Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 13, 2016

Costochondritis is also known as chest wall pain, costosternal syndrome, or costosternal chondodynia. Its symptoms can arise without any apparent cause and create distress and concern in a patient.


Definition & Facts

By definition, costochondritis is the inflammation of the cartilage that connects the individual ribs to the breast bone, called the sternum. Typically, women are afflicted with the disease more than men (70% of patients are female compared to 30% male), and women over 40 years of age are more likely to have this condition.

If costochondritis is accompanied by swelling, the condition may be Tietze syndrome. This is an extremely rare condition that is usually found in teenagers and young adults. The occurrence of Tietze syndrome seems to appear in young men and women equally.

Many of its symptoms, such as sudden chest pain typically on the left side of the chest, can be confused with the symptoms of a heart attack. This condition, however, is a simple inflammation of cartilage that usually resolves itself in a matter of weeks. If for any reason a patient exhibits symptoms of costochondritis or a heart attack, it is always recommended to seek immediate medical attention.

Symptoms & Complaints

The symptoms of costochondritis can range from a dull ache to a sharp pain in the chest, usually on the left side of the breast bone. This pain can radiate backward to the stomach or back. The pain can also be experienced as a kind of pressure similar to the sensation of a heart attack.

The pain is usually associated with the fourth, fifth, or sixth rib, and can affect more than one rib at a time. Taking a deep breath or coughing makes the symptoms worse, while breathing quietly or moving less can reduce the pain symptoms. Pressing on the area in the chest where tenderness occurs should replicate the same tenderness experienced when moving or breathing deeply.


There is no direct cause to costochondritis, but certain activities have been known to increase the likelihood that one will suffer from an episode of the condition. Minor injuries, particularly injuries that involve a blow to the chest, can be a trigger for costochondritis. Heavy lifting or intense aerobic exercise can lead to physical strain of the chest muscles which may cause inflammation in the cartilage of the ribs.

In some cases, arthritis may be linked to costochondritis. This can be any type of arthritis, including osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis. In some rare cases, tumors can be the direct cause of costochondritis. Both cancerous and non-cancerous tumors can move to the ribs from another location, such as the breast or lung, causing joint inflammation in the ribs. Any recent history with infection, such as an upper respiratory infection, can increase a person’s likelihood to suffer from costochondritis at a later date.

Diagnosis & Tests

There is no single test that can be performed to diagnose a person with costochondritis. Instead, doctors most likely will perform tests to rule out any other possible health concerns. To pinpoint the areas in the chest affected by the pain, a doctor might feel along the patient’s rib cage to locate any pain or swelling. The chest pain symptoms of costochondritis should be easily replicated by applying pressure to the affected joints. The doctor may also ask the patient to twist or move around the torso to recreate the symptoms.

Many of the symptoms of costochondritis can overlap with symptoms commonly found in lung disease, heart disease, gastrointestinal disease, and osteoarthritis. To ensure that these more serious conditions are not the culprit for the chest pain, the doctor may order tests including an X-ray, CT scan, MRI, or electrocardiogram.

Treatment & Therapy

Most of the time, treatment for costochondritis revolves around pain management. Costochondritis will normally clear itself up in a matter of weeks, so managing the pain in the meantime becomes the priority. There are several at home treatments that can help. Simple anti-inflammatories, such as ibuprofen, can help manage the pain. Hot compresses and cold compresses work well also. It is also suggested to limit ongoing strenuous activity that may worsen the chest pain.

Another alternative for managing pain associated with costochondritis is to use physical therapy. Stretching and strengthening exercises for the chest muscles has been known to help the condition. Treatment with transcutaneous electrical nerve stimulation nerve in which small electric currents are directed into the joints may help because the currents are able to redirect the pain signals and prevent them from entering a person’s brain.

In some cases, the doctor may prescribe medication to better manage the pain. A prescription strength variant of common over the counter nonsteroidal anti-inflammatory drug may be prescribed. If the pain is sever enough, narcotic drugs that contain codeine, such as Vicodin® or Percocet® may be recommended by the doctor. It should be cautioned though, that these can become habit forming.

Certain antidepressants, such as tricyclic antidepressants may be used especially if the patient is experiencing difficulty sleeping. If the costochondritis continues for a sustained period of time, epilepsy medicine called gabapentin has been successfully used to manage chronic pain.

Prevention & Prophylaxis

Costochondritis has no real cause, so it is impossible to prevent the condition completely. There are, however, known triggers for the condition that can be avoided in order to minimize the chances of becoming afflicted with costochondritis. Because the condition can come on as a result of a minor injury to the chest area, it is always recommended to wear the appropriate padding and protection when participating in contact sports.

Also, making sure the chest muscles are properly stretched before participating in activities that strain the chest muscles, such as heavy lifting or deep breathing from intense running is important. Furthermore, practicing good posture on a daily basis will help keep the chest and back muscles strong which can greatly reduce a person’s chances of becoming afflicted with costochondritis.