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Costochondritis is an inflammation of the cartilage that attaches the inner end of the upper ribs to the flat bone in the middle of the chest (known as the sternum). Cartilage is a type of tissue that helps form many important body structures. For example, the ears are mostly made of cartilage.
WHAT ARE COMMON SYMPTOMS OF COSTOCHONDRITIS?
The symptoms of costochondritis usually begin slowly over time. The initial symptom of costochondritis can feel like a heart attack, causing may sufferers to go to the emergency room. In fact, about 30% of people that go to the hospital with chest pain have costochondritis.
Sharp chest pain, irritation, and chest tightness usually occurs in costochondritis. The chest pain may radiate outwards from one side of the chest to the other and to the arms and neck. It can also radiate to the back and stomach. The pain is more common on the left side of the body. It is possible to feel pain in more than one body part at the same time in costochondritis.
In the beginning of costochondritis, the pain is usually worse. Eventually, the chest pain usually becomes a dull, constant ache. A sharp pain is often felt in the ribs, which are often sensitive when touched. The pain is usually anywhere from the 4th through the 6th ribs, but can occur in any of the first 7 ribs. In over 90% of the cases more than one rib is affected. For reference, the 1st rib is underneath collar bone, the 2nd rib is underneath the first rib, the 3rd rib is underneath the 2nd rib, and so on.
It has been estimated that about 10% of chest pain episodes in the United States are due to costochondritis. Among children, about 10 to 30% of chest pain episodes are due to costochondritis.
Women with costochondritis may find that it hurts to wear a bra. People with costochondritis often find that it hurts to breathe (especially when taking deep breaths) or make sudden movements. The reason why it hurts to breath is because the inflamed cartilage causes there to be less room for the lungs to enlarge. The lungs are two organs in the body that help people breathe.
HOW IS COSTOCHONDRITIS DIAGNOSED?
The doctor can usually diagnose costochondritis by taking a complete history of the patient and doing a physical examination. The doctor will push on the ribs to see if it causes pain or if that area is sensitive to touch. Without this sensitivity being present, the doctor will usually not diagnose costochondritis. Some patients are not aware of the sensitivity in the chest until they are examined. The doctor's main area of concern will be to make sure that the reported symptoms are not due to a heart attack or heart condition. If a heart related problem is not the cause, costochondritis will usually be diagnosed. There is no test for costochondritis, but the doctor may send the patient for a chest x-ray to see if there are any other possible causes of the symptoms.
WHO USUALLY GETS COSTOCHONDRITIS?
Costochondritis usually occurs in older children and young adults, but it can occur in any age group. Most people that get costochondritis are between the ages of 12 and 14. Approximately 650,000 people between the ages of 10 to 21 are evaluated for chest pain every year. Females are more likely than males to have costochondritis. Specifically, one study found that about 69% of people with costochondritis are females whereas 31% are male.
WHAT CAUSES COSTOCHONDRITIS?
It is not always known what causes costochondritis. Some possibilities include an infection (from bacteria or a virus), a disease that causes inflammation in the chest area, a traumatic injury to the chest muscles, or recent chest or heart surgery. A virus that affects the ability to breathe can lead to costochondritis because the person may strain while coughing. In addition, the virus may directly cause the rib cartilage to be inflamed. Chest or heart surgery can make it more likely for the rib cartilage to become infected with bacteria. If infection after chest surgery is the cause, there will be redness, swelling, or pus located at the surgery site. Pus is a yellow or green creamy substance sometimes found at the site of infections.
Any physical activity (such as exercise, moving heavy objects) that causes strain to the ribs or chest can lead to costochondritis. Sometimes, the cause may be repeated minor trauma to the chest or ribs. Rarely, infection from a fungus will cause costochondritis. A fungus is a simple type of parasite. A parasite is an organism that lives in or on another organism to obtain nourishment.
HOW IS COSTOCHONDRITIS TREATED AND MANAGED?
The first way costochondritis is usually treated is for the person to get a lot of rest and to apply heat to the painful area of the chest. The heat can be in the form of a heating pad, hot bath, or warm, moist towels. This is usually done for 10 to 20 minutes, every hour, for 48 hours. Many doctors will tell patients with costochondritis to take medications that decrease inflammation, such as aspirin, acetaminophen, or ibuprofen. These are medications that can be purchased at the store without a prescription. If a stronger anti-inflammatory medication is needed, the doctor can prescribe one.
Some doctors use cortisone shots to decrease the inflammation associated with costochondritis. Cortisone is another type of drug that reduces inflammation. This drug is not usually used for long periods of time because it can damage the cartilage. Also, cortisone shots do not cure costochondritis. If costochondritis is caused by an infection, antibiotic medications will be provided to fight the infection.
One way that costochondritis is treated is by avoiding the conditions that make the pain worse. Thus, avoiding exhausting physical activity and not bumping into the ribs will be helpful. Trying to perform physical activities in an easy, less stressful manner is also helpful. Physical therapy has been used to treat costochondritis. Gentle stretching of the chest muscles 2 to 3 times a day has provided relief for some patients.
Some sufferers of costochondritis have turned to acupuncture for help. Acupuncture is a form of Chinese medicine that inserts needles into a person's skin to reduce pain and treat various disorders. Some doctors will treat cases of costochondritis that keep coming back with a local nerve block. Biofeedback can be helpful to decrease the pain. Biofeedback is a technique in which body processes (such muscle tension) are made perceptible to the senses in order to control them with the power of thought. As a last resort, if no medical treatment has worked, some patients have opted to have the sensitive cartilage removed after surgery.
HOW LONG DO THE SYMPTOMS LAST?
The symptoms of costochondritis usually go away in about 3 to 8 weeks. Costochondritis may take as long as a year to go away in some people, and the condition can be chronic, meaning that it is a long-term continuous problem. In chronic costochondritis, the pain increases and decreases periodically, but any sudden movement may make it worse or can cause it to reoccur.
In general, costochondritis caused by an infection takes longer to go away than costochondritis that is not caused by an infection. Stress can worsen the pain in this condition, as can pushing, pulling, sneezing, coughing, repetitive movements, working long hours, and consuming caffeine. Cold, rainy, and humid weather can also make the condition worse.
WHAT IS THE PROGNOSIS FOR PEOPLE WITH COSTOCHONDRITIS?
The prognosis for people with costochondritis is excellent. The condition typically goes away completely. However, after one year, half of patients with costochondritis may still have discomfort and about 30% may still be sensitive when touched on the ribs.
CAN COSTOCHONDRITIS BE PREVENTED?
Because there is no clear cause for costochondritis, it is a difficult condition to prevent. However, decreasing physical trauma to the chest and ribs would be helpful in prevention efforts.
WHAT ELSE IS COSTOCHONDRITIS KNOWN AS?
Costochondritis is sometimes spelled as costochondritis and is sometimes referred to as Tietze's syndrome. However, Tietze's syndrome is technically a different condition that involves swelling in the rib area. There is no swelling in the rib area in costochondritis. Also, sensitivity in Tietze's syndrome usually occurs in the 2nd and 3rd ribs, whereas in costochondritis, the sensitivity is usually in the 4th through 6th ribs. Whereas the symptoms of Tietze's syndrome usually begin suddenly, the symptoms of costochondritis usually begin slowly over time.
WHAT IS THE ORIGIN OF THE TERM, COSTOCHONDRITIS?
Costochondritis comes from the Latin word "costa" meaning "rib," the Greek word "chondros" meaning "cartilage," and the Greek word "itis" meaning "inflammation." Put the words together and you have "rib cartilage inflammation"