What is Costochondritis? Pain in Rib-Sternum Cartilage

Costochondritis is the inflammation of the costal cartilage that connects the rib to the sternum (breastbone). While the costal cartilage is seen as an extension of the rib, it actually articulates with both the rib and sternum at two joints – sternocostal joint which is between the sternum and costal cartilage and the costochondral joint which is between the rib and costal cartilage. In costochondritis, the inflammation may also affect the movement at these joints.


Picture from Wikimedia Commons

The flexible cartilage and joints allows for the expansion of the chest cavity during breathing. It also helps the chest absorb force applied directly to it or transmitted via the upper limbs through the clavicle (collarbone). A number of ligaments and muscles stabilize these joints. Costochondritis is a common cause of chest pain (refer to Bone Chest Pain), especially in children, teens and young adults. Joint swelling is not common in costochondritis and if swelling is present, it may be Tietze’s syndrome.

Costochondritis Pain

While the pain in costochondritis is a result of the costal cartilage inflammation, it may also be associated with strain of the surrounding ligaments and muscles. This is common in cases where costochondritis is a result of physical strain, as with persistent coughing, weight lifting and other forms of physical activity that may strain the cartilage, muscles and ligaments.

Costochondritis pain is usually not present when breathing at a normal rate and depth but any deep breathing, coughing or sneezing and certain movements of the trunk and upper limbs will elicit pain. Costochondritis is often described as breast bone pain, where the pain is felt towards the side of the sternum. Inflammation of this cartilage may also result in a popping sternum noise or sensation upon stretching and movement.

Causes of Costochondritis

Costochonditis is more likely to arise with minor injury to the chest wall and repeated strain associated with coughing, and excessive force that travels through the clavicle to the ribcage.

Other causes are more likely to be associated with infections caused by viruses, bacteria or even fungi. Although repeated coughing associated with respiratory tract infections may lead to costochondritis, the inflammation of the costal cartilages may be due to an infection itself. This is often seen with bacteria that reach the cartilage and joints through the bloodstream, direct entry through wounds on the chest wall or after surgery.

Less commonly the inflammation of the costal cartilages and neighbouring joints arises with arthritis or fibromyalgia. A significant number of cases of costochondritis occurs for no known reason. Many of these idiopathic cases may be related to previous trauma although the incidents that led to costochondritis is forgotten or not associated with the current condition.

Treatment of Costochondritis

The treatment options include the use of anti-inflammatory drugs to reduce pain and inflammation. In chronic cases the relief is usually not permanent and a corticosteroid injection may be necessary at intermittent periods to relieve severe pain. Hot and cold therapy over the chest wall may be helpful in providing symptomatic relief. Limiting movement of the joint, by not breathing too deeply or treating an underlying persistent cough may be effective. Some people find moderate relief with strapping but this should be done by a physical therapist.

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  • linda brown

    Hi please help me as i write this i am crying because i have so much burning in my ribs its gotten i can not even keep my own grandchildren I have a burning in both sides of my ribs it started on the lower right rib it has worked its way up to both sides of my ribs and also between shoulders it is a BURNING not an aching. I have done everything to try and diagnose this problem I went to a gasterologist, urologist and now i am going to a pain clinic my pain clinic doctor says it is something called intercoastal neurology i really do not believe this I looked it up i have virtually no symtoms I do not want to give up for me and the sake of my grandchilden they are all i have left since the death of my parents.I really get down so much I feel like commiting suicide so the pain will go away. I hope you will be able to help me because i know you probably get so many complaints whats another one. Please tell me on my email what i can do i have even payed for doctors comments that might help could be the cheapest is the right answer and by the way this is so thought for some people who cannot afford to pay for answers there are still people who really want to help others an no expense so please please please send me an email telling me what i can do for my illness.God Bless. Linda

  • Dr. Chris

    Hi LindaBrown

    Since you have seen so many specialists and have obviously excluded that the pain is due to any organs within chest (heart, lung. espohagus) and so on, we can assume that the problem is with the chest wall. You don’t mention your age but as you get older, the chest wall becomes more rigid and pains such as these are not uncommon. Of course the pain should not be so debilitating. Go and see an ortheopedist (orthopedic surgeon). There are a multitude of possibilities and you will require a host of tests, if they have not been done already. Refer to the article on Chest Pain Tests. I assume that you meant that the pain is on both sides of the breastbone (you said ribs) so this could be costochondritis where the cartilage connecting the ribs to the breastbone is inflamed or just the joints between the bones and cartilage may be the issue. It could also be muscular in origing but then you would be responding to medication. Your doctor may be correct and this could be related to the nerves in the spaces between your ribs. There are man causes of this – refer to the article on Nerve Chest Pain. We cannot provide you with any conclusive answer as this is against our comment policy and we are not aware of your entire case, results of the tests that have been done and so on.

