleve). Your doctor may also prescribe:

  • antianxiety medications
  • other painkillers such as narcotics
  • prescription-strength NSAIDs

Lifestyle Changes

If you have persistent or chronic costochondritis, your doctor may recommend permanent changes to your routine. Some kinds of exercise can aggravate this condition. Some manual labor may also have a negative effect. Doctors may also recommend:

  • bed rest
  • alterations to exercises
  • physical therapy
  • hot/cold therapy using a heating pad and ice

Your doctor may use pain levels to check whether you are responding to treatment. After you are diagnosed with costochondritis, medical professionals often recommend gradually building back up to previous activity levels.

Outlook for Costochondritis

In many cases, costochondritis will go away on its own. This condition does not tend to be persistent. You can take the following measures to lessen chances of persistent and chronic costochondritis:

  • Ensure proper hand-washing and hygienic conditions at home to avoid infection
  • Do less high-impact exercise or labor.
  • Carry heavy loads properly.
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