What are the symptoms of costochondritis?

Symptoms of Costochondritis

Costochondritis is primarily characterized by chest pain associated with inflammation of the ribs and/or cartilages, specifically at the costochondral junctions where ribs connect to the sternum. 1

Primary Symptoms

• Chest pain - The hallmark symptom, typically described as:

  • Sharp, stinging (53%) or pressing (35.1%) in quality 2
  • Located at the costochondral junctions, commonly retrosternal (52%) or left-sided (69.2%) 2
  • Reproducible with palpation of the affected costochondral joints 1, 2
  • May worsen with deep breathing, coughing, or physical activity 3

• Tenderness - Focal tenderness at the costochondral junctions that can be elicited during physical examination 1

Pain Characteristics

• Occurs more than once daily in many patients (62.9%) 2
• Often becomes chronic, with many patients experiencing symptoms for >6 months (55.4%) 2
• May be exacerbated by certain movements or positions 4
• Usually affects multiple ribs, most commonly ribs 2-5 3

Associated Features

• Generally no associated systemic symptoms (absence of fever distinguishes from infectious causes) 1, 5
• No redness or swelling in typical cases (presence would suggest infectious costochondritis) 6
• Normal laboratory values and imaging studies 4

Differential Diagnosis Considerations

• Musculoskeletal chest pain is the most common cause of non-cardiac chest pain, with costochondritis accounting for 42% of these cases 2
• Must be distinguished from more serious causes of chest pain such as:
  • Cardiac conditions (acute coronary syndrome) 1
  • Pulmonary conditions (pulmonary embolism, pneumonia) 1, 5
  • Gastrointestinal conditions (esophageal rupture) 1
  • Infectious costochondritis (which presents with purulent drainage, fever, and elevated inflammatory markers) 6

Special Populations

• In children and adolescents, costochondritis is a common cause of chest pain and typically follows a benign course 5
• May be associated with axial spondyloarthritis in some patients 2
• Athletes may develop costochondritis due to repetitive movements or physical exertion 7

Clinical Course

• Usually self-limiting with symptoms resolving within weeks to months 3
• When symptoms persist beyond the expected timeframe, it is referred to as atypical costochondritis 4
• Chronic cases may significantly impact quality of life and physical activity 7

Remember that costochondritis is primarily a diagnosis of exclusion, and serious causes of chest pain should be ruled out before confirming this diagnosis, particularly in patients over 35 years of age or those with risk factors for coronary artery disease 3.