  • clide lane

    Ive been experiencing pain beneath my rightbreast bone.When i sneeze it hurts. ive had xray done and it show nothing. but i know something is wrong cause my bone beneath the breast hurts when i bend over or even try sitting

    please give suggestion

  • Dr. Chris

    Hi Clide
    Based on the limited information you have provided, this could be due to two possibilities :
    1. Pericarditis
    2. Costochondritis
    If you are not satisfed with the treatment by your doctor, seek a second opinion.

  • jncoguyjohn

    I have been diagnosed with Costochondritis and I think I got it from working in a warehouse loading semi trucks. Do you think I could get workmens comp for this. Because at my job being a loader, you have to move pretty fast hand loading freight and with a forklift. I can’t do that much anymore because of this condition. And my boss tells me that I don’t have to have any restrictions at work, based off my diagnosis. What should I do?

  • jncoguyjohn

    I just don’t know if it can be proved that I got it from the job, because I don’t do any heavy lifting outside of work. The pain does not feel good in an extremely hot warehouse and heavy objects that are hard to move by hand.

  • Dr. Chris

    Hi Jncoguyjohn

    You are going to be hard pressed to prove that this happened due to your job. We cannot comment on workman’s compensation or any other legal aspect for compensation. You should speak to a lawyer about this. But costochondritis is a condition that can be treated and well managed so you should speak to your doctor.

  • sholt

    I have just been diagnosed with costochondritis by my doctor. I’m training for an Ironman triathlon on Nov. 6. I have all the above symptoms, sharp chest pain from deep breathing, or even out of no where. I also have the popping feeling. I have been perscribed steriods to help with inflammation. How long does this typically last? When or can I resume exersice, i.e. running, biking, swimming, and weight? Can any exersice be continued during pain? Will exersice make it worse?

  • Dr. Chris

    Hi Sholt

    If it is costochondritis, it will take some time to ease. Cannot give you an exact time scale because a lot depends on when you started the medication and how severe it is and so on. Some patients respond within 2 to 3 weeks, especially if they are not that active. Others take up to 6 weeks or so. In some situations, patients almost never respond in that the symptoms ease for short periods, only to recur. But of course, there are many other contributing factors to consider in each case so you should discuss this with your doctor.

    Exercise usually does make it worse but also depends on the level of activity. It is always advisable not to strain the area – most exercise will put additional strain on the ribcage – cycling, swimming and weight training puts a lot more strain as force is transferred via the arms to the chest area. Some patients bind the chest area firmly (but not tight) with wrap around bandages. This is not something I am advising though. Speak to your doctor or physical therapist about your options in terms of exercise during this time.

  • Rknight

    Hi Dr. Chris,

    I’ve had what seems to be Costochondritis for 3 years now and have gone to two doctors about it. One believed the condition to be caused by cliff-diving I’d done the summer it started, the other believed it to have developed on its own. Both thought there was nothing I could do for it at this point.

    The pain is mild and comes and goes, but sometimes flares up after a particular movement (as described in your article). Usually it flares up after swinging my arms upwards, such as after a long jump. It seems to be located on the left side, just above the heart.
    My main concern actually has nothing to do with the pain. As a singer, I’m constantly worried that the inflammation due to the condition will hurt my lung capacity, breathing ability, etc. My doctors were split on this, one saying that it very well could hurt my breathing and the other saying it couldn’t.

    What do you think? And, if it can hurt my breathing ability, is there anything I can do?

  • Dr. Chris

    Hi RKnight

    It is very unlikely that it will affect your lung capacity. However, what it will hamper is the chest movement, particularly expansion, when you breath in deeply to ful your lungs with air. Although I am no expert on breathing practices among singers, I believed that deep breathing is necessary. In mild costochondritis, this should not be too much of a concern.

    But in severe cases, it can most definitely affect your ability to take in deep breaths as it may elicit pain during inspiration. It is only natural for us to avoid any movement that may elicit pain so in turn you will take more shallow breaths. Difficult to say what there is to do in your specific case but your doctors should be able to advise you. If anti-inflammatory drugs are not helping, you may need a corticosteroid injection. This will reduce any pain and inflammation.

  • Rknight

    So the problem would be if the pain was so great that it was causing me to take shallower breaths, rather than an actual inability of my ribs to expand? Because I have usually have very little pain when I inhale deeply, it’s more when I move certain ways that it hurts.

    Thanks a lot

  • Dr. Chris

    Rknight, yes, you are correct. Of course, many patients with costochondritis do not experience discomfort upon breathing deeply. Certain movements, coughing and sneezing is more likely to elicit. The chest cavity would still be able to expand but yes, it would be painful in severe cases.

