Costochondritis
(Tietze’s Syndrome)
Definition:
Costochondritis is a localized pain in the anterior (front) chest wall.
Occurring in patients of any age, costochondritis merely means pain at the junction of the bony and cartilaginous parts of a rib—usually the second, third, fourth, or fifth rib—that is highly localized. Sometimes, but not always, there is accompanying swelling and inflammation, a condition preferably referred to as Tietze’s syndrome. Neither costochondritis nor Tietze’s syndrome is a serious disease, but their symptoms mimic those of several dangerous conditions.
Causes:
There is no known specific cause, but several types of arthritis may affect the costochondral joints.
Risk Factors:
The following factors increase your chances of developing costochondritis. If you have any of these risk factors, tell your doctor:
- Rheumatoid arthritis
- Ankylosing spondylitis
- Reiter’s syndrome
Symptoms:
If you experience any of these symptoms do not assume it is due to costochondritis. These symptoms may be caused by other, serious health conditions such as a heart attack, digestive problems, and cancers that invade the bone. If you experience any one of them, see your physician.
- Sharp, localized anterior chest pain, possibly radiating to the arm or shoulder and possibly aggravated by sneezing, coughing, deep breathing, or twisting motions of the chest
- Tenderness or swelling over a costochondral joint (located on each rib1-2 inches on either side of the breast bone)
Diagnosis:
Your doctor will ask about your symptoms and medical history, and perform a physical exam. If the diagnosis is in doubt, tests to examine the ribs more closely and to rule out other conditions may include the following:
- Chest x-ray
- EKG to evaluate the heart
- Endoscopy or contrast x-rays of the esophagus and stomach to look for digestive diseases
- Bone scan to look for cancer in the bones (generally not useful because it is non-specific)
Treatment:
Talk with your doctor about the best treatment plan for you. Once the diagnosis is confirmed and no serious condition is found, treatment is optional. Treatment choices include the following:
- Hot or cold compresses– Often thermal treatments will provide satisfactory relief until the condition resolves itself.
- Over-the-counter analgesics–Aspirin, acetaminophen (Tylenol), ibuprofen (Motrin), naproxen (Alleve).
- Cortisone injections– An injection of local anesthetic and cortisone directly into the sore joint often relieves the pain.
- Intercostal nerve block– Very rarely the pain is sufficiently intense and prolonged to require numbing the area with a nerve block.
Prevention:
Costochondritis occurs spontaneously at any age, usually without warning or identified causes. There is no way to prevent it.
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