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# Costochondritis

Costochondritis is inflammation of the cartilage where the [ribs](https://durgical.com/en/anatomy/ribs/) join the breastbone, causing chest pain that hurts more when the spot is pressed.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Costal cartilages](https://durgical.com/en/anatomy/costal-cartilage/)
- [Sternum](https://durgical.com/en/anatomy/sternum/)
- [Ribs (back part)](https://durgical.com/en/anatomy/ribs/)
- [Pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/)
- [Intercostal nerves](https://durgical.com/en/anatomy/intercostal-nerves/)
- [Internal intercostals](https://durgical.com/en/anatomy/internal-intercostal-muscles/)

## What it is

Inflammation of the cartilage where the ribs join the [sternum](https://durgical.com/en/anatomy/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

## Red flags

- Exertional pain, sweating, breathlessness or radiation to the arm or jaw (acute coronary syndrome)
- Fever, redness or swelling over the joint (infection)
- Sudden breathlessness or hypoxaemia (pulmonary embolism, pneumothorax)
- Abnormal ECG or vital signs

## 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](https://durgical.com/en/anatomy/region/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

Think of the answer, then tap the question to see it.

## 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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## Related conditions

- [Stable angina](https://durgical.com/en/conditions/stable-angina/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Pneumothorax](https://durgical.com/en/conditions/pneumothorax/)
- [Acute pericarditis](https://durgical.com/en/conditions/acute-pericarditis/)
- [Rib fractures](https://durgical.com/en/conditions/rib-fractures/)

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

Sources: [Costochondritis](https://www.ncbi.nlm.nih.gov/books/NBK532931/) (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/costochondritis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/costochondritis/