Costochondritis

Costochondritis
Other names	Chest wall pain syndrome, costosternal syndrome
The costal cartilages
Specialty	Family medicine, internal medicine, general practitioners, rheumatology, orthopedics
Symptoms	Chest pain
Risk factors	Strenuous coughing, exercise, lifting, infection of the costosternal joint
Diagnostic method	Clinical physical examination and the ruling out of other conditions
Differential diagnosis	Acute coronary syndrome, pneumothorax, pulmonary embolism, aortic dissection, angina, myocardial infarction, Tietze syndrome, slipping rib syndrome, rib fracture, fibromyalgia, pneumonia
Treatment	Analgesics, nonsteroidal anti-inflammatory drugs, ice, heat, rest, manual therapy, TENS unit, injections, opioids

Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral (rib to cartilage) and sternocostal (cartilage to sternum) joints. 90% of patients are affected in multiple ribs on a single side, typically at the 2nd to 5th ribs.^[1] Chest pain, the primary symptom of costochondritis, is considered a symptom of a medical emergency, making costochondritis a common presentation in the emergency department. One study found costochondritis was responsible for 30% of patients with chest pain in an emergency department setting.^[2]

The exact cause of costochondritis is not known; however, it is believed to be due to repetitive minor trauma, called microtrauma. In rarer cases, costochondritis may develop as a result of an infectious factor. Diagnosis is predominantly clinical and based on physical examination, medical history, and ruling other conditions out. Costochondritis is often confused with Tietze syndrome, due to the similarity in location and symptoms, but with Tietze syndrome being differentiated by swelling of the costal cartilage.

Costochondritis is considered a self-limited condition that will resolve on its own. Treatment options usually involve rest, pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), ice, heat, and manual therapy. Cases with persistent discomfort may be managed with an intercostal nerve blocking injection utilizing a combination of corticosteroids and local anesthetic. The condition predominantly affects women over the age of 40, though some studies have found costochondritis to still be common among adolescents presenting with chest pain.^{[1][3]: 388}