Treatment for Costochondritis
For patients with costochondritis, a 1-2 week trial of nonsteroidal anti-inflammatory drugs (NSAIDs) is the first-line treatment, with the addition of low-dose colchicine as needed. 1
First-Line Treatment Options
Pharmacological Management
- NSAIDs: First-line therapy for 1-2 weeks 1, 2
- Options include ibuprofen, naproxen, or diclofenac
- Use the lowest effective dose for the shortest duration to minimize side effects
- Consider GI risk factors when selecting specific NSAID
- Acetaminophen/Paracetamol: Alternative for those who cannot tolerate NSAIDs 2
- Dosing up to 3g/day, adjusted based on age and comorbidities
- Colchicine: Can be added to NSAIDs for persistent inflammatory symptoms 1
Non-Pharmacological Approaches
- Activity Modification: Avoid activities that exacerbate symptoms 2
- Limit heavy lifting, pushing, or pulling
- Avoid repetitive movements that stress the costochondral junctions
- Local Heat Application: May provide symptomatic relief 2
- Stretching Exercises: Progressive stretching of chest muscles has shown significant improvement in pain compared to conventional treatment alone 3
- Focus on pectoral muscles and thoracic mobility
- Can be particularly helpful for persistent symptoms
Second-Line Treatment Options
For patients with persistent symptoms despite first-line treatment:
Physical Therapy: Consider referral for specialized stretching and mobilization techniques 4
- Instrument-assisted soft tissue mobilization
- Rib manipulation techniques
- Manual therapy targeting thoracic spine and ribs
Local Injections: For refractory cases, though evidence is limited
- Local anesthetic or corticosteroid injections may be considered
Special Considerations
Differential Diagnosis
Before confirming costochondritis, rule out serious causes of chest pain:
- Cardiac causes (especially in patients >35 years or with cardiac risk factors) 2
- Pulmonary conditions
- Gastrointestinal disorders
Diagnostic Approach
- Diagnosis is primarily clinical, based on reproducible tenderness over costochondral junctions 2
- For patients >35 years or with cardiac risk factors:
- Obtain ECG
- Consider chest radiograph
- Further cardiac testing may be warranted based on risk profile
Infectious Costochondritis
- Rare but serious variant requiring different management 5
- Suspect if:
- Fever is present
- Purulent drainage
- Systemic symptoms
- Treatment involves antibiotics and possibly surgical debridement
Monitoring and Follow-up
- Most cases resolve within weeks with appropriate treatment
- If symptoms persist beyond 2-3 weeks despite treatment:
- Reassess diagnosis
- Consider additional imaging
- Evaluate for atypical costochondritis 4
Prognosis
- Costochondritis is typically self-limiting and benign 2
- Most patients respond well to conservative management
- Chronic cases may benefit from multimodal approaches including physical therapy and stretching exercises 4, 3
Remember that costochondritis is often a diagnosis of exclusion, particularly in older adults or those with risk factors for cardiac disease. Ensure appropriate cardiac evaluation has been completed before attributing chest pain solely to costochondritis.