Skip to Main Content

++

CONDITION/DISORDER SYNONYM

++

  • Costochondral junction syndrome

++

ICD-9-CM CODE

++

  • 733.6 Tietze disease

++

ICD-10-CM CODE

++

  • M94 Other disorders of cartilage

++

PREFERRED PRACTICE PATTERN

++

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation

++

PATIENT PRESENTATION

A 22-year-old young man presents with right chest pain and heart burn. He states that pain began suddenly after reaching behind from the front seat to the back seat in the car. He also states that the pain gets worse when he coughs or sneezes. He complains of difficulty with sleeping at night when there is pressure on the lateral portion of the ribs. Palpable tenderness and reproduction of pain are localized at the right fourth rib costosternal junction. The patient also complains of discomfort in the fourth rib laterally.

++
KEY FEATURES
++
Description
++

  • Local palpable pain at the costal cartilage between the sternum and the ribs

++
Essentials of Diagnosis
++

  • Can be reproduced with compression of the cartilage that attaches the ribs to the sternum

  • Pain may be provoked by certain movements like overhead reaching

  • Usually caused by exercise, upper respiratory infection, or minor trauma

  • Most common sites: Second to fifth ribs1

  • Tietze syndrome now thought to be a progression from costochondritis or of severity level

  • Benign

++
General Considerations
++

  • Rule out myocardial infarction

  • Need to rule out a heart attack until proven otherwise

  • Stabbing or twinging pain, but no radicular or systemic symptoms

  • Inflammation, tenderness

  • Relatively harmless

++
Demographics
++

  • Children and adolescents, 10 to 20 years of age2

  • Females > males

++
CLINICAL FINDINGS
++

SIGNS AND SYMPTOMS

  • Acute or chronic upper anterior chest pain

  • Stabbing pain, but no radicular or systemic symptoms

  • No radicular pain, helps to differentiate with Tietze syndrome

  • Pain increases with respiration or activity with rib movement

  • Nausea

  • Tenderness along the costal cartilage and the sternum (breastbone)

++
Functional Implications
++

  • Aerobic/breathing limitations

  • Pain with sleeping and lying on the ribs

  • Inability to carry bags of groceries by one’s side

  • Inability to turn the steering wheel in a car

  • Inability to carry heavy items

  • Inability to dig in the garden

++
Possible Contributing Causes
++

  • Physical strain

  • Repetitive coughing

  • Injury to chest and breast tissue

  • Impact form airbag/steering wheel in a car accident

  • Injury during exercise (dips, chest fly, exercises that open the chest wall)

  • Viral infection

++
Differential Diagnosis3
++

  • Myocardial infarction (heart attack) can have identical symptoms with acute pain and pain in the shoulder and arm.

  • Costochondritis is different in that no electrical heart change and no damage to the organs occurs.

  • Costochondritis pain ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.