Does applying pressure to the rib cage alleviate pain during inhalation in patients with costochondritis?

Pain Characteristics in Costochondritis During Breathing

In costochondritis, applying pressure to the rib cage typically causes pain to worsen rather than improve during inhalation.

Diagnostic Features of Costochondritis

• Costochondritis is characterized by tenderness to palpation of the costochondral joints, which is the hallmark physical finding 1
• Pain is typically reproducible with palpation of the affected costochondral joints 1
• The pain in costochondritis is often described as stinging (53%) or pressing (35.1%), and is commonly retrosternal (52%) or left-sided (69.2%) 1
• When examining a patient with suspected costochondritis, careful examination should focus on specific costochondral junctions, particularly ribs 6 and 7 if those areas are painful 1

Pain Behavior During Breathing

• When pressure is applied to inflamed costochondral junctions during inhalation, the pain typically worsens rather than improves 2
• This occurs because inhalation causes expansion of the rib cage, which increases tension on the already inflamed costochondral junctions 2
• The mechanical stress from breathing creates additional strain on the inflamed tissue, exacerbating pain when combined with external pressure 2

Clinical Examination Techniques

• During examination, reproducible pain with palpation over the costal cartilages is usually sufficient to make the diagnosis in most patients 2
• The examiner should apply gentle but firm pressure to the costochondral junctions while asking the patient to breathe normally, then deeply 1, 2
• An increase in pain during deep inspiration while pressure is maintained is consistent with costochondritis 2
• This differs from pleuritic pain, which worsens with breathing regardless of external pressure 3

Differential Considerations

• It's important to distinguish costochondritis from other causes of chest pain, as coronary artery disease can be present in 3-6% of adult patients with chest wall tenderness 2
• Patients older than 35 years or with risk factors for coronary disease should have appropriate cardiac evaluation even if costochondritis is suspected 2
• Musculoskeletal chest pain accounts for approximately 42% of nontraumatic chest wall pain, with costochondritis being the most common cause 1
• Pleuritic pain, which is sharp and worsens with breathing regardless of palpation, suggests a respiratory rather than musculoskeletal etiology 3

Treatment Approaches

• NSAIDs are typically recommended as first-line treatment for the inflammatory component of costochondritis 1
• Local application of heat or ice can be used as adjunctive therapy 1
• Stretching exercises have shown promising results in reducing pain associated with costochondritis 4
• For persistent cases, low-dose colchicine may be considered if symptoms persist despite NSAID therapy 1

By understanding the typical pain response during examination, clinicians can more accurately diagnose costochondritis and distinguish it from other serious causes of chest pain.