Chest pain is not an uncommon symptom. While it may not be considered uncommon, it is disconcerting to say the least. When faced with chest pain, people typically think of a heart attack. But, several other conditions are also associated with chest pain. It is imperative to be assessed immediately and have the cause determined.
Aside from cardiac problems, chest pain may be caused by pulmonary or gastrointestinal disease. Pain also may radiate to the chest with cervical or thoracic spine disease. Musculoskeletal diseases, costochondritis and Tietze's syndrome, also are associated with chest wall pain.
Distinguishing Between Costochondritis and Tietze's Syndrome
While costochondritis and Tietze's syndrome are often regarded as different names for the same condition, there is one feature that distinguishes them. Costochondritis and Tietze's syndrome are both caused by inflammation of costochondral junctions of ribs or the chondrosternal joints of the anterior chest wall. Both conditions are characterized by tenderness of costal cartilages -- the cartilages that connect the sternum (i.e., breastbone) and the ends of the ribs. However, there is local swelling with Tietze's syndrome and no swelling with costochondritis.
- is less common than costochondritis
- onset may be gradual or sudden
- swelling usually occurs in the second or third costal cartilage
- pain can radiate to the shoulder and is aggravated by coughing, sneezing or movement of chest wall
- tenderness is palpable
- one costal cartilage site is involved in 70% of cases
- is more common than Tietze's syndrome
- is associated with pain and tenderness of chest wall, with no swelling
- tenderness usually extends over more than one costochondral area in 90% of cases
- the second to fifth costochondral junctions are usually involved
- is also referred to as anterior wall syndrome, costosternal syndrome, parasternal chondrodynia, chest wall syndrome
During a physical examination of the chest, pain that can be reproduced with palpation over the costal cartilages generally is enough to make the diagnosis of costochondritis in children, teens, and young adults. For patients who are older than 35 years of age, patients with a risk or history of coronary artery disease, or anyone having cardiopulmonary symptoms, an EKG (electrocardiogram) and chest x-ray are usually recommended in addition to the physical exam.
Clinical trials of treatment for costochondritis do not exist. Treatment essentially focuses on pain relief. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and other analgesic drugs are prescribed to manage pain associated with costochondritis. Along with prescribed medications, pain management may include rest, heat compresses, heating pads, and avoiding activities that increase pain. Physical therapy is rarely needed, but in certain cases, it may be a useful treatment option. Lidocaine/corticosteroid injections into the affected costochondral areas can be considered, especially if other treatment options are providing little to no relief, but it is rarely needed.
What to Expect
The duration of costochondritis varies. The condition typically lasts for a few weeks. It may last for months. Almost always, costochondritis is resolved within one year. It is possible, although rare, to have a more persistent case of chest wall tenderness with costochondritis.
The Bottom Line
Rheumatoid arthritis patients have a higher risk of heart disease than the general population. For these patients especially, chest pain is understandably scary. If you experience chest pain, the importance of being evaluated, without delay, cannot be overstated.
Primer on the Rheumatic Diseases. Arthritis Foundation. Thirteenth edition.
Costochondritis: Diagnosis and Treatment. Anne M. Proulx, D.O. and Teresa W. Zryd, M.D. American Family Physician. 2009 September 15;80(6):617-620.