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Costochondritis, also called chest wall pain, costosternal syndrome, or costosternal chondrodynia, occurs when the cartilage between a rib and the breastbone (sternum) becomes inflamed and swollen. The symptoms can mimic that of a heart attack, so always go to the doctor at the first sign of chest pain to rule out a heart attack. The doctor will also be able to advise you on how to best combat the pain while you wait for it to heal.
Steps
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Go immediately to the doctor or call emergency responders if you experience chest pain. A medical professional will be able to determine whether it is a heart attack or something less serious, like costochondritis. [1] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- Know what to expect at the doctor’s office. The doctor will likely palpate (examine with their fingers) along your sternum to determine where it hurts and the extent of the inflammation.
- If the doctor is able to reproduce the pain while palpating, it is likely costochondritis and not a heart attack. They will also likely ask about events in your life, like recent injuries, which might be the cause.
- Your doctor may ask you to undergo other tests to rule out other conditions frequently associated with chest pain, including osteoarthritis, lung disease, gastrointestinal conditions, or an infection of the joint. They may request x-rays, CT scans, an MRI, or an electrocardiograph.
- Tell your doctor if you have heart, liver, or kidney disease, high blood pressure, ulcers, or have had internal bleeding in the past. This knowledge will help your doctor tailor your pain management plan to what is right for you. [2] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source
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Take prescription antibiotics if recommended by your doctor. If your case of costochondritis is caused by an infection in the joint, your doctor will likely prescribe antibiotics to be taken orally or through an IV. [3] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- It’s important to note, however, that infections are rarely the cause of costochondritis, so antibiotics usually aren’t necessary.
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Discuss prescription drug options with your doctor. If your pain does not go away after a few weeks, and over-the-counter nonsteroidal anti-inflammatory drugs have not been effective, your doctor may suggest something stronger to help you cope with the pain. Possible prescription medications may include: [4] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- Prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs) similar to ibuprofen (Advil, Motrin). This is the main treatment for costochondritis. If you take these for a long period of time you must be observed by a doctor because they can harm your stomach and kidneys.
- Medications containing codeine, like Vicodin, Percocet, etc. It’s important to exercise caution with these medications, as they can be addictive. [5] X Trustworthy Source Johns Hopkins Medicine Official resource database of the world-leading Johns Hopkins Hospital Go to source
- Some antidepressants or anti-seizure medications can also be effective in managing chronic pain. [6] X Research source
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Consider more invasive procedures to combat the pain. Most cases of costochondritis heal on their own over time. But if the pain remains unbearable, your doctor may suggest: [7] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- Injection of a corticosteroid and a numbing medication directly into the joint that hurts. [8] X Research source
- Transcutaneous electrical nerve stimulation (TENS). This technique uses weak electrical signals to interrupt the pain signals and prevent them from registering in your brain. [9] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
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Try over-the-counter painkillers. Nonsteroidal anti-inflammatory drugs, such as Advil and Aleve, are most likely to be effective. Ask your doctor if they recommend using non-prescription painkillers. These medications may provide you with some relief. [10] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source [11] X Expert Source Ni-Cheng Liang, MD
Board Certified Pulmonologist Expert Interview. 18 June 2021.- If you are taking prescription medicines for this or any other condition, consult with your doctor before starting any over-the-counter medications.
- Your doctor will be able to advise you of any potential interactions between the over-the-counter medications and your other medications.
- Follow the manufacturer’s instructions and consult your doctor if you plan on taking the over-the-counter medications for more than a few days. Do not exceed the recommended dose listed in the medication’s instructions.
- Talk to your doctor before using these over-the-counter medications if you have heart disease, high blood pressure, kidney disease, liver disease, or are prone to stomach ulcers or internal bleeding.
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Rest to give your body time to heal. This may mean refraining from strenuous sports for several weeks. Costochondritis is usually due to activities that stretch the cartilage and muscles around the chest wall, so the number one doctor-prescribed treatment is avoiding the activity that is causing the discomfort. The pain usually goes away after a few days or weeks, but it could take up to a few months. [12] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source
- Rest until you no longer feel pain.
- Reintroduce physical activity into your life slowly to give yourself time to build up lost muscle and stamina.
- Be particularly careful of activities that require sudden, sharp moves, high stress on your chest muscles, or put you at risk of receiving blows to the chest. These include tennis, baseball, golf, basketball, and karate.
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Apply heat to the area that is sore. This may help increase the blood flow and relax muscles that may be tight. [13] X Research source [14] X Expert Source Ni-Cheng Liang, MD
Board Certified Pulmonologist Expert Interview. 18 June 2021.- Use a hot water bottle or a heating blanket.
