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Acute Costochondritis

How to tell if the pain in your chest is an emergency.

What is acute costochondritis?

Acute costochondritis, also called chest wall pain syndrome, is a common cause of pain in the front of your chest near the breastbone (sternum). Usually, the pain occurs because of inflammation of the cartilage between the sternum and the ribs. This inflammation is called costochondritis.

It can happen after straining, coughing, or weightlifting. Most often, though, the cause is unknown. The pain can get worse when you cough or take a deep breath. You may confuse this pain with having a heart attack.

Costochondritis can be treated by avoiding strenuous activities involving your chest muscles, stretching, and taking anti-inflammatory medications if needed.

What is causing your symptoms?

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What does costochondritis feel like?

Pro Tip

Costochondritis is one of the most common conditions diagnosed in the emergency room. —Dr. Alvin Chen

Most commonly, you will have pain near your breastbone where it connects to the ribs. It is usually sharp and may feel like pressure. It can get worse when you take a deep breath or cough. It usually worsens when you press directly on the area.

Chest wall pain is different from heart attack pain. But since you may find it hard to tell the difference, get treatment so you can rule that out.

Main symptoms

Next steps

If you have new crushing or burning chest pain—and especially if that pain shoots toward your jaw or left side—call your primary care doctor. If they can’t be reached, go straight to the ER.

If your chest pain is due to costochondritis, it’s not an emergency. But it could be a heart attack, pulmonary embolism (blood clot in the lungs), or aortic dissection (a tear in the aorta). They need to be ruled out first, especially if you’re over 40, male, have a hard time breathing, and/or have a personal or family history of heart disease or heart attack.

If a heart attack or other serious condition is ruled out, your doctor can treat the symptoms of costochondritis with a regular appointment.

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What is the best treatment for costochondritis?

Dr. Rx

Depending on the setting of the evaluation (emergency room vs. urgent care vs. outpatient clinic), the next steps would likely involve an electrocardiogram (ECG), blood tests (troponin, CK-MB to rule out heart attack), chest x-ray, CAT scan of the chest, or stress testing. —Dr. Chen

The goal of treatment for chest wall pain syndrome is pain relief—since this is not a life-threatening condition.

  • The most important step in treatment is rest and avoiding activities that aggravate the pain. This means no push-ups, bench press, or other upper body exercises in the gym.
  • Physical therapy or stretching exercises can be helpful.
  • You can add heat to the area by using a heating pad or analgesics (such as Bengay or Voltaren gel).
  • Over-the-counter anti-inflammatory medication, such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve) can help relieve pain.
  • In severe cases, your doctor may prescribe steroid or opioid medications to help with your symptoms. However, these treatments are generally only used for short term treatment as they have numerous side effects.
  • If you’re coughing a lot, an over-the-counter cough suppressant can be helpful. Guaifenesin-dextromethorphan (Robitussin DM) is one option. If that doesn’t work, your doctor can prescribe you benzonatate (Tessalon).
  • If the pain doesn’t get better on its own in a week, a physical therapist may be able to help you with a number of therapies including cross fiber friction massage, postural exercises, hot/cold pads, dry needling, and electro-accupuncture.
  • If these treatments don’t work, your doctor might want to give you an injection with a local anesthetic, such as lidocaine (Xylocaine) or an injectable corticosteroid, such as depo-methylprednisolone, according to the American Academy of Family Physicians. They’ll inject it into the joint and it will help dull the pain.

What causes acute costochondritis?

Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions.

Inflammation can be caused by microtrauma, overuse, or straining of the chest muscles. Often there is no identifiable cause.

But you’re more likely to develop it if you are:

  • Over 40 years of age.
  • Overusing your chest muscles.
  • Experiencing or have a previous injury in your chest wall (the skin, fat, muscles, bones, and tissues that form a protective structure around the vital organs in your chest).
  • Doing strenuous exercise, usually repeated, including running, cycling, weightlifting, or vigorous sports.
  • Coughing a lot.
  • Engaging in manual labor.

Your risk is also higher if you have a medical history of:

Chest pain in children

Pro Tip

Many resources downplay the seriousness of costochondritis. While it is true that it is not life-threatening, it can be quite debilitating, which is why you need medical attention. —Dr. Chen

Chest wall syndrome is very common in kids. In fact, 40% of the time a child complains about chest pain, it will be from this. Treatment is the same as it is for adults.

While kids rarely get heart attacks, if your child has chest pain, contact or see your pediatrician as soon as possible.

Preventative tips

It is difficult to prevent costochondritis because it is hard to know what causes it. If you get it once, do the following to prevent it from happening again:

  • Stretch your chest muscles before and after exercise.
  • Don’t overuse your chest muscles.
  • Always use good form to lift and move heavy items.
  • If you do manual labor for your job, see if you can move to a position that doesn’t use the chest as much.
  • If coughing was the cause, take a cough suppressant when you get a cough in the future. And see your doctor to treat the cause of the cough.
  • If you have ongoing (chronic) costochondritis, you should ask your doctor about physical therapy.
Hear what 1 other is saying
Probable DiagnosisPosted February 10, 2020 by A.

I am a 25 year old female who started having stabbing chest pain above my left breast that gradually aggravates my left shoulder muscles throughout the day. To me, this diagnosis seems the most accurate since I have been exercising more than I usually do plus lifting a 35+ pound baby almost everyday. So far, Ibuprofen seems to help and lessening my activity level also helps. It has been almost two weeks since this has been occurring and hopefully with meds and rest it will disappear entirely. Thanks for the info! :)

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