What Is Acute Costochondritis (Chest Wall Syndrome)?
Acute costochondritis is the inflammation of the flexible cartilage that connects each rib to the breastbone. Costochondritis is caused by excessive coughing or by straining the upper body, as with weightlifting. It is a common occurrence seen in children, teenagers, and adults.
Symptoms include a sudden, sharp, aching pain anywhere in the chest wall, especially near the breastbone where it connects to the ribs. The pain gets worse with deep breathing or with almost any movement.
Treatment involves rest along with over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs). Injections of corticosteroid medication to ease pain and inflammation are occasionally used.
You can safely treat this condition on your own by taking over-the-counter pain relief medications such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Local heat or ice compress can also improve symptoms.
How common is Acute Costochondritis (Chest Wall Syndrome)?
Acute Costochondritis (Chest Wall Syndrome) is also known as
- Costosternal syndrome
- Anterior chest wall syndrome
- Costosternal chondrodynia
- Parasternal chondrodynia
- Chest wall pain
- Tietze syndrome
Acute Costochondritis (Chest Wall Syndrome) Symptoms
Any sort of chest pain should be seen by a medical provider, especially if the person is over 35 and/or has had any cardiopulmonary symptoms. Heart attack symptoms can be mistaken for costochondritis in some cases.
There are a few main symptoms of acute costochondritis that can indicate the severity of the condition or if there is another condition involved. Chest pain, swelling between the ribs, and difficulty breathing are described below.
Chest pain is the main symptom of acute costochondritis and can be described by the following details:
- Develops quickly over a period of days
- Sharp, aching, or pressure-like
- Specific location: The pain is usually located in a specific spot on the front or side of the chest, rather that diffusely across the entire chest.
- Worsens with activity: The pain usually gets worse with movement, deep breathing, and exertion.
Swelling between the ribs
This symptom is a common condition called Tietze syndrome, which is sometimes viewed as a form of costochondritis . The swelling may be described by:
- Being within the space between two or more ribs
- A widening of the rib area: The swelling may cause the distance between the two ribs to be wider than normal.
If you have difficulty breathing not described by the following, there may be another cause other than acute costochondritis. In acute costochondritis, difficulty breathing will occur if:
- Your pain is severe
- You move your chest
- You breathe deeply
Acute Costochondritis (Chest Wall Syndrome) Causes
Acute costochondritis is a sudden-onset inflammation of the costochondral junctions, which are the connections between the ribs and the cartilage lining the ribs. It can also refer to inflammation at the chondrosternal joints, which are the connections between the cartilage lining the ribs and the breastplate. Acute costochondritis is usually defined by the ability to reproduce the pain when the painful area of the chest is pushed upon.
Acute costochondritis can affect both children and adults and is a common cause of chest pain. The exact cause of acute costochondritis is unclear. However, certain things such as injury or strain, arthritis, or tumors have been linked to developing acute costochondritis.
Injury or strain
Traumatic injury to the chest could lead to the development of acute costochondritis due to resulting inflammation and the healing process. In the absence of a traumatic injury, physical strain could also lead to acute costochondritis. Examples include heavy lifting, strenuous exercise, or vigorous coughing, which could create inflammation in the chest from repeated movement.
Arthritis of the joints in the chest
Arthritis of the joints in the chest could contribute to the development of acute costochondritis. Since the joints are located close to the costochondral junctions, inflammation of the joints could also cause inflammation in the adjacent costochondral junctions. Several disease processes can cause arthritis of the joints in the chest, including:
- Osteoarthritis: Joint damage from regular "wear and tear"
- Rheumatoid arthritis: An inflammatory joint disease due to an immune system abnormality
- Septic arthritis: An infection that causes inflammation of a chest joint, called septic arthritis, can also lead to acute costochondritis. Infections are commonly caused by bacteria, but can be caused by viruses or fungi.
Tumors cause an inflammatory response that could contribute to the inflammation seen in acute costochondritis. These include tumors of the muscles or bones in the chest, tumors of the lungs, or tumors from elsewhere in the body that spread to the cartilage in the chest.
Treatment Options and Prevention
Acute costochondritis will usually go away on its own without treatment. It usually lasts for only a few days, but in some cases may last for weeks or months (chronic costochondritis). Various treatment options can be used to try the manage the acute costochondritis symptoms, such as pain medications, at-home remedies, and further medical support.
Pain medications may be more mild or higher in strength, depending on the amount of pain you are in.
- Over-the-counter NSAIDs: Most cases of acute costochondritis can be managed with acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
- Opioids: In some cases, people with with severe pain may be prescribed a course ofhydrocodone/acetaminophen (Vicodin) or oxycodone/acetaminophen (Percocet).
At-remedies may include further over-the-counter medication and lifestyle adjustments.
- Applying heat to the area of pain: This can be done by using a hot compress or heating pad and can be repeated multiple times per day. This can be especially helpful for acute costochondritis caused by muscle strain or overuse.
- Avoiding strenuous activity: This includes coughing, or other activities that exacerbate the pain. People with acute costochondritis whose pain is exacerbated by coughing can try taking cough drops or cough suppressants such as medications containing dextromethorphan (Robitussin, DayQuil, and others), though some studies suggest that honey works equally well .
Further medical treatment
Further medical treatment can be recommended by your physician if you fail to find relief through other methods. These may include:
- Undergoing physical therapy: Physical therapy can help strengthen the muscles in the chest to provide more support and relieve acute costochondritis symptoms.
- Getting steroid injections into the areas of pain: This is rarely required but may be helpful in relieving symptoms for some people.
When to Seek Further Consultation
If you experience any symptoms of acute costochondritis, you should go see your physician. While acute costochondritis is not a serious condition, many other diseases can cause chest pain, some of which are more serious and require specific treatment. Your physician can perform an examination and possibly order laboratory and/or imaging tests to determine if your chest pain is due to acute costochondritis or another condition, and then offer the appropriate treatment.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Do you have a cough?
- Any fever today or during the last week?
- Are you sick enough to consider going to the emergency room right now?
- Do your symptoms occur after an emotional time or recent stress?
- Do you currently smoke?
The above questions are also covered by our A.I. Health Assistant.
- Tietze Syndrome. National Organization for Rare Disorders. NORD Link.
- Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Cochrane Database Syst Rev. 2014;9(2):445-446. Cochrane Link.
- Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80(6):617-620. AAFP Link.
- Wise. CM, Goldenberg DL, Kunins L. Major causes of musculoskeletal chest pain in adults. UpToDate. Updated Nov. 22, 2017. UpToDate Link
- Le Gal G, Testuz A, Righini M, Bounameaux H, Perrier A. Reproduction of chest pain by palpation: diagnostic accuracy in suspected pulmonary embolism. BMJ. 2005;330:452 BMJ Link. Accessed September 10,2018.
- Fam AG, Smythe HA. Musculoskeletal chest wall pain. Can Med Assoc J. 1985;133(5):379-389. PubMed Link
- Jensen S. Musculoskeletal causes of chest pain. Aust Fam Physician. 2001 Sep;30(9):834-9. PubMed Link.