- Do not apply the heat source directly to your skin. If you use a hot water bottle, wrap it in a towel to protect you from burning yourself.
- Apply the heat for several minutes, then remove it to give your skin a chance to cool down.
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Put an ice pack on the affected joint. The joint is the sore area where your sternum and ribs connect. The ice will help reduce the swelling and soothe the inflammation. [15] X Research source
- A bag of frozen peas or corn wrapped in a towel makes a quick, handy ice pack.
- Do not apply the ice pack directly to your skin.
- After 15–20 minutes, remove the ice pack and give your skin a chance to warm up. Repeat this three to four times daily.
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Stretch tightened chest muscles around the joint. Be careful to do so slowly, gently, and only with a doctor's approval. [16] X Research source The doctor may send you to a specialist to learn what types of exercises would best suit your injury.
- Start easy by stretching your chest muscles with slow deep breaths.
- When you feel ready, add pectoral muscle stretches. An easy way to do this is to brace your forearm against a doorway and then slowly lean forward until you feel the muscles below and around your shoulders stretch. [17] X Research source
- Yoga poses combined with deep breathing are an excellent way to both relax and stretch. Try the Sphinx pose. Lie on your stomach while supporting yourself on your elbows. Then open your chest, stretching up and backwards.
- If the exercises hurt, stop immediately to avoid injuring yourself further.
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Experiment with different positions when you sleep to minimize your discomfort. Try to avoid positions that put pressure on the painful joint. [18] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- It will probably be uncomfortable to sleep on your stomach, for example.
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Improve your posture to reduce the strain on your chest. Sitting or standing with a hunched posture is likely to aggravate your costochondritis and increase your discomfort. To prevent any excess strain on the chest wall area, take steps to maintain proper posture. [19] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- Practice sitting, standing, and walking with a book balanced on your head.
- Concentrate on opening your chest and letting your shoulders roll back.
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Recognize the symptoms. Costochondritis can cause extreme discomfort. Sufferers describe the pain as: [20] X Trustworthy Source National Health Service (UK) Public healthcare system of the UK Go to source
- A sharp, aching, or pressure-like pain located on the side of the breastbone. Common locations are the fourth, fifth, and sixth ribs.
- The pain may also spread to your stomach or back. [21] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source
- The pain may span more than one rib joint and be aggravated by coughing or deep breathing.
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It can be hard to tell the difference between costochondritis and the onset of a heart attack. This is because the main symptom of both is chest pain. The key difference is that, for costochondritis, the painful area is generally sensitive to the touch, and the pain is reproducible when your doctor examines you and palpitates the area. [22] X Research source Even so, in all cases of chest pain, it is essential to see a doctor immediately to rule out a heart attack. [23] X Trustworthy Source National Health Service (UK) Public healthcare system of the UK Go to source
- Signs of a heart attack include discomfort located in the center of the chest (uncomfortable pressure, squeezing, fullness, or pain), discomfort in other areas of your upper body (arms, back, neck, jaw, or stomach), shortness of breath, lightheadedness, and nausea. [24] X Trustworthy Source American Heart Association Leading nonprofit that funds medical research and public education Go to source
- If you experience any of these symptoms, call 911 and seek medical attention immediately.
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Know what can cause costochondritis. Costochondritis has various causes. Some frequent ones are: [25] X Trustworthy Source National Health Service (UK) Public healthcare system of the UK Go to source
- An injury which damages the cartilage that joins the rib and breastbone. This may be the result of a blow, or straining while carrying heavy items.
- An upper respiratory infection that causes severe coughing can also trigger costochondritis. [26]
X
Expert Source
Ni-Cheng Liang, MD
Board Certified Pulmonologist Expert Interview. 18 June 2021. - Arthritis in the joint. Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis can cause chest pain.
- An infection in the joint, such as tuberculosis, syphilis, or aspergillosis. Sometimes costochondritis is caused by a bacterial infection in the joint after surgery as well.
- A tumor infecting the joint.
- In other cases there may be no clear cause. [27] X Research source
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Expert Q&A
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QuestionHow can I get rid of costochondritis pain fast?Dr. Ni-Cheng Liang is a board certified Pulmonologist and the Director of Pulmonary Integrative Medicine at Coastal Pulmonary Associates affiliated with the Scripps Health Network in San Diego, California. She also serves as a Voluntary Assistant Professor of Medicine at the University of California San Diego School of Medicine while volunteering for the UCSD Medical Student-Run Free Clinic for uninsured patients. With over 15 years of experience, Dr. Liang specializes in pulmonary and respiratory medical concerns, mindfulness teaching, physician wellness, and integrative medicine. Dr. Liang received her Doctor of Medicine (MD) from the University of Maryland School of Medicine. Dr. Liang was voted as a San Diego Top Doctor in 2017 and 2019. She was also awarded the 2019 American Lung Association San Diego Lung Health Provider of the Year.Ask a healthcare professional if Tylenol or ibuprofen are recommended for you. Over-the-counter pain relievers or analgesics might provide some temporary relief.
