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145: COSTOCHONDRITIS

Eric Shamus, PhD, DPT, PT, CSCS

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 ...

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