From the Guidelines
Costochondritis should be initially managed with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and conservative measures to reduce inflammation and pain, as most cases resolve within a few weeks without serious complications 1.
Diagnosis and Classification
Costochondritis is a common cause of nontraumatic chest wall pain, accounting for approximately 42% of cases, and is often readily diagnosed by physical examination without the need for diagnostic imaging 1. Chest wall pain may be broadly classified as traumatic or nontraumatic, with costochondritis being a nontraumatic condition. The symptoms of costochondritis can include stinging or pressing pain, often retrosternal or left-sided, and may occur more than once daily, with over half of patients experiencing chronic symptoms lasting more than 6 months 1.
Treatment Approach
For the treatment of costochondritis, starting with over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) for 1-2 weeks is recommended to reduce inflammation and pain. Additionally, applying heat or ice to the affected area for 15-20 minutes several times daily can help manage discomfort. It is also advised to rest and avoid activities that worsen the pain, particularly heavy lifting or intense physical exercise 1. If the pain is severe, a doctor may prescribe stronger pain medications or inject a corticosteroid directly into the affected area.
Importance of Differential Diagnosis
It is crucial to distinguish costochondritis from other causes of chest pain, especially acute cardiovascular processes such as myocardial infarction or aortic dissection, which are more life-threatening 1. If chest pain is accompanied by shortness of breath, fever, or spreads to the arm or jaw, it is essential to seek immediate medical attention to rule out cardiac issues. However, in the case of costochondritis, while the pain can be uncomfortable, it is generally not serious and does not cause permanent damage to the heart or lungs.
Prognosis and Quality of Life
Most cases of costochondritis resolve within a few weeks with conservative treatment, and the condition does not typically lead to long-term morbidity or mortality 1. The focus of treatment should be on managing pain and inflammation to improve the patient's quality of life during the recovery period. By following a conservative treatment approach and avoiding activities that exacerbate the condition, patients can expect a favorable outcome with minimal impact on their daily activities and overall well-being.
From the Research
Definition and Diagnosis of Costochondritis
- Costochondritis is a self-limiting, poorly described, and benign condition that usually manifests as non-cardiac chest pain 2.
- The symptoms usually tend to resolve in a couple of weeks, but serious causes of chest pain should be ruled out prior to diagnosing costochondritis, as it is often a diagnosis of exclusion 2, 3.
- Palpation of the affected chondrosternal joints of the chest wall elicits tenderness, and history and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults 3.
Treatment of Costochondritis
- Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance 3.
- A multimodal approach, including manipulative therapy, instrument-assisted soft tissue mobilization (IASTM), and stretching, can be useful in the treatment of rib dysfunction, especially in atypical costochondritis 2.
- The addition of short-term oral corticosteroids has shown a clear benefit for use in improvement of pain and quality of life in patients with Tietze syndrome, a rare form of chest wall costochondritis with joint swelling 4.
Management Considerations
- Adequate debridement is the single most important factor to ensure eradication of costochondritis, and well-vascularized tissue coverage reduces ischemic factors, resists secondary infection by contamination, and promotes rapid healing 5.
- The pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps are the primary choices for pedicle-flap coverage 5.
- Further studies are required to expand our knowledge of costochondritis and physical therapy (PT) techniques, which would allow for early identification and effective treatment of the condition 2.