Costochondritis: Symptoms, Causes, Treatment, Cost, and Side Effects

Costochondritis is an inflammation condition of the cartilage that connects the rib to the breastbone (sternum). The areas where the upper ribs join the cartilage that holds the breastbone are called costochondral junctions. The pain due to costochondritis can often be mistaken for a heart attack and other chest ailments. However, chest pain due to costochondral may not require treatment.

Often, the condition is also called chest wall pain syndrome, costosternal chondrodynia or costosternal syndrome.

At times, costochondritis is also accompanied by swelling called the Tietze syndrome.

One must also note that symptoms of costochondritis and Tietze syndrome are very similar. In Tietze syndrome, an inflammatory disorder, tissues connecting the ribs to the breastbone swell up. Tietze’s syndrome is also known as costochondral junction syndrome and affects the second and third ribs.

Both the syndromes are, however, referred to as benign.

Following are the symptoms of costochondritis:

• The sharp pain generally happens on the left side of your chest, typically where the rib meets the breastbone. It can slowly spread to the upper abdomen, back, arms and shoulder.
• It gets worse with coughing, sneezing, deep breaths or any kind of chest wall movement. The pain might get better with the pause of any movement.
• A feeling of tenderness when you press your rib joints. If you do not feel the same, in all probability you are not suffering from costochondritis.
• An aching pain can affect more than one rib.
• In some instances, if costochondritis occurs due to an infection following surgery, there will be swelling and pus discharge from the surgery wound.
• Nausea, dizziness and trouble breathing despite medication.
• High fever and pus discharge around rib joints.

Costochondritis may happen after a heavy workout, upper respiratory ailment and similar conditions. The reasons behind the exact cause are still very unclear.

However, doctors believe that there are a few underlying causes leading to costochondritis diagnosis and they could be:

• Repeated injury to the chest wall.
• Tumours can move from other parts of your body to settle in the chest.
• Costochondritis can often be identified as a symptom that leads to rheumatoid arthritis, osteoarthritis and other diseases affecting one’s cartilage.
• Viral infections and rare fungal infections cause respiratory diseases.
• Bacterial infection due to consistent use of IV drugs following surgery in the upper chest area.

Costochondritis mostly occurs in children and adolescents. Women above 40 may also stand the risk of having costochondritis. It is said that in adults, costochondritis affects men more than women.

Relapsing polychondritis, reactive arthritis, fibromyalgia, and injury is likely to cause costochondritis.

Health experts have not been able to ascertain any particular cause for inflammatory costochondritis. Hence there is no perfect way to prevent it. However, it is suggested that you avoid lifting heavy weights improperly.

Doctors are yet to find a specific test to diagnose costochondritis. However, to rule out any possibility of underlying conditions of the sharp chest and breast pain, doctors may start with a few tests including an echocardiogram (ECG) and chest X-Ray.

You may be recommended to undergo a gallium study which is a more sophisticated imaging study of the chest. You can also be tested for an increase in white blood cells to check for an infection.

They may further examine to feel tenderness around your rib joints, usually over the fourth and fifth ones.

There is no specific test to diagnose this disorder. Physicians usually perform a physical examination where they feel the breastbone to check for inflammation. Since the signs of costochondritis are similar to many heart or lung problems, doctors may recommend a blood test for white blood cells, or CT of your chest or an X Ray of the chest to eliminate the possibility that your signs are caused by anything other than costochondritis.

Whenever you notice unusual symptoms that have cropped up for no reason, contact your doctor. It is difficult to check for costochondritis at home. However, a sudden sharp pain or pressure on your breast bone is usually a clear indicator of costochondritis. Take a deep breath and see if the pain worsens. You may even notice a wheezing cough when you breathe deep.

Besides medical consultation, a patient can try the following home remedies to reduce the pain occurring from costochondritis:

• Costochondritis stretches: Costochondritis exercises and stretching including side stretch, throat stretch, wall sides etc, can be helpful in managing sternum pain. It can also be an efficient physical therapy.
• Heat or ice: Compress the place of inflammation with heat or ice. This might help in relieving the pain. Do not use heat or ice for more than 15 minutes at a stretch.
• Topical pain relievers: Gels, patches, and spray, which contain anti-inflammatory drugs, can be applied to numb the pain.
• Anti-inflammatory diet: An anti-inflammatory diet including anti-inflammatory herbs and vegetables can reduce inflammation, which is the root cause of costochondritis pain areas. The diet may include ginger, turmeric, green leafy vegetables, bok choy, cherries etc.
• Rest: Avoid excessive workouts, movement of arms and heavy activities that may worsen the pain.

Costochondritis often goes away on its own, although it may take up to several weeks and months for the pain to ease.

The basic medications include anti-inflammatory drugs, narcotics, anti-seizure drugs, and antidepressants.

An anti-inflammatory diet helps with costochondritis pain and combating infection in any part of the body.

• Include a lot of ginger in your diet as ginger serves as a major anti-inflammatory food item.
• You must eat a lot of leafy vegetables and fruits that are high in antioxidants.
• Non-juice and noni-fruit from the “painkiller tree” can help in reducing pain.
• Herbs like chamomile, ginger, fennel, turmeric, garlic chia seeds and so on can induce calmness in the body.
• Food rich in omega-3 fatty acids like oily fish, walnuts, flax seed, milk, and eggs.

People with costochondritis symptoms must avoid the following food items:

• One must not consume food that triggers inflammation like refined sugar and processed meat should be avoided.
• You should avoid fried items that contain trans-fat.
• Do not have gluten-rich food like food items made of flour such as cake, cookies, pasta, noodles etc.
• Actively avoid processed meat and food items like chips and cookies, high in calories.
• Do not consume alcohol.
• Avoid carbohydrate-rich food items.
• Other sweet dishes including candies, ice cream, pancakes, cake, and other flour items, must be avoided during the recovery period.