  • JohnConnor

    Howdy — I’ve been having a dull, aching feeling in my sternum area for several weeks now. It’s never a horrible type of pain — sometimes sharp, but usually dull. My sternum is not painful to the touch ever, but the pain will occur randomly, when I turn my head a certain way, when I stand up straight, etc. I initially thought it may be an esophagus thing.

    My lungs and heart feel fine — I can go for a two mile run with no trouble during or afterward (I’m 29 y/o).

  • Dr. Chris

    Hi JohnConnor

    From what you say, it could be muscular in origin or even related to a tendon or ligament. It could also be due to muscular pain elsewhere that is referred to the chest or due to the joints between the sternum and collarbone or ribs. If firm pressure on the chest wall, at the sternum and around it, do not trigger any discomfort, then it may be related to one of the internal structures within the chest cavity. It is difficult to say what the cause could be – if you experience any dizziness when standing up or turning your head, this could indicate certain cardiovascular causes. You should see a doctor about it as many serious conditions may occur in your age group as well and not be very obvious at the outset.

  • Mary

    Hi, iv been told I have Costochondritis by the hospital & a local doctor. I have a lot of pain in my upper chest & at first breathing. But now the pain has spread down one arm, my right side of my chest. What I find unusual is my neck hurting & part of my head. Is this normal? Also can I take Co-codamol asleep as Diciolfenac sodium?

  • Dr. Chris

    Hi Mary

    Yes, costochondritis can cause many of these symptoms and some may arise secondary to the condition as change in posture and movement can cause additional strain on related muscles and joints. I would however advise that you speak to your doctor. Depending on your age, medical history and current health status, there may be other conditions that need to be investigated (some very serious) which may present with these symptoms.

  • anlewi

    I have costochronditis and have done the cortisone injections and they helped. Now they say I can’t do them anymore for health reasons? Isn’t not being able to breathe a health reason? Sorry I am a S.A. sometimes. The pain is terrible and I can’t hardly breathe because of the pain. I went from running with the dogs one week to the next not being able to breathe. It is going on 6 months now and they keep telling me it will get better. Sorry don’t believe you. I no longer have a life, I just sit in a chair or sit up in bed because it hurts so bad to breathe. When in the hospital several months ago they had me on haldol and even that didn’t help with the pain and I am NOT a whimp when it comes to pain. I have rootcanals done with no pain meds. I did look on the internet and found out they can do surgery for costo. and they remove the cartiledge. My question is where and who does this type of surgery? My doctor is NO help. Hopefully someone out there can help me.

  • Chest pain

    I was in a car accident almost a year ago, and fractured my sternum. I still have pain when I sneaze, or stretch and sometimes wake up in the evening experiencing pain. With the car accident I also fractured my T4 vertebra and fractured a rib in the top left hand side.

    I have been to a chiropractor 8 times also.

    Is it normal for the pain after a year? I am a bit concerned…

  • Mikael

    Hi, im a man at 30 years of age. I have suffered from some chest pain in the upper part of the of my chest, located just between my breasts a little to the right. It usually comes when I lie on my left side or hunch sitting in my chair. Some stretching will make the chest pop and the pain dissapears leaving a faint sore feeling that fades over time. This first appeared during a time when I went to the gym quit often but even after I stopped going to the gym it hasnt fully dissapeared in 4 months. Do you think that its worth to see a doctor or should I try a chiropractor?

  • Dr. Chris

    Hi Anlewi

    Your doctor is correct – you cannot use cortisone injections indefinitely. Anti-inflammatory drugs should be prescribed on an ongoing basis (and you should use it as so) to help reduce the inflammation thereby providing pain relief and allowing the area to heal. You are obviously in great discomfort and further treatment options need to be considered. You should see an orthopedic surgeon (orthopedist) as soon as possible so other options can be considered.

  • hey mikael, shot in the dark but along time back you posted ”
    Hi, im a man at 30 years of age. I have suffered from some chest pain in the upper part of the of my chest, located just between my breasts a little to the right. It usually comes when I lie on my left side or hunch sitting in my chair. Some stretching will make the chest pop and the pain dissapears leaving a faint sore feeling that fades over time. This first appeared during a time when I went to the gym quit often but even after I stopped going to the gym it hasnt fully dissapeared in 4 months. Do you think that its worth to see a doctor or should I try a chiropractor?”
    just curious if any updates for you on this? been dealing with this exact same issue and my doctor hasnt been able to help. have had xrays and such but other than that, just dealing with it. i life weights regularly and hate the idea of stopping and not even sure if that would help. so im just wondering how it went for you and if u found a “cure” or still dealing with it?

