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Costochondritis

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Costochondritis
SpecialtyRheumatology Edit this on Wikidata

Costochondritis, also known as chest wall pain, costosternal syndrome, or costosternal chondrodynia[1] is a benign[2] and often temporary inflammation of the costal cartilage, which connects each rib to the sternum at the costosternal joint, and is a common cause of chest pain.[1][3][4] Though costochondritis is often self-limited, it can be a recurring condition that can appear to have little or no signs of onset.[5] Treatment options are quite limited and usually involve a combination of rest, analgesics, or anti-inflammatory medications;[6] however, in cases with intractable discomfort, cortisone injections[6][7] or surgery may be indicated. Typically, costochondritis patients are instructed to refrain from physical activity to prevent the onset of an attack.[8]

Costochondritis symptoms can be similar to the chest pain associated with a heart attack.[7][9] Unexplained chest pain is considered a medical emergency until life-threatening cardiac issues can be ruled out.[4][9] Severe cases of costal cartilage inflammation that also involve painful swelling are sometimes referred to as Tietze's syndrome, a term sometimes used interchangeably with costochondritis; however, some physicians view costochondritis and Tietze's syndrome as separate disease states due to the absence of costal cartilage swelling in costochondritis.[2][6]

Signs and symptoms

Pain or tenderness to palpation usually occurs on the sides of the sternum, affects multiple ribs, and is often worsened with coughing, deep breathing, or physical activity.[2][10] On physical examination, physicians will inspect and palpate the patient for areas of swelling or tenderness and can often reproduce the pain associated with costochondritis by moving the patient's rib cage or arms.[4][11] Costochondritis tends to occur in patients who are aged between 20 and 40, typically female, and tends to affect the third, fourth, fifth, or sixth costosternal joints.[2][6]

Causes

In most cases of costochondritis, no cause is identified.[1][2][7] However, costochondritis may be the result of physical trauma (due to direct injury, strenuous lifting, or severe bouts of coughing), ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, or a tumor (benign or cancerous).[12] Infection of the costosternal joint may cause costochondritis in rare cases. Most cases of infectious costochondritis are caused by Actinomyces, Staphylococcus aureus, Candida albicans, and Salmonella. In rare cases, Escherichia coli can be a cause of infectious costochondritis.[13]

Pathogenesis

The pathogenesis underlying the development of costochondritis remains unclear. Proposed mechanisms of injury include neurogenic inflammation, muscular imbalance, or a derangement of the mechanical structure of the costochondral junction.[9]

Differential diagnosis

Other causes of chest pain similar to that produced by costochondritis may include, but are not limited to:[9][14]

Treatment

Costochondritis may be treated with physical therapy (with or without nerve stimulation) or with medication. Treatment may involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or other pain relief medications (analgesics) such as acetaminophen.[3][4] Severe cases of costochondritis may call for the use of opioid medications such as hydrocodone or oxycodone, tricyclic antidepressant medications such as amitriptyline for pain from chronic costochondritis, or anti-epileptic drugs such as gabapentin may be used.[16] Oral or injected corticosteroids may be used for cases of costochondritis unresponsive to treatment by NSAIDS; however, this treatment has not been adequately studied with randomized controlled trials and its practice is currently based on clinical experience.[17] Patients are often instructed to rest from stressful physical activity while recovering.[4] --> The vertical tango has also been proven to be helpful.

Epidemiology

Costochondritis is a common condition and is responsible for 30% of emergency room chest pain related visits. One-fifth of visits to the primary care physician are for musculoskeletal chest pain, of this 20% of primary care office visits, 13% is due to costochondritis.[9]

See also

References

  1. ^ a b c Mayo Clinic Staff (2012). "Costochondritis Definition". Mayo Clinic. Retrieved 26 December 2012.
  2. ^ a b c d e Jindal, A; Singhi, S (2011). "Acute chest pain". Indian journal of pediatrics. 78 (10): 1262–1267. doi:10.1007/s12098-011-0413-1. PMID 21541647.
  3. ^ a b U.S. National Library of Medicine (2010). "Costochondritis". National Institutes of Health. Retrieved 26 December 2012.
  4. ^ a b c d e Proulx, AM; Zryd, TW (2009). "Costochondritis: diagnosis and treatment". American Family Physician. 80 (6): 617–620. PMID 19817327.
  5. ^ Stochkendahl, MJ; Christensen, HW (2010). "Chest pain in focal musculoskeletal disorders". The Medical clinics of North America. 94 (2): 259–273. doi:10.1016/j.mcna.2010.01.007.. PMID 20380955. {{cite journal}}: Check |doi= value (help)
  6. ^ a b c d e f Fauci, Anthony S. (2008). Chapter 330. Arthritis Associated with Systemic Disease, and Other Arthritides Harrison's principles of internal medicine (17th ed. ed.). New York: McGraw-Hill. ISBN 978-0-07-147693-5. {{cite book}}: |edition= has extra text (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  7. ^ a b c d e Ricker Polsdorfer, M.D. (2012). "Costochondritis". Keck Medical Center of USC. Retrieved 30 December 2012.
  8. ^ Beers, Mark (2006). "Chapter 5". The Merck Manual of Diagnosis and Therapy (18th ed.). Merck Research Laboratories. ISBN 0-911910-18-2.
  9. ^ a b c d e Ayloo A, Cvengros T, Marella S (2013). "Evaluation and treatment of musculoskeletal chest pain". Prim Care (Review). 40 (4): 863–87. doi:10.1016/j.pop.2013.08.007. PMID 24209723. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  10. ^ Mayo Clinic Staff (2012). "Costochondritis:Symptoms". Mayo Clinic. Retrieved 26 December 2012.
  11. ^ Mayo Clinic Staff (2012). "Costochondritis:Tests and diagnosis". Mayo Clinic. Retrieved 26 December 2012.
  12. ^ Mayo Clinic Staff (2012). "Causes". Mayo Clinic. Retrieved 26 December 2012.
  13. ^ Sakran, W; Bisharat, N (2011). "Primary Chest Wall Abscess Caused by Escherichia coli Costochondritis". Am J Med Sci. 342 (3): 241–6. doi:10.1097/MAJ.0b013e31821bc1b0. PMID 21681074.
  14. ^ "Costochondritis Diagnosis Differential". BMJ Publishing Group. 2012. Retrieved 26 December 2012.
  15. ^ Seferović PM, Ristić AD, Maksimović R, Simeunović DS, Milinković I, Seferović Mitrović JP, Kanjuh V, Pankuweit S, Maisch B (2013). "Pericardial syndromes: an update after the ESC guidelines 2004". Heart Fail Rev. (Review). 18 (3): 255–66. doi:10.1007/s10741-012-9335-x. PMID 22855353. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  16. ^ "Treatments and drugs". Mayo Clinic. 2012. Retrieved 26 December 2012.
  17. ^ Gandhi V, Costello J (2012). "Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: The use of corticosteroids in the management of costochondritis". Emerg Med J (Review). 29 (8): 686. doi:10.1136/emermed-2012-201590.4.. PMID 22787240. {{cite journal}}: Check |doi= value (help); Unknown parameter |month= ignored (help)
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