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Condition/Disorder Synonyms

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  • Costochondral junction syndrome

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ICD-9-CM Code

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  • 733.6 Tietze's disease

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ICD-10-CM Code

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  • M94 Other disorders of cartilage

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Key Features

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Description

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  • Pain at the costal cartilage between the sternum and ribs

  • Most common between 2nd and 5th costochondral junction1

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Essentials of Diagnosis

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  • 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

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

  • Benign

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General Considerations

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

  • Inflammation, tenderness

  • Need to rule out a heart attack until proven otherwise

  • Relatively harmless

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Demographics

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  • Children and adolescents, 10 to 20 years of age

  • Females > males

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Clinical Findings

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Signs and Symptoms

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  • Acute or chronic upper anterior chest pain

  • No radicular pain, helps to differentiate with Tietze syndrome

  • Pain increases with respiration or activity with rib movement

  • Tenderness along costal cartilage along the sternum (breast bone)

  • Erythema, heat and swelling are usually absent2

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Functional Implications

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  • 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

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Possible Contributing Causes

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  • 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

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Differential Diagnosis

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  • Myocardial infarction (heart attack)—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 occurs during muscle exertion or deep breathing, whereas myocardial infarction can present at rest or after an activity

  • Tietze syndrome is different in that there is swelling of the costal cartilage and radiating arm pain

  • Bruised ribs

  • Fractured ribs1

  • Pleurisy

  • Pneumothorax

  • Shingles

  • Pneumonia

  • Viral respiratory infection

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Blood testing for heart damage (cardiac enzymes and troponin levels), negative for inflammation

  • Sedimentation rate

  • C-reactive protein test (CRP test)

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Imaging

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  • X-ray usually not helpful for cartilage, usefully for pneumonia and to rule out parenchymal lung disease and rib fracture

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Diagnostic Procedure

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  • ECG

  • Diagnostic confirmation with ...

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