Costochondritis
Everything about the causes, symptoms, and treatments for inflammation of the costal cartilage.
Symptoms and causes
Costochondritis is the inflammation of the costal cartilage, which connects the ribs to the sternum. When there is a palpable swelling that sometimes deforms the cartilage, the condition is referred to as Tietze syndrome. Although there are some differences, these conditions are often considered as the same disease.
Generally, Tietze syndrome affects only one joint (the second or third rib), whereas costochondritis can involve several simultaneously (most commonly the third, fourth, and fifth ribs).
Costochondritis is an uncommon condition that, in most cases, has a favorable prognosis. Although the persistence of symptoms varies from patient to patient, they usually resolve completely with appropriate treatment.
Symptoms
The usual symptoms of costochondritis are:
- Sharp pain on one side of the sternum that worsens with movement.
- Occasionally, pain radiating to the shoulders and arms.
- A sensation of pressure in the chest.
When associated with Tietze syndrome, additional symptoms may include:
- Swelling in a localized area of the chest.
- Skin redness.
- Increased tenderness at the costosternal junction (costochondral area).
Causes
The exact causes of costochondritis and Tietze syndrome are unknown, but they are generally related to irritation of the cartilage due to one of the following circumstances:
- Trauma.
- Excessive physical exertion.
- Repetitive movements.
- Severe, persistent coughing.
- Infections.
Risk Factors
The risk of developing costochondritis or Tietze syndrome increases in the following situations:
- Age: incidence is higher between 10 and 30 years.
- Viral, fungal, or bacterial infections.
- Inflammatory diseases: rheumatoid arthritis, ankylosing spondylitis.
- Previous thoracic surgery.
- Prolonged poor posture.
Complications
Both costochondritis and Tietze syndrome are self-limiting conditions that usually resolve spontaneously without causing complications.
Prevention
There is no way to prevent Tietze syndrome or costochondritis, as their causes are unknown. However, it is recommended to maintain good posture, avoid excessive effort and repetitive movements, strengthen chest muscles, and manage stress to reduce risk.
Which specialist treats costochondritis?
Family and community medicine and Rheumatology specialists diagnose and manage Tietze syndrome and costochondritis. If trauma or structural injury is suspected, Traumatology may intervene. Physical medicine and rehabilitation specialists and Physiotherapy are also often involved in treatment.
Diagnosis
Diagnosing inflammation of the costal cartilage can be challenging because the symptoms are similar to certain respiratory conditions, gastrointestinal disorders, or even myocardial infarction.
Diagnosis usually involves reviewing the patient’s Medical history, evaluating symptoms, and performing a physical examination to observe and palpate the sternum for tenderness, increased sensitivity, or swelling.
If there is any doubt, cardiological tests and chest X-rays may be performed to rule out other conditions before confirming Tietze syndrome or costochondritis.
Treatment
Inflammation of the costosternal area is self-limiting, so treatment focuses on relieving symptoms, which may persist for several weeks or months. A combination of two main approaches is usually applied:
Medication:
- Non-steroidal anti-inflammatory drugs (NSAIDs) for swelling and pain.
- Analgesics for pain relief.
- Corticosteroid injections for severe pain.
Physiotherapy:
- Manual therapy.
- Stretching and muscle-strengthening exercises.
- Cryotherapy.
- Postural exercises.
During recovery, applying warm compresses to relieve pain or ice packs to reduce inflammation is recommended. If possible, relative rest should be observed.
Antibiotics are not typically needed unless there is a secondary infection.
