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  • Costochondral junction syndrome

  • 733.6 Tietze’s disease

  • M94 Other disorders of cartilage


  • Pain at the costal cartilage between the sternum and ribs
  • Most common between 2nd and 5th costochondral junction1

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

General Considerations

  • Stabbing or twinging pain, but no radicular or systemic symptoms
  • Inflammation, tenderness
  • Need to rule out a heart attack until proven otherwise
  • Relatively harmless


  • Children and adolescents, 10 to 20 years of age
  • Females > males

Signs and Symptoms

  • 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

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 Diagnosis

  • 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

Laboratory Tests

  • Blood testing for heart damage (cardiac enzymes and troponin levels), negative for inflammation
  • Sedimentation rate
  • C-reactive protein test (CRP test)


Diagnostic Procedure

  • ECG
  • Diagnostic confirmation with a local anesthetic block1

  • Tenderness, palpable at costal cartilage
  • Spirometric evaluation should be normal, unless painful3



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