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Costochondritis

What Is It, Causes, Treatment, and More

Author:Anna Hernández, MD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


What is costochondritis?

Costochondritis refers to the inflammation of the rib cage cartilage located in the chest wall. It is one of the most common causes of chest pain in adults, and although it is usually self-limited and benign, it should be distinguished from other, more serious causes of chest pain, such as a heart attack

Rib cage cartilage inflamed.

What causes costochondritis?

Costochondritis can be caused by the inflammation of the costochondral joints or the chondrosternal joints. The costochondral joints connect the sternal ends of the ribs with their respective costal cartilages, whereas the chondrosternal joints connect the costal cartilages directly to the sternum, or breastbone. The exact cause of costochondritis is not completely understood, although risk factors may include a history of respiratory infection with coughing, strenuous exercise, or physical activity involving the upper limbs

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What are the signs and symptoms of costochondritis?

The main symptom of costochondritis is chest wall pain that is typically described as sharp, aching, or pressure-like. The pain typically worsens when taking a deep breath, coughing, performing activities involving the upper body, or lying on the affected side. Costochondritis usually affects the second to fifth ribs, and pain is usually noted at more than one location, typically close to the sternum. There is generally not any swelling or induration of the costochondral joints. 

How is costochondritis diagnosed?

Costochondritis can be diagnosed clinically based on the findings from the medical history and physical exam. The most characteristic sign of costochondritis is pain and tenderness upon palpation of the affected area. Oftentimes, costochondritis is confused with Tietze syndrome, a similar but less common disorder that causes swelling of a single costal cartilage, usually of the second or third rib. Unlike Tietze syndrome, costochondritis causes diffuse pain and is generally not associated with any swelling or induration of the costochondral joints. 

In individuals with suspected costochondritis, additional tests are not necessary for the diagnosis unless diagnosis is uncertain or if fever or signs of inflammation are present. In individuals with a history or risk of heart disease, additional tests may be conducted to rule out other causes of chest pain, such as a heart attack. Other medical conditions that may need to be ruled out include pneumonia, pneumothorax, pulmonary embolism, or rib fractures among others. Depending on the clinical suspicion, additional testing may involve an electrocardiogram (ECG), chest X-ray, or laboratory investigations.

How is costochondritis treated?

Treatment focuses on relieving the pain with medications, like acetaminophen (i.e., paracetamol), non-steroidal anti-inflammatory drugs (i.e. NSAIDs), and other analgesics. Applying heat with heating pads or warm compresses may also help to relieve the pain. In addition, individuals may be advised to minimize exercises or activities involving the upper body as well as use cough suppressants to relieve pain associated with coughing. Once movement becomes pain free, physical therapy and strengthening or stretching exercises may be beneficial for early recovery. In cases of refractory costochondritis, treatment may involve local injections of corticosteroids into the costovertebral facet joints to decrease the inflammation. Most cases of costochondritis are mild and often resolve within one or two months, though they may occasionally last longer or relapse over time.

What are the most important facts to know about costochondritis?

Costochondritis is a self-limited inflammation of the costochondral joints or costosternal joints of the chest wall. Although costochondritis is one of the most common causes of chest pain in adults, it is important to distinguish this pain from other causes of chest pain, like a heart attack, which could be life-threatening. Diagnosing costochondritis involves palpation of the costochondral and chondrosternal joints, which typically reproduces the pain. Treatment is focused on pain-relief medications and minimizing upper body activities until inflammation resolves. 

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Related links

Bones and joints of the thoracic wall
Anatomy clinical correlates: Thoracic wall

Resources for research and reference

Proulx, A. M., & Zryd, T. W. (2009). Costochondritis: Diagnosis and treatment. American Family Physician, 80(6), 617–620.

Winzenberg, T., Callisaya, M., & Jones, G. (2022). Musculoskeletal chest wall pain. In Australian Family Physician. Retrieved 27 April 2022, from https://www.racgp.org.au/afp/2015/august/musculoskeletal-chest-wall-pain