hi everyone this lesson is on costochondritis in this lesson we're going to talk about what this condition is we're also going to talk about some of the pathophysiology behind why it occurs and then we're going to talk about the signs and symptoms how it's diagnosed and how it's treated so costochondritis if we were to actually look at the word costochondritis costo refers to the ribs the prefix cond refers to cartilage and the suffix itis refers to inflammation so costochondritis is a musculoskeletal condition involving inflammation of costal cartilage which is actually rib cartilage we're going to talk a bit more about this in a moment causal chondritis is actually a common cause of chest pain and it affects all age groups so it is actually a relatively common complaint that is brought to the emergency department now the etiology as to why costochondritis occurs is not entirely known it's believed that it may be due to trauma or a previous infection now let's talk briefly about the pathophysiology behind why this occurs first it's important to note that costochondritis is a benign condition but as mentioned before it's an inflammatory condition it involves inflammation of parts of the rib cage so some of those parts include the costal cartilage so the costal cartilage is this reddened area here and then the costochondrial junctions which are where these oni ribs meet with the cartilage and these parts are going to be most often affected so the reddened areas here are going to be the most often affected and it's going to affect the second to fifth costochondrial joints most often so the second to fifth are going to be here so the second third fourth and fifth and oftentimes it's going to be unilateral which means on one side but it can affect both sides as well so what are some of the signs and symptoms of costochondritis as mentioned before casa chondritis is a common cause of chest pain so chest pain is going to be the main symptom of costochondritis and the pain is going to be described as a dull sharp aching or pressure like pain and again it's going to be located from the second to the fifth costochondrial joint most commonly it varies in intensity so it can be very mild or can be severe in some cases and this pain worsens with changes in position and movement so it may look like a positional chest pain and it worsens with taking a deep breath and it's also important to note that there's no swelling that's present so the causal cartilage does not become swollen if it does that is a different condition and as mentioned before it's most often unilateral and what's going to be important with regards to costochondritis the chest pain and cascandritis is that it's tender to touch it's tender to palpation so this pain is often reproducible when palpated or when touched so can be quite focal so if you touch on a certain area that can often reproduce the pain that the patient is experiencing and again this is going to be very important when determining that a patient has cosmic androidis because reproducibility to touch is actually a very atypical finding with chest pain from coronary artery disease but having said that it's not entirely out of the realm of possibilities that if you were to touch an area and you reproduce that pain that it's going to be caustic androidis it could be one of those other more serious conditions like coronary artery disease or some other condition so again this can look like coronary artery disease it may even look like pericarditis in some cases but what's going to give it away is that tender to palpation that reproducibility by touching the area that's affected we're going to talk a bit more about this in a moment but this is very important to take away here it's also important to note that the chest pain should not be associated with the following characteristics it shouldn't radiate to the neck or the arms there shouldn't be a fever present there shouldn't be a productive cough present there shouldn't be nausea and vomiting there shouldn't be pre-syncope or syncope which is feeling faint or fainting there shouldn't be a shortness of breath and then there shouldn't be any arrhythmias if any of these are present then this chest pain is going to be more likely to be from a more serious cause so again the chest pain from causandritis can look like a serious condition but if it is carcinogens if it's caused by cosmetics this is a benign condition so again these are very important to look out for and again the big thing to take away here is that the chest pain is tender to palpation and then what's also important to take note of from a patient's history is that there's often a history of strenuous exercise trauma or a previous cough how is causing android is diagnosed and treated what i want you to take away from this is that it's important to rule out serious causes of chest pain especially in patients older than the age of 35 so under the age of 35 it's still important but it is more likely that it could be related to causing andreitis especially if it's reproducible to touch or tender to palpation in that same area the patient is noting if the patient is older it's very important to rule out these other serious causes including myocardial infarction pericarditis and so on and in order to do that it's important to perform an ecg and to take troponin levels to see if there is any sign of a myocardial infarction for instance so again very important to look out for so oftentimes costochondritis itself is going to be after more serious causes have been ruled out and it's going to be clinical diagnosis from what we talked about in the last slide so again history and physical exam very important how is costcondritis treated so clinicians once they make the diagnosis how do they treat it oftentimes causing dendritis itself is a self-limiting condition but what can help with the symptoms include the following applying heat to the affected area so a heat pack to the affected area can help it's also important to minimize the causative activity so for instance those strenuous exercise which can be something that may be triggering or exacerbating the pain from the costochondritis non-steroidal anti-inflammatory drugs like nsaids can be utilized for pain relief so nsaids including ibuprofen and proxin and then acetaminophen so tylenol can be used for patients with contraindications for nsaid use and for patients who continue to have issues with caustic contrast so refractory costochondritis physical therapy may help with these patients if you want to learn more about other causes of chest pain please check out my approach to chest pain lesson and if you haven't already please like and subscribe for more lessons like this one thanks much for watching and hope to see you next time