What is the diagnosis and treatment for Costochondritis (Inflammation of the cartilage that connects the ribs to the sternum)?

From the Guidelines

Costochondritis should be treated with a combination of rest, over-the-counter pain relievers, and heat or ice therapy, with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen being the first line of treatment, as recommended by the most recent study 1. For patients with costochondritis, the goal is to reduce inflammation and pain, and improve quality of life. The condition is generally not serious, but it's essential to evaluate the patient to rule out other conditions, especially if pain is severe or accompanied by other symptoms. Some key points to consider in the treatment of costochondritis include:

• Taking NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) for up to 10 days to reduce inflammation and pain, as suggested by 1.
• Applying a heating pad or ice pack to the affected area for 15-20 minutes several times daily to help reduce pain and inflammation.
• Resting and avoiding activities that worsen the pain, particularly heavy lifting or intense physical exercise.
• Considering prescription-strength NSAIDs or, rarely, corticosteroid injections if the pain is severe or persistent, under medical supervision.
• Gentle stretching exercises for the chest muscles can help once acute pain subsides, as mentioned in 1. It's also important to note that costochondritis typically resolves on its own within weeks to months, with symptoms gradually improving, as stated in 1. However, if the pain is severe or persistent, it's crucial to seek medical attention to rule out other conditions.

From the Research

Definition and Diagnosis of Costochondritis

• Costochondritis is an inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, as stated in the study 2.
• The diagnosis of costochondritis can be made by history and physical examination, with palpation of the affected chondrosternal joints eliciting tenderness 2.
• Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph to rule out other causes of chest pain 2.

Epidemiology and Demographics

• Costochondritis is a common condition, with a higher frequency among women and Hispanics, as found in the study 3.
• The study 3 also reported that 69% of patients with costochondritis were women, and 47% were Hispanics.
• Widespread pain was more common in the costochondritis group (42% vs 5%) compared to the control group 3.

Treatment and Management

• Traditional practice is to treat costochondritis with acetaminophen or anti-inflammatory medications, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance 2.
• The study 4 found that early diagnosis and management of costochondritis can reduce acute chest pain admissions, and that sulfasalazine may be of additional long-term benefit in recurrent cases.
• The use of COX-2 inhibitors, such as celecoxib, has been found to increase the risk of myocardial infarction and death, and should be used with caution and at the lowest effective dosage 5.

Prognosis and Outcome

• The study 3 reported that 55% of patients with costochondritis were still suffering from chest pain one year later, but only one third still had definite costochondritis.
• The study 4 found that early diagnosis and treatment of costochondritis can reduce admission and investigation rates, and improve patient care.