Costochondritis
Updates to Article Attributes
Costochondritis (CC) (rare plural: costochondritides), also known as costosternal syndrome, parasternal chondrodynia or anterior chest wall syndrome) is
It is important to not conflate/confuse this diagnosis with Tietze syndrome, which is a different, rarer, condition 1,2.
EpidemiologyClinical presentation
Costochondritis
- chest wall pain: sharp, aching or like a heavy weight
-
pain is
commonlocalised to multiple costochondral junctions-
often second to fifth junctions, in
published studies,particular ribs 3 and 4-
any of the
Clinical presentationIt presents as multiple painfulthecostosternal joints.may be affected
-
any of the
-
self-limitingcommonly unilateral - worsened by upper body motion, deep inspiration and exercise
-
often second to fifth junctions, in
- affected joints are tender on physical exam
- no visible/palpable swelling of the involved joints
In patients older than 35 years it is pertinent to rule out more serious causes of chest wall pain, such as ischaemic cardiac disease, which may occasionally present with chest wall tenderness 1,3.
Pathology
The pathogenesis of costochondritis remains unclear, and postulated mechanisms include dysfunction of neurogenic and/or musculoskeletal dysfunction structures 3.
Treatment and prognosis
In the majority of cases costochondritis is a self-limiting condition, with resolution in weeks to months. And in general, analgesia to control the pain suffices, e.g. NSAIDs or paracetamol. Clearly avoiding any activities that aggravate/produce the symptoms is sensible. Rarely an image-guided steroidcorticosteroid injection of the worst affected joint(s) might be needed 1.
Occasionally the condition might rumble on for up to a year 1.
History and etymology
Historically, costochondritis has been known as costosternal syndrome, parasternal chondrodynia or anterior chest wall syndrome. Also, whilst strictly correct, the term costosternitis is never seen.
Differential diagnosis
-<p><strong>Costochondritis</strong> (<strong>CC</strong>) (rare plural: costochondritides), also known as <strong>costosternal syndrome</strong>, <strong>parasternal chondrodynia</strong> or <strong>anterior chest wall syndrome</strong>) is a common self-limiting painful inflammation of multiple costochondral junctions and/or the costosternal articulation. There is usually a distinct absence of swelling and chest wall palpation usually reproduces the pain. </p><p>It is important to not conflate/confuse this diagnosis with <a title="Tietze syndrome" href="/articles/tietze-syndrome">Tietze syndrome</a>, which is a different, rarer, condition <sup>1,2</sup>.</p><h4>Epidemiology</h4><p>Costochondritis is common, in published studies, the </p><h4>Clinical presentation</h4><p>It presents as multiple painful costochondral and/or the costosternal joints.</p><ul>-<li>self-limiting</li>- +<p><strong>Costochondritis</strong> (<strong>CC</strong>) (rare plural: costochondritides) is a common self-limiting painful inflammation of multiple costochondral junctions and/or the costosternal articulation. There is usually a distinct absence of swelling and chest wall palpation usually reproduces the pain. </p><p>It is important to not conflate/confuse this diagnosis with <a href="/articles/tietze-syndrome">Tietze syndrome</a>, which is a different, rarer, condition <sup>1,2</sup>.</p><h4>Clinical presentation</h4><ul>
- +<li>chest wall pain: sharp, aching or like a heavy weight</li>
- +<li>pain is localised to multiple costochondral junctions<ul>
- +<li>often second to fifth junctions, in particular ribs 3 and 4<ul><li>any of the seven costochondral junctions and/or costosternal joints may be affected</li></ul>
- +</li>
- +<li>commonly unilateral</li>
- +<li>worsened by upper body motion, deep inspiration and exercise</li>
- +</ul>
- +</li>
-</ul><p>In patients older than 35 years it is pertinent to rule out more serious causes of chest wall pain, such as ischaemic cardiac disease <sup>1</sup>.</p><h4>Pathology</h4><p>The pathogenesis of costochondritis remains unclear, and postulated mechanisms include neurogenic and/or musculoskeletal dysfunction <sup>3</sup>.</p><h4>Treatment and prognosis</h4><p>In the majority of cases costochondritis is a self-limiting condition, with resolution in weeks to months. And in general, analgesia to control the pain suffices, e.g. <a title="NSAIDs" href="/articles/non-steroidal-anti-inflammatory-drugs">NSAIDs</a> or <a title="Paracetamol" href="/articles/paracetamol">paracetamol</a>. Clearly avoiding any activities that aggravate/produce the symptoms is sensible. Rarely an image-guided steroid injection of the worst affected joint(s) might be needed <sup>1</sup>.</p><p>Occasionally the condition might rumble on for up to a year <sup>1</sup>.</p><h4>Differential diagnosis</h4><ul>-<li><a title="Tietze syndrome" href="/articles/tietze-syndrome">Tietze syndrome</a></li>- +</ul><p>In patients older than 35 years it is pertinent to rule out more serious causes of chest wall pain, such as ischaemic cardiac disease, which may occasionally present with chest wall tenderness <sup>1,3</sup>.</p><h4>Pathology</h4><p>The pathogenesis of costochondritis remains unclear, and postulated mechanisms include dysfunction of neurogenic and/or musculoskeletal structures <sup>3</sup>.</p><h4>Treatment and prognosis</h4><p>In the majority of cases costochondritis is a self-limiting condition, with resolution in weeks to months. And in general, analgesia to control the pain suffices, e.g. <a href="/articles/non-steroidal-anti-inflammatory-drugs">NSAIDs</a> or <a href="/articles/paracetamol">paracetamol</a>. Clearly avoiding any activities that aggravate/produce the symptoms is sensible. Rarely an image-guided corticosteroid injection of the affected joint(s) might be needed <sup>1</sup>.</p><p>Occasionally the condition might rumble on for up to a year <sup>1</sup>.</p><h4>History and etymology</h4><p>Historically, costochondritis has been known as costosternal syndrome, parasternal chondrodynia or anterior chest wall syndrome. Also, whilst strictly correct, the term costosternitis is never seen.</p><h4>Differential diagnosis</h4><ul>
- +<li><a href="/articles/tietze-syndrome">Tietze syndrome</a></li>
References changed:
- 1. Proulx A & Zryd T. Costochondritis: Diagnosis and Treatment. Am Fam Physician. 2009;80(6):617-20. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19817327">Pubmed</a>
- 2. Rokicki W, Rokicki M, Rydel M. What Do We Know About Tietze's Syndrome? Kardiochir Torakochirurgia Pol. 2018;15(3):180-2. <a href="https://doi.org/10.5114/kitp.2018.78443">doi:10.5114/kitp.2018.78443</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30310397">Pubmed</a>
- 3. Ayloo A, Cvengros T, Marella S. Evaluation and Treatment of Musculoskeletal Chest Pain. Prim Care. 2013;40(4):863-87, viii. <a href="https://doi.org/10.1016/j.pop.2013.08.007">doi:10.1016/j.pop.2013.08.007</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24209723">Pubmed</a>
Systems changed:
- Chest
Tags changed:
- cases
Unable to process the form. Check for errors and try again.