What is the treatment for costochondritis?

Treatment of Costochondritis

The first-line treatment for costochondritis is a 1-2 week course of NSAIDs to address the inflammatory component of this condition, combined with non-pharmacological measures such as local application of heat or ice. 1, 2

Diagnosis Confirmation

• Costochondritis is characterized by tenderness to palpation of the costochondral joints, which is the hallmark physical finding 2
• Pain is typically reproducible with palpation of the affected costochondral joints and is commonly retrosternal (52%) or left-sided (69.2%) 2
• For patients older than 35 years or with cardiac risk factors, an ECG should be obtained to rule out cardiac causes 1
• Chest radiography may be useful as an initial imaging test to evaluate for specific etiologies that may simulate chest wall pain 1

Pharmacological Management

First-line Treatment

• NSAIDs for 1-2 weeks for pleuritic-type pain or when there is an underlying inflammatory component 2
• Acetaminophen can be used as an alternative if NSAIDs are contraindicated 2

Second-line Treatment

• Low-dose colchicine may be added if symptoms persist despite NSAID therapy 2
• Topical analgesics like lidocaine patches may provide localized pain relief with minimal systemic effects 2

Non-Pharmacological Approaches

• Local application of heat or ice can be used in conjunction with drug therapy 2
• Stretching exercises have shown significant improvement in pain compared to control groups in patients with costochondritis 3
• Avoiding activities that produce chest muscle overuse is recommended 4
• Manipulative therapy and instrument-assisted soft tissue mobilization may be beneficial in cases of atypical costochondritis that doesn't respond to conventional treatment 5

Treatment Algorithm

1. Initial Treatment:

   • NSAIDs for 1-2 weeks (e.g., ibuprofen or naproxen) 2
   • Local application of heat or ice 2
   • Activity modification to avoid chest wall strain 4

2. If Inadequate Response:

   • Consider adding low-dose colchicine 2
   • Consider topical analgesics like lidocaine patches 2
   • Implement stretching exercises targeting the chest wall 3

3. For Persistent Cases (Atypical Costochondritis):

   • Consider referral for physical therapy with focus on manipulative therapy and soft tissue mobilization 5
   • Reassessment to rule out other potential causes of persistent pain 2

Special Considerations

• Distinguish costochondritis from Tietze syndrome, which involves visible swelling of the affected costochondral junction 1
• Be aware that anterior chest wall pain may be the first manifestation of axial spondyloarthritis in some patients 1
• Infectious costochondritis is rare but should be considered in cases with purulent discharge, fever, or other signs of infection, requiring antibiotic treatment and possibly surgical debridement 6
• In patients with costochondritis who remain symptomatic after treatment, further evaluation with history, physical examination, radiographs, and/or MRI may be necessary to assess healing 7

Monitoring and Follow-up

• Most cases of costochondritis are self-limiting and benign, resolving within a few weeks with appropriate treatment 4
• For persistent symptoms, reassessment is recommended to rule out other potential causes of chest pain 2
• Patients should be reassured about the benign nature of the condition once serious causes have been ruled out 4