What is costochondritis?
Costochondritis is an inflammation of the cartilage that connects the inner end of each rib with the breastbone (sternum), otherwise known as the costochondral joint.
It can occur in any age group and is most common in young adults.
Exactly how common it is in the UK is not known. But in the US, costochondritis has been shown to account for 10 per cent of chest pain episodes in the community and 30 per cent of people with chest pain presenting as an emergency to hospital.
Why or how does a person get costochondritis?
The risk of developing costochondritis increases with any physical activity that causes trauma or strain to the ribcage.
It's a benign condition, usually of short duration that resolves completely. Sometimes though, it can recur or become persistent.
What are the symptoms?
The symptoms of costochondritis may occur suddenly or develop gradually.
The predominant symptom is a sharp pain in the affected area – most commonly involving the second or third ribs that are often very tender to touch. (Ribs are counted down from the top and the first rib lies under the collar bone.)
The pain is usually related to movement, coughing and sneezing and can occur in more than one place simultaneously.
Pain can also radiate into the arm and can be associated with a feeling of tightness in the chest. These may also be the symptoms of a heart attack, so it is always necessary to take them seriously and make the diagnosis of costochondritis with care.
Should you experience these symptoms and be concerned that there is a real risk of heart attack, dial 999 immediately and ask for an ambulance.
Never be complacent about chest pain. Always ensure you undergo medical assessment for this symptom, so that more serious causes can be excluded
How is costochondritis diagnosed?
The person's medical history and results of examination are usually sufficient. But if the pattern of pain suggests that it could be heart pain, it needs to be thoroughly investigated.
What can you do yourself?
First, ensure that you consult your doctor and have the diagnosis properly confirmed. If possible, avoid any movements that aggravate the symptoms.
Self-treatment with simple painkillers, including non-steroidal inflammatory drugs such as ibuprofen (eg Nurofen), is quite acceptable (provided you can tolerate such medicines – your pharmacist will be able to advise you on this).
What can your doctor do?
The doctor's role is to give reassurance regarding the nature of the condition and provide treatment advice.
The patient has often already tried mild painkillers, but stronger painkillers do not necessarily help the symptoms. Any doubt over the diagnosis will require further investigation.
If simple painkillers fail, sometimes an injection of cortisone, eg triamcinolone, may be administered.
Transcutaneous nerve stimulation (TNS) and acupuncture can be effective in resistant cases.
Disla E, Rhim HR, et al: Costochondritis: a prospective analysis in an emergency department setting. Arch Intern Med 1994; 154: 2466-2469.
Wolf E, Stern S: Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med 1976; 136: 189-191.