Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Costochondral junction syndrome ++ 733.6 Tietze’s disease ++ M94 Other disorders of cartilage +++ Description ++ Pain at the costal cartilage between the sternum and ribsMost common between 2nd and 5th costochondral junction1 +++ Essentials of Diagnosis ++ Can be reproduced with compression of the cartilage that attaches the ribs to the sternumPain may be provoked by certain movements like overhead reachingUsually caused by exercise, upper respiratory infection, or minor traumaTietze syndrome now thought to be a progression from costochondritis or of severity levelBenign +++ General Considerations ++ Stabbing or twinging pain, but no radicular or systemic symptomsInflammation, tendernessNeed to rule out a heart attack until proven otherwiseRelatively harmless +++ Demographics ++ Children and adolescents, 10 to 20 years of ageFemales > males +++ Signs and Symptoms ++ Acute or chronic upper anterior chest painNo radicular pain, helps to differentiate with Tietze syndromePain increases with respiration or activity with rib movementTenderness along costal cartilage along the sternum (breast bone)Erythema, heat and swelling are usually absent2 +++ Functional Implications ++ Aerobic/breathing limitationsPain with sleeping and lying on the ribsInability to carry bags of groceries by one’s sideInability to turn the steering wheel in a carInability to carry heavy itemsInability to dig in the garden +++ Possible Contributing Causes ++ Physical strainRepetitive coughingInjury to chest and breast tissueImpact form airbag/steering wheel in a car accidentInjury during exercise (dips, chest fly, exercises that open the chest wall)Viral infection +++ Differential Diagnosis ++ Myocardial infarction (heart attack)—identical symptoms with acute pain and pain in the shoulder and armCostochondritis is different in that no electrical heart change and no damage to the organs occursCostochondritis pain occurs during muscle exertion or deep breathing, whereas myocardial infarction can present at rest or after an activityTietze syndrome is different in that there is swelling of the costal cartilage and radiating arm painBruised ribsFractured ribs1PleurisyPneumothoraxShinglesPneumoniaViral respiratory infection +++ Laboratory Tests ++ Blood testing for heart damage (cardiac enzymes and troponin levels), negative for inflammationSedimentation rateC-reactive protein test (CRP test) +++ Imaging ++ X-ray usually not helpful for cartilage, usefully for pneumonia and to rule out parenchymal lung disease and rib fracture +++ Diagnostic Procedure ++ ECGDiagnostic confirmation with a local anesthetic block1 ++ Tenderness, palpable at costal cartilageSpirometric evaluation should be normal, unless painful3 +++ Medications +... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.