Costochondritis

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Costochondritis
Classification and external resources

The costal cartilages
ICD-10 M94
ICD-9 733.6
MedlinePlus 000164

Costochondritis, also known as chest wall pain, costosternal syndrome, or costosternal chondrodynia[1] is a benign[2] 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.[1][3][4] Though costochondritis is often self-limited, it can be a recurring condition that can appear to have little or no signs of onset.[5] Treatment options are quite limited and usually involve a combination of rest, analgesics, or anti-inflammatory medications;[6] however, in cases with intractable discomfort, cortisone injections[6][7] or surgery may be necessary. Typically, costochondritis patients are instructed to refrain from physical activity to prevent the onset of an attack.[8]

Costochondritis symptoms can be similar to the chest pain associated with a heart attack.[7] Unexplained chest pain is considered a medical emergency until potentially life-threatening cardiac issues can be ruled out.[4][8] 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.[2][6]

Contents

Etiology [edit]

In most cases of costochondritis, there is no definite cause.[1][2][7] However, costochondritis may be the result of physical trauma (direct injury, strenuous lifting, or severe bouts of coughing), ankylosing spondylitis, Ehlers-danlos syndrome, rheumatoid arthritis, osteoarthritis, infection of the affected joint, or a tumor (benign or cancerous).[9]

Symptoms [edit]

Pain or tenderness to palpation usually occur on the sides of the sternum, affect multiple ribs, and are often worsened with coughing, deep breathing, or physical activity.[2][10] 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.[4][11] 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.[2][6]

Treatment [edit]

Costochondritis may be treated with chiropractic, physical therapy (with or without nerve stimulation) or with medication. Treatment may involve the use of nonsteroidal anti-inflammatory drugs such as ibuprofen or other pain relief medications (analgesics) such as acetaminophen.[3][4] Severe cases of costochondritis may call for the use of opioid medications such as hydrocodone or oxycodone, tricyclic antidepressant medications such as amitryptyline may be used to treat pain from chronic costochondritis, and anti-epileptic drugs such as gabapentin may be used.[12] Patients are often instructed to rest from stressful physical activity while recovering.[4]

Differential diagnosis [edit]

Other causes of chest pain that may be considered when attempting to diagnose chest pain may include:[13]

See also [edit]

References [edit]

  1. ^ a b c Mayo Clinic Staff (2012). "Costochondritis Definition". Mayo Clinic. Retrieved 26 December 2012. 
  2. ^ a b c d e Jindal, A; Singhi, S (2011). "Acute chest pain.". Indian journal of pediatrics 78 (10): 1262–1267. doi:10.1007/s12098-011-0413-1. PMID 21541647. 
  3. ^ a b U.S. National Library of Medicine (2010). "Costochondritis". National Institutes of Health. Retrieved 26 December 2012. 
  4. ^ a b c d e Proulx, AM; Zryd, TW (2009). "Costochondritis: diagnosis and treatment". American Family Physician 80 (6): 617–620. PMID 19817327. 
  5. ^ Stochkendahl, MJ; Christensen, HW (2010). "Chest pain in focal musculoskeletal disorders". The Medical clinics of North America 94 (2): 259–273. doi:10.1016/j.mcna.2010.01.007.. PMID 20380955. 
  6. ^ a b c d e f Fauci, Anthony S.; Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Joseph Loscalzo (2008). Chapter 330. Arthritis Associated with Systemic Disease, and Other Arthritides Harrison's principles of internal medicine (17th ed. ed.). New York: McGraw-Hill. ISBN 978-0-07-147693-5. 
  7. ^ a b c d e Ricker Polsdorfer, M.D. (2012). "Costochondritis". Keck Medical Center of USC. Retrieved 30 December 2012. 
  8. ^ a b Beers, Mark (2006). "Chapter 5". The Merck Manual of Diagnosis and Therapy (18th ed.). Merck Research Laboratories. ISBN 0-911910-18-2. 
  9. ^ Mayo Clinic Staff (2012). "Causes". Mayo Clinic. Retrieved 26 December 2012. 
  10. ^ Mayo Clinic Staff (2012). "Costochondritis:Symptoms". Mayo Clinic. Retrieved 26 December 2012. 
  11. ^ Mayo Clinic Staff (2012). "Costochondritis:Tests and diagnosis". Mayo Clinic. Retrieved 26 December 2012. 
  12. ^ "Treatments and drugs". Mayo Clinic. 2012. Retrieved 26 December 2012. 
  13. ^ "Costochondritis Diagnosis Differential". BMJ Publishing Group. 2012. Retrieved 26 December 2012. 

External links [edit]

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