Conditions · Chest

Costochondritis !

Costochondritis is inflammation of the cartilage where the ribs join the breastbone, causing chest pain that hurts more when the spot is pressed.

Updated 2026-10-29

Structures involved

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What it is

Inflammation of the cartilage where the ribs join the sternum, causing sharp anterior chest pain that is reproduced by pressing on the joint. It is a diagnosis of exclusion once cardiac and other serious causes are ruled out.

Who gets it

A frequent cause of chest pain in primary care and emergency departments, especially in women, adolescents and young adults.

Causes

Usually idiopathic
Repetitive minor trauma or unusual exertion
Severe or persistent coughing
After respiratory infections
Rarely infection after sternotomy or injection drug use

Risk factors

Female sex
Age under 40
Strenuous upper body exercise or heavy lifting
Recent respiratory infection with cough
Fibromyalgia

Pathophysiology

Low-grade inflammation of the costochondral and costosternal joints, usually ribs 2 to 5, sensitises the joint, so movement, deep breathing and pressure provoke pain. Unlike Tietze syndrome, there is no visible swelling.

Symptoms and signs

Sharp or aching anterior chest pain, often on the left
Pain reproduced by pressing on the costochondral junctions
Pain worse with deep breathing, coughing or moving the arms and trunk
Usually several adjacent junctions, without swelling

Diagnosis

Clinical: Reproducible point tenderness at the costochondral junctions with a normal examination otherwise. It is diagnosed only after cardiac and other serious causes are reasonably excluded; tenderness alone does not rule out heart disease.
Tests: ECG and troponin when the history or risk factors suggest a cardiac cause; inflammatory markers if infection or systemic disease is suspected.
Imaging: Chest X-ray when lung or bone disease is possible; imaging is normal in costochondritis.

Differential diagnosis

Acute coronary syndrome or stable angina
Pericarditis
Pulmonary embolism
Pneumothorax
Gastro-oesophageal reflux
Tietze syndrome or rib fracture

Goal of treatment

Relieve pain, reassure once serious causes are excluded and return the patient to normal activity.

Treatment

Conservative: Explanation and reassurance, relative rest and avoiding activities that provoke the pain; local heat.
Medical: Simple analgesics and non-steroidal anti-inflammatory drugs, oral or topical, if there are no contraindications.
Rehabilitation: Gentle chest wall stretching and physiotherapy for persistent cases.
Follow-up: Review if pain changes or warning signs appear; local injection is rarely used for refractory cases.

Complications

Missed cardiac or pulmonary diagnosis if evaluation is incomplete
Chronic or recurrent chest pain
Anxiety about heart disease

Prognosis

Benign and self-limiting; most cases resolve in weeks to months, though some recur.

Test yourself

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What finding supports costochondritis on examination?

Pain reproduced by pressing on the costochondral or costosternal junctions, usually ribs 2 to 5.

Why is costochondritis called a diagnosis of exclusion?

Because cardiac, pulmonary and other serious causes of chest pain must be excluded first; chest wall tenderness does not rule them out.

How is costochondritis different from Tietze syndrome?

Tietze syndrome has visible swelling of the joint, usually ribs 2 to 3; costochondritis has no swelling.

What drug class is usually used for costochondritis pain?

Non-steroidal anti-inflammatory drugs, oral or topical, plus simple analgesics.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Costochondritis (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

Costal cartilages highlighted on the Durgical 3D model