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Costochondritis

Chest Pain: Is It Costochondritis?

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD

Could costochondritis be causing your chest and shoulder pain?Pain in the chest wall around the breastbone (or sternum) is the most characteristic feature of the condition known as costochondritis. Medically, the term chondritis refers to inflammation of any cartilage in the body. Costochondritis refers specifically to inflammation of the cartilage that joins the ribs to the breastbone (called costal cartilages). The chest pain of costochondritis sometimes is severe.

Costochondritis usually, but not always, involves one side of the breastbone. Sometimes the pain can extend to the shoulder or arm on the involved side. When costochondritis is accompanied by swelling of the areas surrounding the cartilage, the condition is called Tietze syndrome. In Tietze syndrome, the swollen area of the inflamed cartilage may be tender to the touch, and the skin overlying the cartilage may be reddened.

Costochondritis is most common in people between 20 and 40 years of age. In most cases, doctors do not know why the condition develops. Trauma to the chest wall may lead to costochondritis, and it also is believed that viral infections, particularly upper respiratory infections, may cause costochondritis. The condition also can occur as a feature of more generalized diseases of inflammation such as certain forms of arthritis, fibromyalgia, and inflammatory bowel disease.

Costochondritis Overview

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone or sternum. The condition causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is a relatively harmless condition and usually goes away without treatment. The cause is usually unknown.

  • Costochondritis (with unknown cause) is a common cause of chest pain in children and adolescents. It accounts for 10-30% of all chest pain in children. Annually, doctors evaluate about 650,000 cases of chest pain in young people 10-21 years of age. The peak age for the condition is 12-14 years.

  • Costochondritis is also considered as a possible diagnosis for adults who have chest pain. Chest pain in adults is considered a potentially serious sign of a heart problem by most doctors until proven otherwise. Chest pain in adults usually leads to a battery of tests to rule out heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor will diagnose costochondritis as the cause of your chest pain. It is important, however, for adults with chest pain to be examined and tested for heart disease before being diagnosed with costochondritis. Often it is difficult to distinguish between the two without further testing. The condition affects females more than males (70% versus 30%). Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.

  • Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by noting the following:

    • Tietze syndrome usually comes on abruptly, with chest pain radiating to your arms or shoulder and lasting several weeks. Tietze syndrome is accompanied by a localized swelling at the painful area (the junction of the ribs and breastbone).


Next: Costochondritis Causes »

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Costochondritis »

In contrast to myocardial ischemia or infarction, costochondritis is a benign cause of chest pain and is an important consideration in the differential diagnosis.

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