  • S G

    I have been feeling a dull ache on the left side of my rib cage, about 2 inches from the sternum (upper abdomen area) for 2 days. I am a 30 y/o white male 145 # and 5’10”. I put in a stone porch about a week ago, which consisted of a lot of lifting, pulling, and moving. If I crouch over I can feel a sharper pain. If I breathe deep, normally it does not exacerbate the pain. It is not tender to the touch, or inflamed. No radiating pain down the arms, shoulder, or neck, just in that location. Any ideas? I know this is an old thread, but it came up in Google search for what I was looking for. Thank you for your time, I’m just exhausted searching. So I thought I would try this. I’m waiting for my insurance to kick in, so didn’t want to run to the doctor just yet.

  • Hi SG. Simple muscle strain is a possibility but your symptoms may not necessarily be linked to the chest wall (ribs, sternum, muscles and so on). It is possible that this is a deeper lying problem. Despite your age and BMI you should not rule out possible heart conditions which is occurring in younger age groups these days. However, another possibility that you may want to consider related to the recent physical strain is a hiatal hernia. The reality is that there are many possible conditions that can present with your symptoms and it is difficult to say with any certainty through an online platform. It may not be anything serious but it is worth having it checked up by a doctor if it persists.

  • Aidan

    Hey, i am a 17 year old male and so have not been to a doctor but i believe i have Costocondritis – there is no constant pain if i breathe normally, but if i do not keep a perfect posture i can feel pain in my sternum. Sometimes if im at the computer for a while (2+ hours) and then get up from my chest feels kinda.. Twingey? So i can sort of twist the top part of my body and then roll sideways and back, all when standing up, to crack it, with a horrendous crack noise. This relieves the “twinge” feeling..(its not really a twinge, its kinda like a constricted tightness that is accompanied by pain). However if i crack too much the pain becomes quite bad and if my posture is anything but perfect its really sore for about 20 minutes before it subsides.
    Im pretty sure i got this from doing regular tricep dips at the gym.. However i stopped doing those atleast 9 months ago and have stopped going to the gym entirely aswell…. 9 months.. Why do i still have this and is there anything i can be doing in everyday life to get rid of this annoyance. Also is it a bad idea to crack my sternum?
    I know from experience that if you keep cracking your fingers it gets easier and easier to do it.. And if u stop, eventually its really hard to crack them again, just a thought.

    Cheers. A reply would be greatly appreciated as this really is beginning to annoy me.

  • Hi Aidan. Even though you have stopped straining these joints the fact is that it is constantly in use. So the symptoms may not resolve entirely. Many people find that costochondritis (if this is indeed the cause) is ongoing for long periods of time. It is often persistent in teens. Nevertheless you should not leave it unattended especially if it is affecting your quality of life. “Cracking” any joint is not advisable but it is usually not serious when it comes to the breastbone region, as long as thee is no pain when doing so and you are not finding any other difficulty. Speak to your doctor and consult with a physical therapist if possible.

  • Aidan

    hmm when I crack there is pain, not a huge amount but its definitely there, despite this there is a sort of satisfaction when I crack it even though its a little sore to do.

  • Emma

    I had a car accident almost 4 weeks ago and I was the passenger we was hit head on which caused me to have bad friction burn to my left shoulder and badly bruised right breast and right ribs although my injuries are healing nicely I’m still having pain just right of the middle of my chest. Could this be this condition or something else it hurts to touch and also when I sneeze cough and breath heavy it’s painful I’ve been taking iburopfen and paracetamol for my other injuries but this pain don’t seem to go away any ideas?

    Thanks

  • Hi Emma. Hopefully you went straight through to the ER and had the necessary tests like an x-ray done. This could be due to the impact but the concern here is that something more serious may have developed. It could also be a separate condition altogether. It is difficult to say for sure. You should speak to your family doctor and it may be necessary to have further tests to confirm the underlying condition. Only then can the appropriate treatment be prescribed.

  • Katrina

    . Am 22. I went to the ER for chest pains, pain in my arms. I was told it was costochondritis. I did ekg, to rule out heart problems. Did a CT scan. Turns out i also have a sunken chest that doesn’t help with this. He gave me good anti-inflammatory pills. They worked. Now i take naproxen. It helps some. When i stress it really starts to hurt. I am having pains on both sides of my ribs, and sternum. It only comes when i stress. What could i do to relieve my pain?

  • Chris Robbins

    Is it possible for this and pleurisy to be mixed up out of curiosity ?

  • Hi Katrina. Costochondritis can be difficult to manage beyond the anti-inflammatory drugs and painkillers.It is helpful to try and find possible trigger factors like carrying heavy objects (the ribcage is where some of the muscles that move the arm anchor). These triggers should be avoided where possible. Heat and cold therapy may also be useful. Cold should follow acute injury while heat therapy can be used in the long term but only if it helps ease the pain. It would be advisable that you follow up with an orthopedist.