What is costochondritis?
cost= rib, chond = cartilage, itis = inflammation
Costochondritis is an inflammation of the
cartilage that attaches the ribs to the breastbone
How do you get costochnodritis?
Costochondritis may be caused by trauma,
such as bumping the rib cage; as a result of a viral infection; or as part
of an inflammatory disease process. Usually the cause is unknown
Does it go away?
For most people, it goes away in six months
to a year; however, for some people it remains a chronic condition.
Note the costochondritis is most painful in the early stages; the
pain does lessen after awhile!
What does costochondritis feel like?
Costo is an inflammation of the rib cartilage,
and is sometimes diagnosed by pushing on the sternum, (area at the
top where your ribs join) or by pushing on any sore spot on your ribs.
Either should cause intense pain. *However*, not everyone with CC
will respond like that.
In the beginning, costo is usually worse,it feels like there is an elephant sitting on your chest, it hurts to breathe, ribs hurt all over with intermittent sharp, stabbing pains, and usually a few "sore spots" on your ribs, that you would faint if someone poked you there. You might also feel like you are having a heart attack. Eventually, it might go down to a dull, but constant ache, or simply the feeling of sore ribs. It hurts to wear a bra, and different motions, like picking a child up from the floor, can cause a flare up, with intense pain. When it is a chronic condition, it tends to wax and wane, come and go. It might be better for a while, then you will reach for something in the wrong position and bam!, it is right back again.
My doctor say the pain of costochondritis is
benign. What does this mean?
Benign means nonmalignant. But, "benign"
is often wrongly translated as "harmless and easy to live with".
Costochondritis is neither!
It feels like I am having a heart attack, what
causes this?
When there is that much inflammation and swelling
in one area there is no room for more swelling- the nerves are over
reactive and the muscles turn into tight knots - this causes the feeling
of having a heart attack. You have all of the muscles and nerves
running between the ribs themselves, then you also have your chest muscles
that are tightening and swollen. With one on top of your heart and
the others on the bottom, there is going to be a heart attack feeling
( You only have so much room). However,
cardiac symptoms cannot be ignored, and must be ruled out first!
I am having trouble breathing- does this affect
my lungs?
Costochondritis is simply the
swelling of the joints and has absolutely nothing to do with your
lungs and will not hurt them. When the body
is hurt, it automatically keeps everything away from the injured area so
that it can heal. Which is the case with costochondritis - there
is the swelling - the body is in fact telling the lung not to expand completely,
allowing you that deep breath, due to the fact that when the lungs
expand they press up against the joints where the ribs meet the
breastbone. So our body is trying to heal
itself but in doing so it doesn't allow us to breath properly.
I feel pain radiating in my shoulders, arms,
or back- what causes this?
Nerves radiate throughout our rib cage and
around to the back along our spine, so the pain/inflammation from
the joints can and will radiate from the breastbone all the way to our
spines in back. If there is anything irritating the nerves, then
you might feel it all the way around. Down the arms and into
the shoulders may be caused from muscle pain which can radiate all over
without any rhyme or reason.
Does stress make it worse?
Yes, stress can make it worse, like most health
conditions. Stress causes the nerves to be more on edge and
tightens the muscles, both of which trigger our CC pain. I have found
that the pain increases quite a bit in stressful situation versus non stress
times. With stress our bodies go into their fight or flight reaction,
which is why some doctors put us on relaxing types of medication so that
our bodies won't go into that reaction, raising the pain level.
How do I treat costochondritis?
Rest, heat or ice on affected areas,
and anti-inflammatories like aspirin, acetaminophen (Tylenol), Ibuprofen
(Advil), or naproxen (Aleve), or prescription anti-inflammatories.
Most people have not found much to help the pain. Medications
and supplements will be discussed more in
what helps?
What about cortisone shots?
