Summary

Costochondritis is inflammation of the costochondral or costosternal joints, causing localised anterior chest wall pain. It is one of the most common causes of non-cardiac chest pain, accounting for 13-36% of emergency department chest pain presentations. The hallmark feature is reproducible tenderness on palpation of the affected costochondral junctions, most commonly the 2nd-5th ribs. Tietze syndrome is a related but distinct condition with visible/palpable swelling. Costochondritis is a diagnosis of exclusion - cardiac and pulmonary causes must be ruled out first. Treatment is reassurance and NSAIDs; it is self-limiting.

Key Facts

• Definition: Inflammation of costochondral/costosternal junctions
• Incidence: 13-36% of ED chest pain presentations
• Peak Age: 20-40 years
• Location: Most commonly 2nd-5th costochondral junctions (unilateral)
• Key Sign: Reproducible tenderness on palpation
• Tietze Syndrome: Costochondritis + Visible swelling (distinct entity)
• Treatment: Reassurance, NSAIDs; Self-limiting

Clinical Pearls

"Diagnosis of Exclusion": Costochondritis is benign, but chest pain is dangerous until proven otherwise. Always exclude cardiac, pulmonary, and aortic pathology first.

"Reproduce the Pain": The key to diagnosis is reproducing the patient's exact pain with palpation. If you can't reproduce it, think again.

"Tietze is Swollen, Costochondritis is Not": Tietze syndrome has visible/palpable swelling, usually affecting a single rib (2nd or 3rd). Classic costochondritis has no swelling.

"ECG First, Reassure Later": Even if you suspect costochondritis, always do an ECG in chest pain. It takes 2 minutes and could save a life.

Vital Signs

• Normal (if abnormal, consider alternative diagnosis)

Inspection

• Chest wall usually normal
• Look for swelling (if present = Tietze syndrome)
• No erythema typically

Palpation

Key Point: Reproduce the pain

Auscultation

• Heart sounds normal
• Lung sounds normal

Red Flag Features (Exclude)

Natural History

• Self-limiting in most cases
• Duration: Days to weeks (occasionally months)
• Recurrence possible

With Treatment

• Symptoms usually improve within 1-2 weeks
• Full resolution expected

Factors Affecting Prognosis

Key Guidelines

1. NICE CKS: Chest Pain
2. European Society of Cardiology: Chest Pain Guidelines

Key Evidence

Epidemiology

• Studies show 13-36% of ED chest pain is musculoskeletal
• Costochondritis most common MSK cause

Treatment

• Limited RCT evidence (benign, self-limiting)
• NSAIDs widely recommended based on clinical practice

What is Costochondritis?

Costochondritis is pain and tenderness where your ribs join the breastbone (sternum). It's caused by inflammation of the cartilage that connects these bones. It's a very common cause of chest pain and is NOT related to your heart.

What Causes It?

Often the cause is unknown. It can be triggered by:

• Strain from heavy lifting or exercise
• Severe coughing (e.g., after a cold)
• Minor injuries to the chest

Is it Serious?

No. Costochondritis is harmless and usually gets better on its own. However, chest pain can have serious causes, so it's important to see a doctor to rule out heart or lung problems.

How Do I Know It's Costochondritis?

Your doctor will press on your chest and if this reproduces your pain exactly, it's likely costochondritis. They may do an ECG and blood tests just to be sure it's not your heart.

How is it Treated?

• Reassurance: Knowing it's not your heart often helps!
• Anti-inflammatory painkillers: Ibuprofen or naproxen for 1-2 weeks
• Heat or ice packs: Applied to the sore area
• Avoid aggravating activities: Until it settles

How Long Does it Last?

Most people feel better within 1-2 weeks. Sometimes it takes a few months. It may come back occasionally but this is not dangerous.

When to Seek Help

See a doctor urgently if you have:

• Crushing chest pain, especially with exertion
• Pain spreading to arm, jaw, or back
• Shortness of breath
• Feeling faint or sweaty with chest pain
• Fever