What are the typical presentations of costochondritis (inflammation of the cartilage that connects the ribs to the breastbone)?

From the Guidelines

Costochondritis typically presents as sharp, stabbing, or aching pain in the chest wall, specifically at the junction where the ribs connect to the breastbone (sternum), with the second to fifth costochondral junctions being most commonly affected, as described in the study by 1. The pain is usually localized to the front of the chest and may worsen with deep breathing, coughing, physical activity, or certain movements that stretch the chest wall. Patients may experience tenderness when pressure is applied to the affected area. Unlike cardiac chest pain, costochondritis pain typically changes with position or breathing and can be reproduced by palpation of the affected joints. The condition is generally self-limiting and benign, though it can mimic more serious conditions like heart attacks. Diagnosis is primarily clinical, based on the characteristic pain pattern and tenderness on examination, with the absence of other concerning symptoms like fever, shortness of breath, or abnormal vital signs, as noted in the study by 1. Some key characteristics of costochondritis include:

• Sharp, stabbing, or aching pain in the chest wall
• Pain localized to the front of the chest
• Worsening of pain with deep breathing, coughing, or physical activity
• Tenderness to pressure on the affected area
• Pain that changes with position or breathing
• Reproducible pain with palpation of the affected joints It's worth noting that while the study by 1 discusses breast pain, it also mentions costochondritis as a potential cause of chest wall pain, highlighting the importance of considering this condition in the differential diagnosis of chest pain. However, the most relevant and recent information on costochondritis is provided by the study by 1, which focuses on nontraumatic chest wall pain and provides guidance on the evaluation and management of this condition. Based on the most recent and highest quality evidence, costochondritis should be considered in the differential diagnosis of chest pain, particularly when the pain is localized to the chest wall and worsens with movement or deep breathing, as described in the study by 1.

From the Research

Typical Presentations of Costochondritis

The typical presentations of costochondritis include:

• Non-cardiac chest pain, often described as sharp or aching, which can be reproduced by palpation over the costal cartilages 2, 3
• Tenderness to palpation over the affected chondrosternal joints of the chest wall 3
• Spontaneous vague pain in the anterior chest area, often occurring in adolescents for unknown reasons 4
• Chest wall pain that can be widespread, with 42% of patients experiencing widespread pain 5
• Pain that can be intermittent or constant, with some patients experiencing pain that resolves on its own within a couple of weeks 2

Demographic Characteristics

Costochondritis can affect anyone, but it is more common in:

• Women, who make up 69% of patients with costochondritis 5
• Hispanics, who account for 47% of patients with costochondritis 5
• Young adults, with a higher frequency of costochondritis in this age group 3

Associated Conditions

Costochondritis can be associated with other conditions, including:

• Fibromyalgia, which is present in a minority of cases 5
• Rheumatoid arthritis and osteoarthritis, which can be diagnosed in some patients with costochondritis 5
• Tuberculosis, which can cause tubercular costochondritis, a rare form of extrapulmonary tuberculosis that affects the ribs 6