What Causes Costochondritis
Costochondritis is primarily caused by inflammation of the costochondral junctions or chondrosternal joints, though the exact etiology is often idiopathic; common precipitating factors include physical exertion, repetitive movements (such as heavy lifting), severe coughing, and trauma to the chest wall. 1, 2, 3
Primary Etiologic Mechanisms
Mechanical and Inflammatory Causes
- Physical overuse and repetitive strain represent the most common identifiable triggers, including activities involving chest muscle overuse, heavy lifting, and repetitive upper body movements 2, 3
- Severe or persistent coughing can precipitate costochondritis by placing repetitive stress on the costochondral junctions 3
- The condition fundamentally represents inflammation of the costochondral junctions or chondrosternal joints of the anterior chest wall, accounting for approximately 42% of all nontraumatic musculoskeletal chest wall pain 1
Infectious Causes (Rare)
- Infectious costochondritis is uncommon but can occur when infection spreads directly from postoperative wounds or adjacent foci 3
- Bacterial pathogens such as Pseudomonas aeruginosa have been documented in cases of infectious costochondritis with associated sternal osteomyelitis 3
- Tubercular costochondritis is extremely rare, representing an atypical presentation of extrapulmonary tuberculosis affecting the ribs, particularly in immunocompromised patients such as those with diabetes 4
Associated Conditions and Risk Factors
Systemic Inflammatory Diseases
- Axial spondyloarthritis can manifest with anterior chest wall pain, and costochondritis may be the first presentation of disease in some patients 1, 5
- SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis), a chronic relapsing condition often involving the sternoclavicular joints, should be considered in the differential 1
Important Clinical Pitfall
- While costochondritis itself is typically self-limited and benign, coronary artery disease is present in 3-6% of adult patients presenting with chest pain and chest wall tenderness to palpation 2
- This underscores the critical importance of ruling out cardiac causes, particularly in patients older than 35 years or those with cardiac risk factors, who should receive an ECG 1, 2
Distinguishing Features from Related Conditions
- Tietze syndrome differs from costochondritis by involving localized inflammation with visible swelling at the costochondral junction, whereas costochondritis typically lacks visible swelling 1
- Slipping rib syndrome involves pain from ribs subluxing from the joint rather than pure inflammation 1
- The hallmark diagnostic finding remains reproducible tenderness to palpation of the affected costochondral joints 1, 5