Does Costochondritis Cause Cough?
No, costochondritis does not directly cause cough—it is a musculoskeletal condition characterized by inflammation of the costochondral junctions that presents with chest wall pain, not respiratory symptoms. 1
Clinical Presentation of Costochondritis
Costochondritis manifests as localized chest wall pain with the following characteristics:
- Reproducible tenderness on palpation of the affected costochondral joints is the hallmark diagnostic feature 2, 3
- Pain is typically described as sharp or aching, localized to the anterior chest wall 3
- 86% of patients experience a recurrent course, while 14% have continuous symptoms 2
- The condition is self-limiting in most cases, though some patients develop chronic symptoms 4, 3
Notably absent from the clinical presentation are respiratory symptoms such as cough, dyspnea, or wheezing. 1
Important Clinical Distinction
When cough occurs in the context of chest wall pain, consider these alternative diagnoses:
Cough as a Cause, Not a Result
- Severe or persistent coughing can actually cause costochondritis through repetitive mechanical stress on the costochondral junctions 5
- Cough-induced rib fractures may present with chest wall pain that mimics costochondritis 1
Relapsing Polychondritis
If a patient presents with both chest wall inflammation AND cough, consider relapsing polychondritis instead:
- Persistent or chronic cough is often one of the first and important symptoms signifying respiratory involvement in this condition 6
- Other respiratory symptoms include wheezing, stridor, dyspnea, and hoarseness 6
- This involves cartilaginous inflammation that can affect the larynx, trachea, and bronchi—unlike costochondritis which is limited to the chest wall 6
Upper Airway Cough Syndrome (UACS)
- UACS is the most common cause of chronic cough and may coexist with chest wall pain 1
- However, these are separate conditions—the cough originates from upper airway irritation, not from costochondritis itself 1
Diagnostic Approach
When evaluating chest wall pain with or without cough:
- Physical examination with direct palpation reproducing the pain confirms costochondritis 2, 3
- In patients over 35 years or those with cardiac risk factors, obtain an electrocardiogram and consider chest radiography to exclude cardiac causes 2, 3
- Chest pain that decreases significantly with inspiration supports a musculoskeletal diagnosis rather than cardiac etiology 2
- If cough is prominent, investigate alternative diagnoses including UACS, relapsing polychondritis, or infectious causes 1, 6, 5
Clinical Pitfall
Do not attribute cough to costochondritis. If both symptoms coexist, they likely represent separate conditions requiring independent evaluation and treatment. The presence of cough should prompt investigation for respiratory pathology, not simply reassurance that it's part of the costochondritis presentation.