From the Guidelines
Costochondritis should be treated with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain, as most cases are readily diagnosed by physical examination without need for diagnostic imaging 1.
Diagnosis and Treatment
The condition is characterized by inflammation of the cartilage that connects the ribs to the breastbone, causing chest pain that can be alarming as it may mimic heart attack symptoms. According to the American College of Radiology, most (42%) nontraumatic musculoskeletal chest wall pain has been attributed to costochondritis 1.
Management
For management, applying heat or ice to the affected area for 15-20 minutes several times daily can help manage discomfort. Rest and avoiding activities that worsen the pain, particularly heavy lifting or intense physical exertion, are also recommended. If pain persists beyond 2 weeks or is severe, consulting a healthcare provider who might prescribe stronger anti-inflammatory medications or consider a local corticosteroid injection is advised. Physical therapy focusing on gentle stretching and posture improvement may also help 1.
Prognosis
Costochondritis typically resolves on its own within weeks to months, though some cases may recur. The condition occurs when the costal cartilage becomes inflamed due to physical strain, repetitive motion, respiratory infections, or sometimes without clear cause, leading to localized pain that worsens with deep breathing or movement. Given the high prevalence of musculoskeletal causes of chest pain, including costochondritis, a thorough physical examination and consideration of the patient's history are crucial for accurate diagnosis and effective treatment 1.
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 condition is characterized by tenderness in the affected chondrosternal joints of the chest wall, which can be elicited by palpation 2.
- Diagnosis is typically made through history and physical examination, with reproducible pain by palpation over the costal cartilages being a key indicator in children, adolescents, and young adults 2.
Treatment and Management of Costochondritis
- Traditional treatment involves the use of acetaminophen or anti-inflammatory medications, as well as advising patients to avoid activities that produce chest muscle overuse and providing reassurance 2.
- A case series study found that physical therapy (PT) utilizing an impairment-based examination and treatment approach, including manual therapy and therapeutic exercise, may facilitate the resolution of costochondritis 3.
- The study found that all subjects showed clinically meaningful changes at discharge, with significant decreases in pain and improvements in functional ability 3.
Special Considerations
- Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should undergo further testing, such as an electrocardiograph and possibly a chest radiograph, to rule out cardiac causes 2.
- Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation, highlighting the importance of careful diagnosis and consideration of potential cardiac causes 2.