Should I go to urgent care for costochondritis?
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The pain of costochondritis may feel like the pain of a heart attack. Hence, it’s recommended that you immediately seek urgent care from your doctor. Otherwise, always remember to consult a medical professional in any case of chest pain. n

Your doctor may start with a few over-the-counter medications to ease the pain. The doctor may prescribe the following medicines to start with immediately. They can be taken twice or thrice a day given the daily dosage prescription:n

• Ibuprofen n
• Naproxen n
• Acetaminophen

For costochondritis, you can first consult a general physician or a general surgeon to seek the initial treatment. In certain cases, emergency room admission also becomes a common occurrence if the pain gets worse.

You may also be referred to a doctor who specialises in joint pain like rheumatoid arthritis.

Complications do not arise if the surgery is performed by experienced doctors. At Pristyn Care, you will be connected to doctors with many years of experience in the required field.

Your doctor may suggest the following medication to treat costochondritis:

• NSAID: Your doctor may prescribe you a few over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naproxen, as and when needed.
• Narcotics: For extreme pain, narcotics drugs like hydrocodone/acetaminophen (Norco, Vicodin) or oxycodone/acetaminophen (Percocet, Roxicet, Tylox) may be prescribed.
• Antiseizure drugs: The medicine for epilepsy, gabapentin (Gralise, Neurontin), is generally used to control chronic pain if you have a costochondritis diagnosis.
• Anti-depressant drugs: Amitriptyline and other medicines which are tricyclic antidepressants or cyclic antidepressants can help in easing the pain. However, they may have side effects such as drowsiness, nausea and so on.
• Steroid shots: In case of extreme joint pain, your doctor may inject a shot of corticosteroid as a last resort.
• Antibiotics: Infectious costochondritis must be treated with IV antibiotics or oral antibiotics. The medication must continue for at least 2-3 weeks accompanied by follow-ups with your doctor.

Further, here’s how the other drugs can help in curing costochondritis:

• Ibuprofen: Ibuprofen is an NSAID which can help with fever, inflammation and moderate pain.
• Naproxen: Naproxen is an NSAID drug prescribed for fever, pain, stiffness, and inflammation caused by similar disease conditions.
• Flurbiprofen: Flurbiprofen is another non-steroidal anti-inflammatory agent (NSAIA). It is prescribed to fight pain and inflammation due to osteoarthritis and rheumatoid arthritis. It is also prescribed for inflammation of the eye, dysmenorrhea and so on.
• Ketoprofen: An NSAID, ketoprofen is prescribed for mild fever, pain and inflammation.

Antibiotics often cure costochondritis without the need for surgery. In most mild cases of this disorder, it may improve with antibiotics. Although surgery remains the standard care, researchers are trying to find out in which cases it is safe to avoid surgery for mild costochondritis.

In rare cases, if the medication does not work out to treat costochondritis, your doctor may recommend removing the sore cartilage that is causing severe pain. The surgery is called chondrectomy.

Another alternative method is to push injection and numb the costochondral junction and then inject shots of corticosteroid.

Surgery for costochondritis is a rare occurrence and extreme measure (surgery) involves the removal of the cartilage.

The price of treating costochondritis differs on the severity of the disease and the longevity of the infection. If the condition can be treated with medicines alone, the expense is much lower than in a surgery case.

Again, if the condition recovers well within a couple of months, the expense is capped at a lower range. However, the expense may shoot up if the condition requires medication for almost a year.

Costochondritis is a non-cardiac disease which is not permanent and usually takes weeks and months to recover. It generally goes away on its own with the application of the right medication.

However, in certain cases, it may reoccur again. The longevity of the condition depends on its cause.

Not really. Chronic cases can last for a year or so, but in most cases, they don’t. Since costochondritis is an inflammatory condition, the pain management medication does not have any permanent result.

However, in a rare case, if other modes of treatment don’t work out, your surgeon may opt to remove your cartilage.

Patients must follow these few steps:

• They must continue to take the prescribed over-the-counter medicines.
• Physical therapy is used at times in more severe cases of costochondritis.
• Doing the prescribed stretching exercises.
• Ample amount of rest and avoid over-use of the arms, shoulders, and heavy physical activities.
• Infectious costochondritis requires a close follow-up with the doctor to prevent a relapse.
• The doctors at Pristyn Care will explain in detail all that you need to do to ensure a quick post surgery recovery.

The side effects of costochondritis may arise due to the intake of the prescribed drugs.

Consistent intake of nonsteroidal anti-inflammatory drugs can have an impact including damage to the stomach lining and kidneys.nSimilarly, continuous intake of narcotics to ease pain can often become addictive for the patients.

Diagnosis of costochondritis compels a person to avoid physical exercises to rule out exertion.

Costochondritis is a self-limiting condition and generally goes away on its own. Although non-infection costochondritis may go away on its own, infectious costochondritis will respond to IV antibiotics and surgery well. This may take time to recover.

You may have costochondritis for months but it’s not a life-threatening condition. It’s not harmful or permanent.

A diagnosis of costochondritis will require you to take ample rest. There is no further diet restriction if you have recovered from the condition or have a mild infection.

However, if costochondritis relapses, you must visit your doctor urgently. Upon visiting your doctor you should evaluate and discuss whether the symptoms have worsened, the exact site of the pain, and the lifestyle you followed post-treatment, is there anything else that made the pain feel worse?