Severe Costochondritis – Causes, Symptoms, Treatment

Costochondritis is the inflammation of the costal cartilage between the ribs and sternum. It is a self-limiting condition meaning that it does not usually progress to a stage where it can result in complications. In most cases, it will resolve over time with no treatment. However, in severe cases of costochondritis, the pain can be so intense that it will prompt a visit to the emergency room with the complaint of excruciating chest pain.

The costal cartilages of the first seven ribs run through to the sternum, while the costal cartilages of the other ribs connect to the costal cartilage of the seventh rib. Costochondritis more commonly affects the cartilages of the fourth to sixth ribs but any of the costal cartilages may be involved. Inflammation of the cartilage can affect the articulation of the cartilage with the rib and sternum. In some cases, there may actually be a slight tear of the costal cartilage.

Causes of Costochondritis

  • Direct trauma to the chest wall and in particular to the costal cartilages. This may vary from a case of assault involving the chest to car accident injuries where the chest hits against the steering wheel or airbag.
  • Physical strain due to exercising, weight lifting and overuse of the upper limbs. In certain positions, force travels along the upper limbs and is transferred to the the chest due to tensing of the pectoral muscles – for example, when doing push-ups or bench pressing.
  • Any cause of constant deep breathing like in COPD (chronic obstructive pulmonary disease) and other causes of dyspnea. Refer to Acute Causes of Dyspnea and Chronic Causes of Dyspnea.
  • Respiratory diseases where there is excessive or persistent sneezing and coughing. These actions increase the pressure on the chest wall and strains the costal cartilage. Refer to Causes of Chronic Cough.
  • Infections within the chest cavity or chest wall may cause an infection and/or inflammation of the costal cartilage.
  • Referred pain from elsewhere in the body.
  • Severe muscle spasm of the chest wall muscle(s).

Many patients diagnosed with fibromyalgia may experience tenderness on the side of the sternum and this could be costochondritis. In severe costochondritis, the cause may be persisting for long periods of time or is intense in nature and is therefore easily identifiable.

Symptoms of Costochondritis

  • Pain of on the side of the sternum (breast bone) is the main symptom. Refer to Causes of Breastbone Pain.
  • Pain that gradually develops over weeks.
  • Pain upon movement, coughing, sneezing or deep breathing – sharp, stabbing, stitching pain.
  • Tenderness – when pressure is applied to the area (sternum or on the side of the sternum).
  • Pain on the chest wall, usually on one side.
  • Popping sternum – sensation or noise of clicking or cracking when moving, breathing in deeply, sneezing or coughing.

There is usually no swelling that may be easily visible or apparent on a chest x-ray, except in acute cases like in a car accident injury. Swelling that can be identified in long standing cases of chest pain may indicate Tietze’s syndrome.

In severe costochondritis, the symptoms are intense to the point that it may impair daily functioning and be present even at rest. A case of costochondritis that persists for more than 3 months may be considered as chronic and require further investigation (refer to some of the tests in Chest Pain Test). This will require specialist medical attention.

Treatment of Costochondritis

Treatment should be directed at the underlying cause if identifiable – for example, treating a persistent cough or sneezing.

  • Non-steroidal anti-inflammatory drugs (NSAID’s) and analgesics for acute aggravations are the usual course of treatment. Analgesic patches may be a better choice for less severe but prolonged cases of costochondritis.
  • Muscle relaxants may be helpful if there is significant muscle spasm.
  • Tricyclic antidepressants may be used for patients with fibromyalgia.
  • Rest and applying ice may also be useful although if there is any muscle spasm, heat therapy may be necessary.
  • Some patients do report that the pain eases when binding the chest firmly with a bandage as this may restrict the chest wall movement. However, this is not a prescribed method of treating costochondritis and should be discussed with a doctor.
  • Cortisone injections may be useful in severe cases of costochondritis or in Tietze’s syndrome.
  • Physical therapy and strapping may also be helpful , especially in sportspersons.

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