|Costochondritis ICD10 = M94|
|Classification and external resources|
The costal cartilages
Costochondritis, also known as chest wall pain, costosternal syndrome, or costosternal chondrodynia is a benign and often temporary inflammation of the costal cartilage, which connects each rib to the sternum at the costosternal joint, and is a common cause of chest pain. Though costochondritis is often self-limited, it can be a recurring condition that can appear to have little or no signs of onset. Treatment options are quite limited and usually involve a combination of rest, analgesics, or anti-inflammatory medications; however, in cases with intractable discomfort, cortisone injections or surgery may be necessary. Typically, costochondritis patients are instructed to refrain from physical activity to prevent the onset of an attack.
Costochondritis symptoms can be similar to the chest pain associated with a heart attack. Unexplained chest pain is considered a medical emergency until potentially life-threatening cardiac issues can be ruled out. Severe cases of costal cartilage inflammation that also involve painful swelling are sometimes referred to as Tietze's syndrome, a term sometimes used interchangeably with costochondritis; however, some physicians view costochondritis and Tietze's syndrome as separate disease states due to the absence of costal cartilage swelling in costochondritis.
Signs and symptoms
Pain or tenderness to palpation usually occurs on the sides of the sternum, affects multiple ribs, and is often worsened with coughing, deep breathing, or physical activity. On physical examination, physicians will inspect and palpate the patient for areas of swelling or tenderness and can often reproduce the pain associated with costochondritis by moving the patient's rib cage or arms. Costochondritis tends to occur in patients who are aged between 20 and 40, typically female, and tends to affect the third, fourth, fifth, or sixth costosternal joints.
In most cases of costochondritis, no cause is identified. However, costochondritis may be the result of physical trauma (due to direct injury, strenuous lifting, or severe bouts of coughing), ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, or a tumor (benign or cancerous). Infection of the costosternal joint may cause costochondritis in rare cases. Most cases of infectious costochondritis are caused by Actinomyces, Staphylococcus aureus, Candida albicans, and Salmonella; E. coli is a rare cause of this condition.
The pathogenesis underlying the development of costochondritis remains unclear. Proposed mechanisms of injury include neurogenic inflammation, muscular imbalance, or a derangement of the mechanical structure of the costochondral junction.
Costochondritis may be treated with physical therapy (with or without nerve stimulation) or with medication. Treatment may involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or other pain relief medications (analgesics) such as acetaminophen. Severe cases of costochondritis may call for the use of opioid medications such as hydrocodone or oxycodone, tricyclic antidepressant medications such as amitriptyline for pain from chronic costochondritis, or anti-epileptic drugs such as gabapentin may be used. Oral or injected corticosteroids may be used for cases of costochondritis unresponsive to treatment by NSAIDS; however, this treatment has not been adequately studied with randomized controlled trials and its practice is currently based on clinical experience. Patients are often instructed to rest from stressful physical activity while recovering.
Costochondritis is a common condition and is responsible for 30% of emergency room chest pain related visits. One-fifth of visits to the primary care physician are for musculoskeletal chest pain, of this 20% of primary care office visits, 13% is due to costochondritis.
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