Cortisone shots have been helpful to some
people- however, they are a temporary measure to kill the pain and reduce
inflammation, and not a cure. Most have not noticed enough help from
them to be considered worth it. There has been some discussion about
cortisone weakening the cartilage.
Supplements
Some people have had luck with the following
supplements
8-28-98
After three days on the above regimen (except for the Bromelain), the
dull ache I had constantly in my ribs went away. It was no miracle
cure, I still had a *lot* of pain, but I would estimate that
about 20% of my pain was gone. A few days later, I woke up
with no chest pain at all, although it came back shortly after I
started moving around. I then added Bromelain, but noticed no difference;
in fact there has not been much of a change since the first week.
9-20-98
I started taking warm baths with Batherapy bath salts once or twice
a day, and using myoflex creme on my ribs, both seemed to help. I
had gotten to the point where 40% of my rib pain was gone, but then I stopped
the glucasomine/chondroitin and a lot of the pain came back.
I also had to quit working out with the light weights, I was pulling
too many muscles, seems like I need to get my neck/shoulders/upper back
stretched out-more flexible before I continue with weights. The massages
are helping a lot in this area. The supplements that seemed to help
me the most were the glucasomine/chondroitin, ginger, EPO oil and Vitamin
C.
The following is a list of prescription medications that have been prescribed for costochondritis
There is an email list for people who suffer
from costochondritis. To subscribe, send
a *blank* email to costo-subscribe@egroups.com
To view the archives of this email list, go to http://www.egroups.com/list/costo/
(you can also subscribe from this website)
Chat Rooms (the chat has been discontinued due to lack of participation- perhaps enough interested people can start it again?)
Yes, there is a chat about costochondritis!
Chat
Delphi-Costo Forum-Wednesdays @ 7:00 p.m. , central time
Frequently Asked Questions
I have pain in my breasts, can this be from
costochondritis?
Yes, pain in the breasts, can be from nerve
pain radiating from the ribs. However, any pain of this type should
be checked out by your doctor.
My costochondritis gets worse just before or
during my periods, why would this be?
Prostaglandins are chemicals released at the
site of an injury. The are believed to be
the substances responsible for producing pain
and inflammation following tissue damage and in immune reactions.
All the NSAIDs block the production of prostaglandins.
The levels of prostaglandins in the body increase as menstruation approaches, with the highest levels at the onset of the menstrual period. Higher protaglandin levels increase uterine contractions causing cramps and pain. In essence, the uterus squeezes so hard that it compresses the uterine blood vessels and cuts off the blood supply. This situation is similar to when the blood supply is cut off from the heart causing pain (angina). In both instances the result is the same--pain because the muscle does not have sufficient oxygen.
In addition, some of the excess prostaglandins escape from the uterus into the bloodstream where they may affect other smooth muscles. Thus, prostaglandins are responsible for the headaches, dizziness, hot and cold flashes, diarrhea and nausea that can accompany painful periods, and can also increase the pain of costochondritis.
Some women have found relief by taking NASAIDs
several days before your period is expected to start, building up
the anti-prostaglandins into your system BEFORE the pain-producing prostaglandins
are secreted! Keep taking until the end of the second day of
your period or whenever the pain usually eases up.
Bras
Nan
I am a 64 year old woman and have always been physically active
and have a pretty stressful job. On May 22 , 1998, I had severe chest
pains at work and was taken to the ER for possible heart attack.
An angiogram showed no blockage or heart problems and I was put on indocin
for 10 days after being diagnosed with costochondritis. My symptoms
were chest pain (no redness or swelling), pain in elbows and wrists and
labored breathing.
