What is the cause of costochondritis?

Cause of Costochondritis

Costochondritis is primarily idiopathic in most cases, though approximately 10% of cases are related to trauma, with other causes including physical exertion, repetitive movements, severe coughing, and rarely infectious etiologies. 1, 2, 3

Primary Etiologies

Idiopathic (Most Common)

• The majority of costochondritis cases occur for unknown reasons, particularly in adolescents and young adults 4
• The condition represents inflammation of the costochondral junctions or chondrosternal joints without a clearly identifiable precipitating factor 5

Trauma and Mechanical Causes

• Approximately 10% of non-cyclic chest pain cases are directly related to trauma 1
• Physical exertion and repetitive movements (such as lifting heavy objects) are common precipitating factors 2
• Severe or persistent coughing can trigger costochondral inflammation 2, 3
• Chest muscle overuse from activities can lead to costochondral junction inflammation 3

Infectious Causes (Rare)

• Infectious costochondritis is uncommon and typically develops when infection spreads directly from postoperative wounds or adjacent foci 2
• Rare cases of hematogenous spread can occur, as documented with Pseudomonas aeruginosa causing costochondritis with sternal osteomyelitis 2
• When infectious, it represents a distinct entity requiring antimicrobial therapy rather than the typical anti-inflammatory treatment 2

Associated Conditions

Systemic Inflammatory Diseases

• Anterior chest wall pain affects a significant percentage of patients with axial spondyloarthritis and may be the first manifestation of disease in some patients 5, 6
• SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a chronic, relapsing condition that can involve the sternoclavicular joints and present similarly 5

Important Clinical Distinctions

Differentiation from Related Conditions

• Tietze syndrome involves localized inflammation with visible swelling of costochondral joints, representing a distinct entity from costochondritis 5, 1
• Slipping rib syndrome involves pain from ribs subluxing from the joint rather than inflammation 5

Key Clinical Caveat

• While costochondritis itself is inflammatory, it is not an infectious process in the vast majority of cases and should be treated with NSAIDs as first-line therapy 2
• The diagnosis is often one of exclusion after ruling out cardiac, pulmonary, and other serious causes, particularly in patients over 35 years or those with cardiac risk factors 5, 3