Symptoms of Costochondritis
Costochondritis is characterized by musculoskeletal chest pain associated with inflammation of one or more ribs and/or cartilages, with the hallmark physical finding being tenderness to palpation of the affected costochondral joints. 1
Primary Symptoms
- Pain is typically described as stinging (53%) or pressing (35.1%), and is commonly retrosternal (52%) or left-sided (69.2%) 2
- Symptoms often occur more than once daily (62.9%), with many patients experiencing chronic symptoms lasting >6 months (55.4%) 2
- Pain is reproducible with palpation of the affected costochondral joints 2
- Tenderness over the costochondral junctions is the hallmark physical finding 1
Pain Characteristics
- Pain may be localized at the tip of one finger, particularly over a costochondral junction 3
- Pain is typically reproduced with movement or palpation of the chest wall 3
- Pain may be exacerbated by physical exertion, repetitive movements (such as lifting heavy objects), and severe coughing 4
Clinical Course
- Costochondritis is usually self-limited and benign, though symptoms can persist 5
- Most nontraumatic musculoskeletal chest wall pain (42%) is attributed to costochondritis 2
- When symptoms persist beyond the typical self-limiting course, it may be referred to as atypical costochondritis 6
Distinguishing Features from Cardiac Chest Pain
Costochondritis pain differs from cardiac pain in several important ways:
- Pain is reproducible with palpation of the chest wall 3
- Pain may be sharp or stabbing rather than the pressure-like sensation of cardiac pain 3
- Pain may be pleuritic (worsened by respiratory movements or cough) 3
Important Differential Considerations
- Tietze syndrome, which involves localized inflammation of at least one joint between the rib and costal cartilage, often with visible swelling (unlike costochondritis, which typically does not have visible swelling) 1
- Slipping rib syndrome, characterized by pain associated with ribs subluxing from the joint 1
- Infectious costochondritis, which is rare but can occur when an infection spreads to the costal cartilage 4
Clinical Pitfalls
- Coronary artery disease is present in 3-6% of adult patients with chest pain and chest wall tenderness to palpation, making it important to rule out cardiac causes in at-risk patients 5
- Patients older than 35 years or with cardiac risk factors should have an ECG to rule out cardiac causes 1, 5
- Anterior chest wall pain can be the first manifestation of axial spondyloarthritis in some patients 1, 2
- Costochondritis is often a diagnosis of exclusion after ruling out more serious causes of chest pain 6