Costochondritis - Treatment, Symptoms, Causes, Diagnosis
What is Costochondritis?
Costochondritis is a benign and a temporary cause of chest pain which is generally harmless. It is a condition characterized by the inflammation of the costal joint or the cartilage that connects the rib to the breastbone or the sternum.
Costochondritis is marked by a localized pain in the chest wall accompanied with tenderness when putting a pressure on the affected part of the rib cage. It is a harmless condition also referred to as costosternal syndrome, chest wall pain or costosternal chondrodynia. Costochondritis is the most common cause of chest pain among children including adolescents and is prevalent in girls. It is generally a self-limited condition although persistent symptom is often experienced. The condition affects children and young adults between the age of 10 to 21 years and the peak onset is 12 to 14 years of age.
Although relatively harmless and self-limited condition, the pain caused by Costochondritis is alarming as the pain can mimic the chest pain of a heart attack. Costochondritis is an inflammation that involves the costal joint and the sternum. The costal joint is the cartilage that attaches the rib cage to the sternum while the sternum is the hard bone that runs down the center of the chest running from the base of the neck down to the apex of the abdomen.
Costochondritis is a temporary and self-limited inflammation of the costal joint marked by a tenderness that can be reproduced when a pressure is put on the affected site of the rib cage particularly the costochondral junction. This is the attribute of Costochondritis that the absence of tenderness upon pressure is unlikely a diagnosis of Costochondritis. The pain and tenderness usually felt on the sides of the sternum or can be felt on multiple ribs upon palpation. The pain or tenderness can be aggravated with deep breathing, coughing and with slight physical activity.
The pain in Costochondritis can be defined as sharp or nagging and which is usually localized although the pain can radiate to the abdomen or at the back causing belly pain or back pain. The fourth, fifth and sixth ribs are the usual site of inflammation and pain causing significant difficulty in breathing as the pain can be aggravated with slight movement and pressure. Diminished movement and slow breathing are usually noted in patients due to pain and tenderness. The pain is usually lessened with decreased movement, a slow breathing and a change in position.
Redness or swelling usually accompany the inflammation site if Costochondritis is due to infection or post surgery with pus discharge that may occur and seen on the incision site.
Anxiety is sometimes seen in patient not only due to the sharp or nagging pain in the chest but also because of a misconception of a heart attack. Costochondritis is an inflammation that usually affects children and young adults and heart attack is uncommon in this age group. General discomfort is also noted due to limited movement and slow breathing in an effort to prevent aggravating the chest pain.
Costochondritis is an inflammatory process that has no definite etiology. The condition involves the costosternal joints that often result in a localized inflammation. It can affect any of the 7 costochondral junction or may affect more than one site. The chest pain caused by the inflammation of the costochondral joints usually lasts for a week or more or it can persist for a few months.
Various factors have been considered to the onset of chest pain brought by Costochondritis and these include the following:
Physical strain from strenuous activities such as rigid exercise, lifting of heavy weights and exertion from a severe bout and persistent coughing are being linked to the onset of Costochondritis. A direct blow to the chest is also considered to result to chest pain and inflammation of the costochondral joints.
Infection from different pathogens is occasionally implicated to Costochondritis. Individuals who underwent surgery of the upper chest are at risk for Costochondritis usually from a bacterial infection. Costochondritis is also being linked to viral infection often due to viral respiratory infection directly inflaming the costochondral junctions or may also be due to a strain from bouts of coughing brought by the infection. Fungal infection is also considered although it rarely causes Costochondritis. Tuberculosis patient may also be seen with Costochondritis often as a result of infection involving the rib joint.
Other inflammatory disease can also result to Costochondritis such as:
Ankylosing spondylitis is a chronic inflammation of the spine and the sacroiliac joints which can also cause Costochondritis often as a complication.
Rheumatoid arthritis is an autoimmune disease marked by a chronic inflammation of various joints and tissues of the body. The chronic inflammation can also involve the costochondral joint thus Costochondritis.
Surgical procedure on the upper chest can also result to Costochondritis often due to incision in tissues involved in the procedure. Possible inflammation post surgery may also occur as a result of infection from the incision site or the operative site which can affect the costochondral joint leading to its inflammation.
Costochondritis is usually diagnosed through physical examination and taking the medical history of the patient. Laboratory tests and imaging tests are usually insignificant to Costochondritis although the tests are usually recommended to rule out other conditions with similar symptoms to Costochondritis. Individuals who previously underwent surgery of the upper chest and those predisposed to heart disease on the other hand are recommended for series of diagnostic procedure to evaluate for infection and other heart problem that may be causing Costochondritis.
Costochondritis however, is marked by a reproducible pain or tenderness upon palpation or application of pressure on the affected site of the rib cage. The absence of reproducible pain and tenderness therefore rules out Costochondritis and patient may be recommended for further test to determine the cause of chest pain.
Costochondritis is a temporary inflammation involving the costochondral joints that usually resolves on its own. Treatment is indicated for those suffering from Costochondritis for a long period of time and the focus is in relief of pain and directed towards the underlying condition resulting to Costochondritis.
Over-the-counter pain relievers may be given while an unresponsive patient may be given with medications such as:
- Nonsteroidal anti-inflammatory drugs
- Narcotics although prescribed with necessary precaution as the drug can be habit forming.
- Anti-seizure drugs are found to be beneficial in controlling chronic pain and can be prescribed for Costochondritis.
Costochondritis patients are usually advised against engaging in strenuous physical activities until full recovery. Normal activities as tolerated are recommended for patients following improvement and full recovery. A complete rest is also necessary during the process of Costochondritis to hasten recovery and help improve the symptoms.