What are the causes of costochondritis?

Causes of Costochondritis

Costochondritis is primarily caused by musculoskeletal factors including physical exertion, repetitive movements, and severe coughing, with other potential causes including inflammatory conditions, infections, and connective tissue disorders. 1

Primary Causes

Musculoskeletal Factors

• Physical exertion and repetitive movements (especially lifting heavy objects) 2
• Severe coughing episodes 2
• Chest muscle overuse 3
• Rib dysfunction requiring manipulation 4

Inflammatory Conditions

• Non-infectious inflammation of the costochondral junctions 1
• Inflammatory processes affecting cartilage and connective tissues 5

Systemic Conditions

• Axial spondyloarthritis (affects 30-60% of patients with this condition) 1
• May be the first manifestation of spondyloarthritis in 4-6% of patients 1
• Relapsing polychondritis (characterized by recurrent inflammation and destruction of cartilage) 5
• Rheumatoid arthritis (found in a small percentage of costochondritis patients) 6
• Osteoarthritis (found in a small percentage of costochondritis patients) 6

Less Common Causes

Infectious Etiologies

• Infectious costochondritis (usually develops when infection spreads from adjacent tissues) 2
• Post-surgical chest wall infections 1
• Bacterial infections (such as Pseudomonas aeruginosa in rare cases) 2

Post-Surgical

• Poststernotomy pain after cardiac surgery 1
• Surgical site complications 1

Risk Factors

Demographic Factors

• More common in women (69% of costochondritis patients in one study) 6
• Higher frequency among Hispanic populations (47% vs 24% in control group) 6

Medical Conditions

• Diabetes mellitus (risk factor for infectious costochondritis) 2
• Fibromyalgia (associated with costochondritis in a minority of cases - 8%) 6
• Widespread pain syndromes (more common in costochondritis patients - 42% vs 5% in controls) 6

Clinical Considerations

Diagnosis

• Costochondritis is often a diagnosis of exclusion 4
• Careful differentiation from cardiac causes is essential, as 3-6% of adult patients with chest wall tenderness may have underlying coronary artery disease 3
• Diagnosis primarily based on physical examination findings of reproducible pain with palpation over costal cartilages 3

Natural History

• Usually self-limiting but can become chronic (atypical costochondritis) 4
• About 55% of patients may still have chest pain one year after initial diagnosis, though only one-third will still have definite costochondritis 6

Treatment Implications

• Understanding the underlying cause helps guide appropriate treatment:
  • Non-infectious cases typically respond to NSAIDs 2
  • Infectious cases require appropriate antibiotics and possibly surgical debridement 2
  • Musculoskeletal causes may benefit from physical therapy interventions 4
  • Systemic inflammatory conditions may require immunosuppressive therapy 5

Key Pitfalls to Avoid

• Failing to rule out serious cardiac causes of chest pain, especially in patients over 35 or with cardiac risk factors 3
• Misdiagnosing infectious costochondritis as simple non-infectious inflammation 2
• Overlooking systemic inflammatory conditions that may present with costochondritis as an initial manifestation 1, 5
• Assuming all costochondritis is self-limiting, as some cases can become chronic and debilitating 4