The second through the fifth costochondral junctions typically are involved.
More than one junction is involved in more than 90% of patients.
Patients may not be aware of the chest wall tenderness until examination.
Costochondritis has no palpable edema.
Pain may be described as follows:
Exacerbated by trunk movement, deep inspiration, and\or exertion.
Lessens with decreased movement, quiet breathing, or change of position.
Sharp, nagging, aching, or pressure like.
Usually quite localized but may extend or radiate extensively.
May be severe and/or debilating.
May wax and wane.
Costochondritis when associated with RPC is best controlled through RPC medications and non-exasperation of the inflammed joints. Active inflammation and pain is a symptom of flaring.
Nonsteroidal anti -inflammatory drugs (NSAIDs) are useful. Used typically for the relief of mild to moderate pain and inflammation. The affects of NSAIDs in the treatment of pain and inflammation tend to be patient specific. Chronic episods of costochondritis may indicate the need for DMARD's and is some cases pain medications.
NSAIDs for pain control.
Avoid repetitive mis-use of muscles.
Modify improper posture or ergonomics of the home or work place.
Local heat or ice packs.
Local infiltration of local anesthetic, steroid, or intercostal nerve block
(reserved for refractory cases).
Gentle stretching of the pectoralis muscles 2-3 times a day may be beneficial.
Primary care follow-up with persistent symptoms.
Imaging studies:
No specific studies exist for costochondritis. The clinical scenario and the most likely differently diagnosis should guide lab orders. Obtain a chest radiograph in the workup of the differential diagnoses. Bone (gallium) scans have been used in the United States, although these are not ED studies.
Costochondritis is an inflammatory process of the costochondral or costosternal joints that causes localized pain and tenderness. Any of the 7 costochondral junctions may be affected, and more than 1 site is affected in 90% of cases. The second to fifth costochondral junctions most commonly are involved costochondritis is a benign cause of chest pain and is an important consideration in the differential diagnosis. Although the term costochondritis often is used interchangeably with fibrositis and Tietze syndrome, these are distinct diagnoses. The condition's course may be self-limited, but the patient often experiences recurrent or persistent symptoms and pain. Severe cases may be complicated by dislocation of the clavicles and ribs, or a flailed chest was secondary to lysis of costosternal cartilage.
The onset is often insidious in Relapsing Polychondritis. Chest wall pain with a history of repeated minor trauma or unaccustomed activity (e.g., painting, moving furniture) is common. Pain with palpation of affected costochondral joints is a constant finding in costochondritis.
Infection from pyogenic organisms, tuberculosis, fungal or viral associated with trauma, a sternotomy incision or drainage from intrathoracic or peritoneal foci.
Chest wall irradiation, and deep chest wall burns (particularly of electrical origin).
Costochondritis secondary to hematogenous seeding of Candida albicans in intravenous drug abusers has become increasingly recognized.
