Costochondritis

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
• a 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.