I learned more about costo from the internet and about glucosamine & condroitin as a possible treatment. I already knew from reading Dr. Andrew Weil's books that Omega-3 and diet of fatty acids nourish soft tissue and cartilage and that ginger is good as an anti-inflammatory supplement, as well as Vitamin E. I began all this and cut way down on eating beef and began eating more salmon and sardines. I also used ice packs. I began a steady recovery and went back to work after complete rest for two weeks after being discharged from hospital. By the end of 5 or 6 weeks I had no symptoms. Remembering back to February and March that I had constructed a new patio laying 128 twelve inch square cement slabs after removing river stones by shoveling them out , led me to believe this to be the cause of the costo. Why it took so long to reach the pain stage is still a puzzle, but I don't know what else could have caused this condition.
Costo generally strikes people from 20 to 40 years of age. I
think one reason for the complete recovery could have something to do with
my age and the fact that I just over did it physically. I also feel
that younger people who contract costo have a weakness in that area already
probably caused from poor diet growing up. Hope this
will help others who have suffered much more than I have.
Articles
of interest (various articles collected from a search
on the internet)
Article # 1
Questions & Answers
Question from Chris of Wyoming, USA--November,
1996.
What is costochondritis? What are the health
effects, concerns for the long term?
How does someone learn to live with it, or
cure it? Is this a genetic disorder?
Dear Chris:
Costochondritis is inflammation of the cartilage
at the junction between the ribs
and the breast bone (sternum). Symptoms of
costochondritis are pain and
tenderness in the front of the chest wall
near the sternum.
Costochondritis is usually treated with ice
and/or heat applications, local
injections of anesthetic and/or cortisone,
and pain relievers. It can recur.
There is no evidence that costochondritis itself
is genetic. Costochondritis can be
associated with other conditions, such as
psoriasis, psoriatic arthritis, ankylosing
spondylitis, and Reiter's syndrome.
MedicineNet is committed to bringing you medical
information to help you, your
family, and friends become better informed
patients. Please remember,
information is never a substitute for an open
doctor-patient relationship.
Thank you for your question.
Costochondritis is anterior chest wall pain associated
with tenderness of the
costochondral and costosternal regions. It produces
diffuse tenderness without
swelling in more than one joint in the
rib cage. It usually follows unusual excessive
physical activity or trauma, and is more
prevalent in females ages 20-40.
Costochondritis is an inflammation of the cartilage that attaches the ribs to the breastbone (costo = rib, chond =cartilage, itis = inflammation).
Costochondritis causes mild to severe pain in the lower rib area or upper breastbone. Some patients fear they are having a heart attack. The most severe pain is usually in the lower rib area between the breast and upper abdomen. The pain may be more noticeable in sitting or reclining positions, and stress is known to aggravate this condition.
Costochondritis may also be caused by trauma, such as bumping the rib cage; as a result of a viral infection; or as part of an inflammatory disease process. Usually the cause is unknown.
Once the diagnosis of costochondritis is made,
it usually responds well to a course of a
pain-killing, anti-inflammatory medications such as aspirin,
ibuprofen, or any of a number of prescription medications.
If this condition doesn't respond to simple
treatment measures, the patient should undergo more
tests. When costochondritis is associated with liver disease, it
is more
difficult to treat.
For more info on PBC, go to
http://members.aol.com/pbcers/pbcers.htm
Article #5
Costochondritis
Authored by Lynn K. Flowers, M.D., LCDR MC
USNR, Assistant Professor, Eastern Virginia Medical School
INTRODUCTION
Background:
Costochondritis is a benign cause of chest pain,
in contrast to myocardial ischemia or infarction, which is an important
consideration in the differential diagnosis of chest pain. Although the
term costochondritis is often used interchangeably with fibrositis and
Tietze’s Syndrome, these are distinct diagnoses.
Pathophysiology:
Costochondritis is an inflammatory process of
the costochondral or costosternal joints that causes localized pain and
tenderness. Any of the seven costochondral junctions may be affected and
more than one site is affected in 90% of cases. The second to fifth costochondral
junctions are most commonly involved.
Frequency:
In the U.S.: The exact
prevalence of a musculoskeletal etiology for chest pain is not known. However,
in one clinic study the overall prevalence of a musculoskeletal etiology
for chest pain was found to be about 10%. In a 1994 Emergency
Department (ED) study 30% of chest pain patients were judged to have costochondritis.
