Costochondritis

What is costochondritis?

The prefix 'costo-' simply means something to do with the ribs, 'chondr-' means related to the cartilage and '-itis' means inflammation. Costochondritis is therefore an inflammation of the cartilage of the ribs, in particular, the cartilage that joins the ribs to the breastbone, at the front of the chest.

Symptoms

Costochondritis usually develops gradually with increasing tenderness over the breastplate and pain if you put pressure on the ribs in this area. The pain is made worse by anything that moves the ribs and pulls on the cartilage connecting them to the sternum.

Breathing moves your ribs up and down, so simply doing so can make the pain worse. More exaggerated respiration, for example from coughing or sneezing, can cause severe pain.

As the pain is in the chest, sometimes to the side of the sternum, it can be mistaken for the pain of heart disease.

Causes and risk factors

The exact cause of costochondritis is not usually clear. Many people describe doing some sort of activity that they are not used to, such as moving furniture, prior to the onset of symptoms, so trauma (even at a microscopic level) may be a factor. In some cases the trauma is more significant, for example damage to the sternum such as a fracture.

Other possible causes include:

• Mechanical pressure or stress on the sternum
• Viral infections

Treatment and recovery

Treatment mostly consists of finding pain relief that works for you while waiting for the body to heal.

Start with simple analgesics such as paracetamol, which must be taken at regular intervals and not just when the pain is bothering you. Pain killers which also reduce inflammation such as ibuprofen (these are known as non-steroidal anti-inflammatory drugs or NSAIDs) may be particularly helpful. Local heat (such as from a warm pack) can also be soothing.

Vigorous exercise might not be a good idea. When you exercise, you need to increase your breathing depth and rate, increasing the movement of your ribs. This is more likely to aggravate any inflammation. Gentle exercise, however, is fine and some research suggests that gentle stretching of the pectoral muscles 2-3 times a day may help.

Although most people find that the pain soon settles, a significant number still have some discomfort and tenderness several months later. In persistent cases local injections of anaesthetic and steroids to the rib area may be recommended.