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Related to costochondritis: Tietze syndrome




Costochondritis is an inflammation and associated tenderness of the cartilage (i.e., the costochondral joints) that attaches the front of the ribs to the breastbone.


Costochondritis causes pain in the lower rib area or upper breastbone. Some patients fear they are having a heart attack. The most severe pain is usually between the breast and the upper abdomen. The pain may be greater when in sitting or reclining positions. Stress may aggravate this condition. Generally the third or fourth ribs are affected. However, any of the seven costochondral junctions may be affected, and more often than not more than one site is involved. The inflammation can involve cartilage areas on both sides of the sternum, but usually is on one side only. Costochondritis should be distinguished from Tietze Syndrome, which is an inflammation involving the same area of the chest, but also includes swelling.

Causes and symptoms

The causes of costochondritis are not well-understood and may be difficult to establish. The most likely causes include injury, repetitive minor trauma, and unusual excessive physical activity.
The primary symptom of costochondritis is severe chest wall pain, which may vary in intensity. The pain becomes worse with trunk movement, deep breathing, and/or exertion, and better with decreased movement, quiet breathing, or changing of position. It is usually localized but may radiate extensively from the chest area. The pain has been described as sharp, nagging, aching, or pressure-like.


Diagnosis is based on pain upon palpation (gentle pressing) of the affected joints. Swelling is not associated with costochondritis. Diagnosis is also dependent on the exclusion of other causes, including heart attack or bacterial or fungal infections found in IV drug users or postoperative thoracic surgery patients.


The goals of treatment are to reduce inflammation and to control pain. To accomplish these goals, nonsteroidal anti-inflammatory agents (NSAIDs) are used, with ibuprofen usually selected as the drug of choice. Other NSAIDS options are flurbiprofen, mefenamic acid, ketoprofen, and naproxen. Additional treatment recommendations include the use of local heat, biofeedback, and gentle stretching of the pectoralis muscles two to three times a day.
For more difficult cases, where the patient continues to exhibit pain and discomfort, cortisone injections are used as therapy.

Alternative treatment

Supplements that are used to reduce inflammation have been used to treat costochondritis. Examples of such supplements include ginger root, evening primrose oil, bromelain, vitamin E, omega-3 oils, and white willow bark. Glucosamine/chondroitin sulfate, which may aid in the healing of cartilage, has also been used. Other alternative therapies include acupuncture and massages.


The prognosis for recovery from costochondritis is good. For most patients, the condition lessens in six months to a year. However, after one year, about one-half of patients continue with some discomfort, while about one-third still report tenderness with palpation.


Though the causes of costochondritis are not well known, avoidance of activities that may strain (e.g., the repetitive misuse of muscles) or cause trauma to the rib cage is recommended to prevent the occurrence of costochondritis. Modification of improper posture or ergonomics of the home or work place may also deter the development of this condition.

Key terms

Inflammation — Process whereby the immune system reacts to infection or other stimulus, characterized by pain, swelling, redness, and warmth of the affected part



Day, C. Costochondritis Web Site. 2001. 〈〉.
Flowers, L. K., and B. D. Wippermann. "Costochondritis." eMedicine Journal: Emergency Medicine/Rheumatology. February 23, 2001.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


Inflammation of one or more costal cartilages, characterized by local tenderness and pain of the anterior chest wall that may radiate, but without the local swelling typical of Tietze syndrome.
Synonym(s): costal chondritis
[costo- + G. chondros, cartilage, + -itis, inflammation]
Farlex Partner Medical Dictionary © Farlex 2012


Inflammation of one or more of the costal cartilages, characterized by pain of the anterior chest wall that may radiate.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Inflammation of rib cartilage, especially sternal Clinical Peristernal pain, tenderness
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


Inflammation of one or more costal cartilages, characterized by local tenderness and pain of the anterior chest wall that may radiate, but without the local swelling typical of Tietze syndrome.
[costo- + G. chondros, cartilage, + -itis, inflammation]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

Patient discussion about costochondritis

Q. how long dose costochondritis last

A. a friend of mine who had the disease saw an improvement within a few weeks, and it resolved completely within a few months,but his doctor said there are patients in whom this problem persists for some time. All symptoms of pain should resolve within six months.

Q. I was in the ER because of a chest pain and the doctor there said its costochondritis. What does it mean? I am a 42 years old man. Last night i went to the ER because of a chest pain. The doctors there did many test and in the end they said its costochondritis. What does it mean? Can someone elaborate about the risk factors that can cause this symptom?

A. It seems that you are suffering from a traumatic injury to the skeleton that is near the heart which is called costochondritis. It can be a result of a simple trauma to the area or (as in my case, I am a rower) due to repetitive use of the muscles of the thorax and arms

Q. What is the differential diagnosis of chest pain in a 35 year old woman? I am a 35 years old woman. I suffer from chest pain for about 24 hours. I just came back from a trip to Europe, and i feel really bad. I smoke and I take anti contraceptive and i know that I am at a risk for pulmonary embolism or costochondritis. Cat it be something else?

A. The differential diagnosis of chest pain is very wide.
It can start in costochondritis if u carried a lot of luggage or might be pulmonary embolism if you didn't move from the chair all the flight. But it can also be a sign for an acute coronary syndrome (even at the age of 35) or a pericarditis. To be sure you need to consult with your GP.

More discussions about costochondritis
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References in periodicals archive ?
I requested a consult with my rheumatologist on the possibility that LD can cause costochondritis. He called my physician, and that was the beginning of the next 12 weeks of intravenous antibiotics.
Swayne, "Gallium detection of Salmonella costochondritis," Journal of Nuclear Medicine, vol.
We present a case study of a female competitive swimmer with anterior chest pain, diagnosed as chronic costochondritis, and managed conservatively.
Mastalgia may be related to infection, malignancy, or extramammary conditions such as muskuloskeletal chest wall pain (Tietze syndrome or costochondritis), cervical spine disease, cardiac disease, or others.
This is likely costochondritis, or some other type of inflammation of the ribcartilage joints that you have in each rib on the front of your chest.
These include bone or muscle pain caused by physical strain or trauma and costochondritis.
The word "potential" can be added to demonstate to outside observers the physician's concern regarding the potential severity of the presenting complaint (eg, anterior heavy chest pain could easily be described as "potential high severity," even if subsequent workup revealed that the patient only had costochondritis).
But he was only cleared to face hot favourite Michael van Gerwen (right) in the semi-finals after being diagnosed with costochondritis - chest wall pain caused by acute inflammation of cartilage connecting ribs to the sternum.
* Osteoarthritis, costochondritis, rheumatoid arthritis, ankylosing spondylitis and other disorders.
The GP said it was a condition called costochondritis and it would settle down.
After all, the costochondritis could be an MI, the headache could be a stroke, and the abdominal pain may mean cancer.