What is the cause of chest pain between the rib and sternum, also known as costosternal (costo-sternal) pain?

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Differential Diagnosis for Pain between Rib and Sternum

Single Most Likely Diagnosis

  • Costochondritis: This is the most common cause of pain between the rib and sternum, characterized by inflammation of the cartilage that connects the ribs to the sternum. It is often caused by strain or overuse and can be exacerbated by activities that involve heavy lifting, bending, or exercise.

Other Likely Diagnoses

  • Musculoskeletal strain: Strain or pull of the muscles between the ribs and sternum can cause pain in this area, often due to overexertion, poor posture, or direct trauma.
  • Rib fracture: A fracture of one of the ribs can cause pain between the rib and sternum, especially if the fracture is near the sternum.
  • Gastroesophageal reflux disease (GERD): GERD can cause pain in the chest, including between the ribs and sternum, due to stomach acid flowing up into the esophagus.

Do Not Miss Diagnoses

  • Myocardial infarction (heart attack): Although less common, pain between the ribs and sternum can be a symptom of a heart attack, especially if it is accompanied by other symptoms such as shortness of breath, dizziness, or pain radiating to the arm or jaw.
  • Pulmonary embolism: A blood clot in the lungs can cause sudden, severe pain between the ribs and sternum, often accompanied by shortness of breath, cough, or fainting.
  • Aortic dissection: A tear in the aorta can cause severe, tearing pain between the ribs and sternum, often radiating to the back.

Rare Diagnoses

  • Tietze's syndrome: A rare inflammatory condition that affects the cartilage of the ribs, causing pain and swelling between the ribs and sternum.
  • Sickle cell crisis: In people with sickle cell disease, a crisis can cause pain between the ribs and sternum due to sickling of red blood cells in the chest.
  • Thoracic outlet syndrome: Compression of the nerves or blood vessels between the ribs and sternum can cause pain, numbness, or tingling in the chest, arm, or hand.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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