Costochondritis 

  • Overview

Introduction 

Costochondritis can cause chest pain and tenderness 

Costochondritis medicines information

Read more about the medicines used to treat costochondritis and Tietze's syndrome

Costochondritis is the medical term for inflammation of the cartilage that joins your ribs to your breastbone (sternum).

Cartilage is tough but flexible connective tissue found throughout the body, including in the joints between bones. It acts as a shock absorber, cushioning the joints.

The area of cartilage joining your ribs to your breastbone is known as the costochondral joint.

Costochondritis and Tietze’s syndrome

Costochondritis can sometimes be confused with a separate condition called Tietze’s syndrome, as it also involves inflammation of the costochondral joint and can cause very similar symptoms.

However, Tietze’s syndrome is much less common than costochondritis, and it tends to cause chest swelling in addition to the other symptoms, whereas costochondritis does not.

The rest of this topic focuses on costochondritis but, as the conditions are very similar, most of the information also applies to Tietze’s syndrome.

Signs and symptoms

When the costochondral joint becomes inflamed, it can result in sharp chest pain and tenderness.

The pain may be made worse by:

  • a particular posture, such as lying down
  • pressure on your chest, such as wearing a seatbelt or hugging someone
  • deep breathing, coughing and sneezing
  • physical activity

In cases of Tietze’s syndrome, there may also be some swelling.

These symptoms can develop gradually or start suddenly.

When to seek medical help

It can be difficult to tell the difference between the chest pain associated with costochondritis and pain caused by more serious conditions, such as a heart attack.

However, a heart attack usually causes more widespread pain and additional symptoms, such as breathlessness, nausea and sweating.

If you, or someone you are with, experiences sudden chest pain and you think there is a possibility it could be a heart attack, dial 999 immediately and ask for an ambulance.

If you have had chest pain for a while, don't ignore it. Make an appointment to see your GP so they can investigate the cause.

What causes costochondritis?

Inflammation is the body’s natural response to infection, irritation or injury. It is not known exactly why the costochondral joint becomes inflamed, but in some cases it has been linked to:

  • severe coughing, which strains your chest area
  • an injury to your chest
  • physical strain from repeated exercise or sudden exertion that you are not accustomed to, such as moving furniture
  • an infection  including respiratory tract infections (RTIs) and wound infections
  • wear and tear  your chest moves in and out 20 to 30 times a minute, and this motion can, over time, lead to discomfort in these joints

Costochondritis tends to be more common in adults over 40 years of age, whereas Tietze’s syndrome usually affect young adults under 40.

Diagnosing costochondritis

If you have symptoms of costochondritis, your GP will carry out a physical examination by looking at and touching the upper chest area around your costochondral joint. They will ask you when and where your pain occurs, and look at your recent medical history.

Before a diagnosis can be confirmed, some tests may need to be carried out to rule out other possible causes of your chest pain. These may include:

  • an electrocardiogram (ECG), which records the rhythms and electrical activity of your heart
  • blood test to check for signs of underlying inflammation
  • a chest X-ray

If no other condition is suspected or found, a diagnosis of costochondritis may be made. Tietze's syndrome may be diagnosed if you have swelling in your chest, in addition to your other symptoms.

Treating costochondritis

Costochondritis often gets better after a few weeks, but self-help measures and medication can manage the symptoms.

Self-help

Costochondritis can be aggravated by any activity that places stress on your chest area, such as strenuous exercise, or even simple movements like reaching up to a high cupboard.

Any activity that makes the pain in your chest area worse should be avoided until the inflammation in your ribs and cartilage has improved.

You may also find it soothing to regularly apply heat to the painful area – for example, using a cloth or flannel that has been warmed with hot water.

Painkillers

Painkillers, such as paracetamol can be used to ease mild to moderate pain.

Taking a type of medication called a non-steroidal anti-inflammatory drug (NSAID) - such as ibuprofen and naproxen  two or three times a day can also help control the pain and swelling. Aspirin, another type of NSAID, is also a suitable alternative.

These medications are available from pharmacies without a prescription, but you should make sure you carefully read the instructions that come with them before use.

NSAIDs are not suitable for people with certain health conditions, including asthma, stomach ulcers, high blood pressure, or kidney or heart problems. Children under 16 should not take aspirin.

Contact your GP if your symptoms get worse despite resting and taking painkillers, as you may benefit from treatment with corticosteroids. 

Corticosteroid injections

Corticosteroids are powerful medicines that can help to reduce pain and swelling. They can be injected into and around your costochondral joint to help relieve the symptoms of costochondritis.

Corticosteroid injections may be recommended if your pain is severe, or if NSAIDs are unsuitable or ineffective. They may be given by your GP, or you may need to be referred to a specialist called a rheumatologist.

Having too many corticosteroid injections can damage your costochondral joint, so you may only be able to have this type of treatment once every few months if you continue to experience pain.

Outlook

Costochondritis can improve on its own after a few weeks, although it sometimes last for several months or more.

The condition is not life-threatening and does not lead to any permanent problems.

In cases of Tietze's syndrome, you may still have some swelling after the pain and tenderness have gone.

Page last reviewed: 14/05/2014

Next review due: 14/05/2016

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The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

louky502 said on 27 September 2014

Ive been suffering from costo for almost 4 yrs, it flares up and aggrivates my bronchitis or vice versa if bronchitis comes on so does the costo. my pain involves chest tightness , short breath, aching in upper rib cages which in beginning started on left side now has spreaded straight across the whole bra area all way round in a circle. heating pad and if you can get someone to massage area that are tender which you will have very tender spots have someone massage areas affected is painful at time but it also helps relieve the pain. i also take ibuprofen. i used to take naproxen for awhile but started upsetting n bloating my stomach. All b4 this all started i did have pleuracy which was misdiagnosed for while which didnt get treated 6 to 8 wks then after that ive had flare ups with costo my doc said it can spread further thru my ribs over time it does even hurt my shoulder at times like muscle hurting.

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Mopsy_Essex said on 30 August 2014

Oh how depressing. I've had the clossic pain for a week and thought I'd look it up as I presumed it was a 'torn muscle' from lifting stuff last week - but 'why is it not getting better?' Looks like 'a few weeks' is normal and up to a year happens to some people.

Thank heavens for NSAIDs

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EENN said on 18 August 2014

c0n1fer - I have exactly the same symptoms as you - This all started about 8 years ago after a virus when i developed severe pain in my rib area. Now, whenever I suffer a trauma to this area I have the same problem, severe pain in the rib area. After a recent serious car accident it has got much worse - Sadly the NHS would not offer to do a scan after my accident or subsequently when visiting my GP, so I can only assume it is costochondtritus. Like you I wake up in pain all over my torso area and cannot bear to lie down on my front back or sides and have to wait for the pain to subside. A recent holiday and being knocked over by a wave has caused the pain to worsen again. I have given up trying to ask for a scan now. Maybe if I wanted cosmetic surgery on the NHS I might be more successful!

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c0n1fer said on 04 August 2014

i dont know why they say this usually goes away but can last up to 7 months, iv had this on and of for almost 4 years after having my daughter and its depressing me, i cant get out of bed in the morning because its the worst time for me the pain is so bad, i have to sit up in bed for about an hour before i can get up, then suffer with the bruising feeling all day in my rib cage, and wearing a bra is unbareable, my doctor didnt even know what it was and i suffered for 3 years with just pain killers that did not work she got fed uo with me constantly going to her i think she thought i was a hypocondriact, not sure how it is spelled sorry, but only recently the surgery got a new doctor and amazingly he knew about this after all the suffering i have been through with no help no wonder it made me depressed.

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