Mortality/Morbidity: The course is generally self limited, but often with recurrent or persistent symptoms.
CLINICAL
History: The onset is often insidious. Chest
wall pain with a history of repeated minor trauma or unaccustomed activity
(i.e. painting, moving furniture, etc.) is common.
Pain description:
Worse with trunk movement, deep inspiration, and/or exertion
Better with decreased movement, breathing quietly, or changing position
Sharp, nagging, aching, or pressure-like
Usually well-localized, but may extend or radiate extensively
Can be severe
May wax and wane
Physical: Pain with palpation of affected costochondral joints is a constant finding in costochondritis. The second through the fifth costochondral junctions are the sites typically involved. More than one junction is involved in >90% of cases. Surprisingly, patients may not be aware of the chest wall tenderness until examination. The diagnosis should be reconsidered in the absence of local tenderness to palpation. Tietze’s Syndrome is characterized by nonsuppurative swelling, whereas costochondritis has no palpable swelling.
Causes:
The etiology is not well defined. Repetitive
minor trauma has been proposed as the most likely cause. Bacterial or fungal
infections of these joints occur uncommonly. These patients are more likely
to be intravenous drug abusers or postoperative thoracic surgery patients.
DIFFERENTIALS
Abdominal Trauma, Blunt
Acromioclavicular injury
Anxiety
Gout and Pseudogout
Herpes Zoster
Myocardial Infarction
Neoplasms, Lung
Sternoclavicular Joint Injury
WORKUP
Lab Studies:
There are no specific
studies for costochondritis. Labs orders should be guided by the clinical
scenario and the most likely differential diagnoses.
Imaging Studies:
Chest x-ray should be
obtained in the work up of the differential diagnoses.
Bone (gallium) scans
have been used in the U.S., though not an ED study.
TREATMENT
Emergency Department Care: Reassurance of the
benign nature of the condition and adequate pain control are the
important objectives. Narcotic analgesics are
not generally required.
Drug Category: Nonsteroidal Anti-inflammatory
Drugs -
Provides pain management and anti-inflammatory effects
Drug Name
ibuprofen (Motrin)
Adult Dose
400-800 mg POq4h-q6h
maximum daily dose 3200mg
Pediatric
10 mg/kg per dose qid
Contraindications
hypersensivity to NSAIDS or aspirin
Interactions
anticoagulants,aspirin,methotrexate,furosemide, ,
lithium
Pregnancy Precautions
Not recommended during pregnancy
Further Outpatient Care:
Nonsteroidal anti-inflammatory
drugs
Local heat
Local infiltration of
local anesthetic, steroid, or both, or intercostal nerve block. (Reserved
for refractory cases.)
Biofeedback
Complications:
Misdiagnosing myocardial
ischemia or infarction
Extensive and expensive
negative work-ups
Prognosis: Excellent
After one year about
one-half may continue with some discomfort, but only one-third report tenderness
with palpation.
Patient Education:
Patients should be given
reassurance of the benign nature of the problem and they should be instructed
regarding the avoidance of provoking activities. Patients should
have a good understanding of the proper use and potential adverse
effects of NSAIDs.
Costochondritis is an inflammation of the ribs, usually where they attach to the breastbone or sternum.
A person with costochondritis may have pain in the front of the rib cage. Sometimes there is redness and swelling of the tissues around the sternum. The chest pain is described as dull and aching. The pain gets worse if pressure is put on the sore ribs.
It is very important to have all pain in and around the chest evaluated by your healthcare provider. Costochondritis is not life threatening but a heart attack is.
Sometimes a blow to the chest wall will cause costochondritis. Many times it is not known why inflammation sets in.
Treatment for the problem is simple. It includes:
© 1998 Loyola University
Health System. All Rights Reserved.