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QuestionIs ice or heat better for costochondritis?Dr. Ni-Cheng Liang is a board certified Pulmonologist and the Director of Pulmonary Integrative Medicine at Coastal Pulmonary Associates affiliated with the Scripps Health Network in San Diego, California. She also serves as a Voluntary Assistant Professor of Medicine at the University of California San Diego School of Medicine while volunteering for the UCSD Medical Student-Run Free Clinic for uninsured patients. With over 15 years of experience, Dr. Liang specializes in pulmonary and respiratory medical concerns, mindfulness teaching, physician wellness, and integrative medicine. Dr. Liang received her Doctor of Medicine (MD) from the University of Maryland School of Medicine. Dr. Liang was voted as a San Diego Top Doctor in 2017 and 2019. She was also awarded the 2019 American Lung Association San Diego Lung Health Provider of the Year.Opt for heat, like a warm compress, heating pad, or hot, wet towel. Feel free to use these when you're sitting, watching TV, or about to go to sleep.
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QuestionCan costochondritis develop four years after cardiac surgery?Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017.Yes, during cardiac surgery there is manipulation of the rib cage, so I can foresee perhaps developing costochondritis later on after the surgery.
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References
- ↑ https://my.clevelandclinic.org/health/diseases/22167-costochondritis
- ↑ https://medlineplus.gov/ency/article/000164.htm
- ↑ https://my.clevelandclinic.org/health/diseases/22167-costochondritis
- ↑ https://www.ncbi.nlm.nih.gov/books/NBK532931/
- ↑ https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids
- ↑ https://www.sydney.edu.au/news-opinion/news/2023/02/02/antidepressants-use-for-chronic-pain-on-the-rise-but-are-they-ef.html
- ↑ https://my.clevelandclinic.org/health/diseases/22167-costochondritis
- ↑ https://health.students.vcu.edu/media/student-affairs-sites/ushs/docs/COSTOCHONDRITIS.pdf
- ↑ https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens
- ↑ https://medlineplus.gov/ency/article/000164.htm
- ↑ Ni-Cheng Liang, MD. Board Certified Pulmonologist. Expert Interview. 18 June 2021.
- ↑ https://medlineplus.gov/ency/article/000164.htm
- ↑ https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=te8250&
- ↑ Ni-Cheng Liang, MD. Board Certified Pulmonologist. Expert Interview. 18 June 2021.
- ↑ https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=te8250&
- ↑ https://health.students.vcu.edu/media/student-affairs-sites/ushs/docs/COSTOCHONDRITIS.pdf
- ↑ https://health.students.vcu.edu/media/student-affairs-sites/ushs/docs/COSTOCHONDRITIS.pdf
- ↑ https://my.clevelandclinic.org/health/diseases/22167-costochondritis
- ↑ https://www.ncbi.nlm.nih.gov/books/NBK532931/
- ↑ https://www.nhs.uk/conditions/costochondritis/
- ↑ https://medlineplus.gov/ency/article/000164.htm
- ↑ https://kidshealth.org/en/parents/costochondritis.html
- ↑ https://www.nhs.uk/conditions/costochondritis/
- ↑ https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
- ↑ https://www.nhs.uk/conditions/costochondritis/
- ↑ Ni-Cheng Liang, MD. Board Certified Pulmonologist. Expert Interview. 18 June 2021.
- ↑ https://health.students.vcu.edu/media/student-affairs-sites/ushs/docs/COSTOCHONDRITIS.pdf
About This Article
Article Summary
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To treat costochondritis, it's important that you seek medical attention immediately since the symptoms of costochondritis can be similar to those of a heart attack. Once your doctor determines that you're suffering from costochondritis, they may prescribe you antibiotics and pain medication. There are also things you can do at home to manage the pain, like taking over-the-counter pain relievers. You can also apply heat to the area for several minutes to relax your muscles, and you can ice the area for 15-20 minutes to help reduce swelling and inflammation. For more advice from our Medical co-author, like how to recognize the symptoms of costochondritis, scroll down.
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"I have had these exact symptoms for many years. It has definitely lowered the quality of my life, as I am unable to do any of the activities I enjoy. I surfed over 50 years, and I am sure all the paddling caused this condition. I am relieved to have found the information you provided. Thank you."
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