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Diseases and Conditions
Costochondritis
From MayoClinic.com
Special to CNN.com

Introduction

Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It causes sharp pain in the costosternal joint — where your ribs and breastbone are joined by rubbery cartilage. Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.

Costochondritis is the most common cause of chest pain originating in the chest wall. It occurs most often in women and people over age 40. However, costochondritis can affect anyone, including infants and children.

Your doctor might refer to costochondritis by other names, including chest wall pain, costosternal syndrome and costosternal chondrodynia. When the pain of costochondritis is accompanied by swelling it's referred to as Tietze's syndrome.

Most cases of costochondritis have no apparent cause, and most go away on their own. This makes it difficult to treat. When there's no obvious cause, treatment is aimed at easing your pain while you wait for costochondritis to resolve on its own.

Signs and symptoms

Costochondritis causes pain and tenderness in the places where your ribs attach to your breastbone (costosternal joints). Often the pain is sharp, though it can also feel like a dull, gnawing pain. Pain associated with costochondritis occurs most often on the left side of your breastbone, though it can occur on either side of your chest.

Other signs and symptoms of costochondritis may include:

  • Pain when taking deep breaths
  • Pain when coughing
  • Difficulty breathing

Causes

Doctors don't know what causes most cases of costochondritis. Only some cases of costochondritis have a clear cause. Those causes include:

  • Injury. A blow to the chest could cause costochondritis.
  • Infection. Infection can develop in the costosternal joint, causing pain.
  • Fibromyalgia. Recurring costochondritis could be a symptom of fibromyalgia. People with fibromyalgia often have several tender spots. The upper part of the breastbone is a common tender spot.
  • Pain from other areas of your body. Pain signals can sometimes be misinterpreted by your brain, causing pain in places far away from where the problem occurs. Your doctor might refer to this as "referred pain." Pain in your chest can sometimes be caused by problems with the bones in your spine compressing the nerves.

When to seek medical advice

Make an appointment to see your doctor if self-care measures aren't helping your pain or if your pain is worsening.

Costochondritis pain is often mistaken for heart attack pain. The pain of a heart attack is often more widespread, while costochondritis pain is focused on a small area. Heart attack pain usually feels as though it's coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself. Heart attack pain may worsen with physical activity or stress, while the pain of costochondritis remains constant.

Don't waste time, though, trying to distinguish between the two if you're experiencing unexplained and persistent chest pain. Chest pain is an emergency — seek medical attention right away.

Screening and diagnosis

Your doctor will conduct a physical exam to diagnose costochondritis. He or she will ask you to describe your pain and what influences it. The pain of costochondritis can be very similar to the pain associated with heart disease, lung disease, gastrointestinal problems and osteoarthritis. Your doctor will feel along your breastbone for areas of tenderness or swelling.

Costochondritis generally can't be seen on chest X-rays or other imaging tests used to see inside your body. Sometimes your doctor orders these tests or others to rule out other conditions.

Treatment

Costochondritis usually goes away on its own. The pain usually lasts a week or two and then resolves.

To ease your pain until it fades, your doctor may recommend:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve).
  • Antidepressants, specifically a category of medicines called tricyclic antidepressants, if pain is making it difficult to sleep at night.
  • Muscle relaxants, which can also help ease pain.

Self-care

It can be frustrating to know that there's little your doctor can do to treat your costochondritis. But you can take self-care measures to make yourself more comfortable, which can give you a greater sense of control over your condition. To help relieve the pain of costochondritis, try to:

  • Rest. Avoid activities that make your pain worse.
  • Exercise. It may seem contradictory to rest, but gentle exercises, such as walking or swimming, can improve your mood and keep your body healthy. Don't overdo it, and stop if exercise increases your pain.
  • Use a heating pad. Apply a heating pad to the painful area several times a day. Keep the heat setting on low.

Once your pain is gone, continue taking it easy. Slowly work your way back to your normal activities.

January 31, 2006

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