Lecture Notes: Costochondritis

Overview

• Costochondritis is a musculoskeletal condition involving inflammation of rib cartilage.
  • "Costo" = ribs, "chond" = cartilage, "itis" = inflammation.
• Common cause of chest pain affecting all age groups.
• Etiology is not entirely known; possibly due to trauma or prior infection.

Pathophysiology

• A benign but inflammatory condition.
• Involves inflammation of parts of the rib cage, specifically:
  • Costal cartilage
  • Costochondrial junctions (where ribs meet cartilage)
• Most often affects the second to fifth costochondrial joints.
• Can be unilateral (one-sided) or bilateral.

Signs and Symptoms

• Main symptom: chest pain (dull, sharp, aching, pressure-like).
• Pain location: Most common from the second to fifth costochondrial joint.
• Pain varies in intensity (mild to severe) and worsens with:
  • Changes in position
  • Movement
  • Deep breaths
• Tender to touch (tender to palpation), often reproducible.
• No swelling of costal cartilage (swelling suggests different conditions).
• Pain is typically unilateral.
• Should not be associated with other symptoms like:
  • Radiation to neck or arms
  • Fever
  • Productive cough
  • Nausea and vomiting
  • Pre-syncope or syncope
  • Shortness of breath
  • Arrhythmias

Diagnosis

• Important to rule out serious causes of chest pain, especially in patients over 35.
• Rule out myocardial infarction, pericarditis, etc., using:
  • ECG
  • Troponin levels
• Costochondritis is typically a clinical diagnosis after more serious causes are excluded.

Treatment

• Condition is often self-limiting.
• Symptom relief may include:
  • Applying heat to the affected area.
  • Minimizing causative activities (e.g., strenuous exercise).
  • Use of Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.
  • Use of acetaminophen for those with NSAID contraindications.
  • Physical therapy for refractory cases.

Additional Resources

• For more on chest pain causes, refer to the "Approach to Chest Pain" lesson.

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