From the Guidelines
Costochondritis should be treated with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain, as this approach is supported by the most recent and highest quality study 1.
Diagnosis and Treatment
Costochondritis is an inflammation of the cartilage that connects the ribs to the breastbone, causing chest pain that can be alarming as it may mimic heart attack symptoms. According to a study published in the Journal of the American College of Radiology 1, most nontraumatic musculoskeletal chest wall pain has been attributed to costochondritis, which, in most cases, is readily diagnosed by physical examination, without need for diagnostic imaging.
Management
For treatment, applying heat or ice to the affected area for 15-20 minutes several times daily can help manage discomfort. Rest and avoiding activities that worsen the pain, particularly heavy lifting or intense physical exertion, are also recommended. If pain is severe, a doctor may prescribe stronger pain medications or inject a corticosteroid directly into the affected area.
Prognosis
Most cases of costochondritis resolve within a few weeks with conservative treatment 1. Costochondritis occurs when the costal cartilage becomes inflamed, often due to physical strain, coughing, or sometimes without a clear cause. While uncomfortable, it's generally not serious and doesn't cause permanent damage to the heart or lungs.
Important Considerations
If chest pain is accompanied by shortness of breath, fever, or spreads to the arms or jaw, seeking immediate medical attention to rule out cardiac issues is crucial. A study published in the Journal of the American College of Cardiology 1 suggests that for patients with chest pain without evidence of ischemia, a variety of empiric treatments may be considered, including a 1- to 2-week trial of nonsteroidal anti-inflammatory drugs.
From the Research
Definition and Diagnosis of Costochondritis
- Costochondritis is an inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, as stated in the study 2.
- The diagnosis of costochondritis can be made by history and physical examination of the chest that document reproducible pain by palpation over the costal cartilages, especially in children, adolescents, and young adults 2.
- Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph to rule out other causes of chest pain 2.
Treatment of Costochondritis
- Traditional practice is to treat costochondritis with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance 2.
- Stretching exercises have been shown to be effective in reducing pain in patients with costochondritis, as demonstrated in the study 3.
- The goal of therapy of costochondritis is to reduce inflammation and the pain, and NSAIDs, local injection of anaesthetic or steroid may have insufficient effectiveness, making stretching exercises a useful instrument in treating the condition 3.
- In some cases, sulfasalazine may be of additional long-term benefit in recurrent cases of costochondritis 4.
Complications and Considerations
- Costochondritis should be distinguished from other, more serious causes of chest pain, such as coronary artery disease, which is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation 2.
- The use of NSAIDs, which are commonly used to treat costochondritis, can have adverse effects on various organs, including the gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary systems 5.
- Adequate debridement and well-vascularized tissue coverage can ensure eradication of costochondritis and promote rapid healing, as discussed in the study 6.