Costochondritis

What is costochondritis?

Costochondritis is painful inflammation in the cartilage that connects your ribs to your breastbone (sternum).

Those sections of cartilage are your costochondral joints. They’re stiff and strong to help your ribcage protect organs like your heart and lungs.

The inflammation can make breathing or moving your chest very painful. The pain can start suddenly or develop slowly and spread (radiate) across your chest.

Some people assume that any chest pain is a sign of a heart attack. But the same issues that cause heart attacks don’t cause costochondritis, and having costochondritis doesn’t mean you’re having a heart attack. But you should always visit a healthcare provider if your chest or ribs hurt, especially if the pain doesn’t get better in a few days.

How common is costochondritis?

Costochondritis is one of the most common causes of chest pain. Experts estimate that around one-third of people who visit a healthcare provider with chest pain or rib pain have costochondritis.

What are costochondritis symptoms?

Chest pain is the most common costochondritis symptom.

What does costochondritis feel like?

Everyone experiences pain differently. Costochondritis usually feels like a low ache in your chest near your affected ribs. The pain might feel suddenly sharp or stabbing when you move your chest or torso. Some movements that can make costochondritis pain worse include:

• Breathing, especially taking deep breaths or breathing heavily.
• Coughing, sneezing or vomiting.
• Twisting your torso.
• Reaching overhead (like grabbing something off a high shelf).
• Hugging someone.
• Exercising.
• Lying down on your affected side.

What triggers costochondritis?

Experts aren’t sure what causes costochondritis. Some experts think activities that put small, repeated stress on your ribs over time (microtraumas) can eventually trigger costochondritis. Microtraumas can include:

• Chest or rib injuries.
• Coughing or vomiting too hard.
• Infections in your chest.
• Doing intense physical activity without enough time to rest and recover (working out, playing sports or having a physically demanding job or hobby).
• Suddenly doing physical activity that you normally don’t (like ramping up a workout routine too fast, or helping a friend move and lifting heavy furniture all weekend).

What are the risk factors?

Anyone can develop costochondritis, but some people have a higher risk:

• Athletes who play contact sports.
• People with physically demanding jobs.
• Being female.
• Hispanic people.

What are costochondritis complications?

Costochondritis doesn’t usually cause any complications. It might be a sign that you have arthritis, especially ankylosing spondylitis.

How do providers diagnose costochondritis?

Diagnosing costochondritis is usually a diagnosis of elimination. This means a healthcare provider might do an exam and perform tests to rule out other, more serious conditions before diagnosing costochondritis.

Your provider will diagnose costochondritis with a physical exam.

They’ll feel your chest and ribs. They might press on your chest to feel how sensitive you are and to pinpoint where your pain is most intense (localized). They’ll examine your torso for other signs of injuries or conditions that might be causing your symptoms.

You might need a blood test to check for infections or other issues.

There’s no imaging test that can diagnose costochondritis. But your provider may use some imaging tests to rule out other causes of rib pain. The most common tests include:

• Chest X-ray.
• A computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Ultrasound.
• Electrocardiogram (EKG).

What is costochondritis treatment?

The most common costochondritis treatment is resting your chest and ribcage. Giving your irritated costochondral joints time to heal is the best thing to do for costochondritis.

Over-the-counter (OTC) medications like NSAIDs (nonsteroidal anti-inflammatory drugs) or acetaminophen can relieve your pain. Talk to your provider before taking pain medication for more than 10 days in a row.

It’s rare, but your provider might inject a corticosteroid into your affected joints to reduce the inflammation if your symptoms aren’t improving after a few weeks.

Some people with costochondritis get better without treatment, but don’t assume it’ll go away on its own. Visit your provider as soon as you notice any type of chest pain.

How can I prevent costochondritis?

You might not be able to prevent costochondritis because experts aren’t certain what causes it.

In general, avoid putting too much stress on your chest and ribs. Make sure to rest after intense physical activity to give your body time to recover.

What can I expect if I have costochondritis?

You should expect to make a full recovery from costochondritis. Once the inflammation heals, you should be able to return to all your usual activities with no long-term effects.

The worst part of costochondritis is usually the chest pain that makes people think they’re having issues with their hearts. Get new symptoms examined right away to rule out something more serious.

How long does costochondritis last?

Costochondritis is usually a short-term issue. Most people experience symptoms anywhere from a few days to a few weeks. It’s rare, but costochondritis can last for several months.

Most people start to gradually feel better as they rest and take over-the-counter pain medications. Talk to your provider if your rib pain isn’t getting better in a few weeks after you start treating costochondritis.

There’s a chance that costochondritis comes back (recurs), even after it heals.

When should I see my healthcare provider?

Visit your provider right away if you notice any new symptoms or changes in or around your chest, especially new pain. Costochondritis usually isn’t dangerous, but it’s important to rule out other, more serious issues as soon as possible.

When should I go to the emergency room?

Call 911 (or your local emergency services phone number) or go to the ER if you think you’re experiencing heart attack symptoms, including:

• Shortness of breath (dyspnea) or trouble breathing.
• Nausea or stomach discomfort.
• Heart palpitations.
• A feeling of anxiety or “impending doom.“
• Sweating.
• Feeling lightheaded or dizzy.

What questions should I ask my provider?

• Do I have costochondritis or another rib issue?
• Which tests will I need?
• How long will it take to heal?
• Which activities should I avoid while I’m recovering?
• When can I resume physical activities like sports?

What is the difference between costochondritis vs. Tietze syndrome?

Tietze syndrome is very similar to costochondritis. It’s another type of irritation in your costochondral joint.

The biggest difference between them is swelling and which ribs they usually affect.

Tietze syndrome causes pain, tenderness and swelling near affected costochondral joints. It usually affects ribs higher up on your ribcage, closer to your shoulders — usually your second or third ribs.

Costochondritis symptoms are almost identical to Tietze syndrome, except costochondritis doesn’t cause swelling that you can see or feel. It typically affects ribs lower down your ribcage — usually ribs two through five.

Because costochondritis and Tietze syndrome are so similar, they’re sometimes confused for each other. The good news is they’re usually treated and diagnosed the same way. Visit a healthcare provider if you have any pain or swelling in or around your chest.

Why do my ribs hurt?

Lots of conditions and injuries can cause rib pain. Other than costochondritis or Tietze syndrome, some rib pain causes can include:

• Rib fractures.
• GERD (chronic acid reflux).
• COVID-19.
• Fibromyalgia.
• Lupus.

Visit your provider if you have new symptoms in your ribs or chest. Costochondritis doesn’t usually cause breast pain or muscle pain.