Costochondritis

Costochondritis (rare plural: costochondritides) is a common, usually self-limiting, painful inflammation of one or multiple costochondral junctions and/or the costosternal articulation. There is usually a distinct absence of swelling and chest wall palpation usually reproduces the pain. 

It is important to not conflate/confuse this diagnosis with Tietze syndrome, which is a different, rarer, condition ^1,2.

Clinical presentation

• chest wall pain: sharp, aching or like a heavyweight

• pain is localized to multiple costochondral junctions

  • often second to fifth junctions, in particular, ribs 3 and 4

    • any of the seven costochondral junctions and/or costosternal joints may be affected

  • commonly unilateral

  • worsened by upper body motion, deep inspiration and exercise

• 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 ischemic heart 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 structures ³.

Infectious costochondritis can occur following infection, most commonly of Staphylococcus epidermidis, Streptococcus pneumoniae, Aspergillus spp. or Candida albicans. There is increased prevalence of infectious costochondritis in intravenous drug users ⁴.

Treatment and prognosis

In the majority of cases, idiopathic 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 acetaminophen. 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 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 (plural: costosternitides) is never seen.

Differential diagnosis

• Tietze syndrome

• myocardial infarction

• pulmonary embolism