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Diseases

Costochondritis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Costochondritis presents with insidious onset of anterior chest wall pain exacerbated by certain movements of the chest and deep inspiration.

  • Key sign is pain on palpation of costochondral joints (particularly the second to the fifth).

  • Clinical diagnosis.

  • Tests used to rule out conditions with a similar presentation.

  • Nonsteroidal anti-inflammatory drugs are the first line of treatment.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Citations

            Key Articles

            • Mott T, Jones G, Roman K. Costochondritis: rapid evidence review. Am Fam Physician. 2021 Jul 1;104(1):73-8.[Full Text]

            • Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.[Abstract][Full Text]

            Referenced Articles

            • 1. Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ. 1985 Sep 1;133(5):379-89.[Abstract][Full Text]

            • 2. Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am. 2010 Mar;94(2):259-73.[Abstract]

            • 3. Freeston J, Karim Z, Lindsay K, et al. Can early diagnosis and management of costochondritis reduce acute chest pain admissions. J Rheumatol. 2004 Nov;3(11):2269-71.[Abstract][Full Text]

            • 4. Epstein SE, Gerber LH, Borer JS. Chest wall syndrome. A common cause of unexplained cardiac pain. JAMA. 1979 Jun 29;241(26):2793-7.[Abstract]

            • 5. Mott T, Jones G, Roman K. Costochondritis: rapid evidence review. Am Fam Physician. 2021 Jul 1;104(1):73-8.[Full Text]

            • 6. Wolfe E, Stern S. Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med. 1976 Feb;136(2):189-91.[Abstract]

            • 7. Calabro JJ. Costochondritis. N Engl J Med. 1977 Apr 21;296(16):946-7.[Abstract]

            • 8. Calabro JJ, Jeghers H, Miller KA et al. Classification of anterior chest wall syndromes. JAMA. 1980 Apr 11;243(14):1420-1.[Abstract]

            • 9. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.[Abstract][Full Text]

            • 10. Ontell FK, Moore EH, Shepard JO, et al. The costal cartilages in health and disease. Radiographics. 1997 May-Jun;17(3):571-7.[Abstract][Full Text]

            • 11. Moses MA, Banwell PE, Murphy JV, et al. Infective costochondritis following breast reconstruction. Plast Reconstr Surg. 2004 Oct;114(5):1356-7.[Abstract]

            • 12. Gotway MB, Marder SR, Hanks DK, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics. 2002 Oct;22 Spec No:S119-35.[Abstract][Full Text]

            • 13. Alvarez F, Chocarro A, Garcia I, et al. Primary costochondritis due to Escherichia coli. Scand J Infect Dis. 2000;32(4):430-1.[Abstract]

            • 14. Heckenkamp J, Helling HJ, Rehm KE. Post-traumatic costochondritis caused by candida albicans. Aetiology, diagnosis and treatment. Scand Cardiovascular J. 1997;31(3):165-7.[Abstract]

            • 15. Volterrani L, Mazzei MA, Giordano N, et al. Magnetic resonance imaging in Tietze's syndrome. Clin Exp Rheumatol. 2008 Sep-Oct;26(5):848-53.[Abstract]

            • 16. Mendelson G, Mendelson H, Horowitz SF, et al. Can 99^M Technetium Methylene Diphosphonate bone scans objectively document costochondritis? Chest. 1997 Jun;111(6):1600-2.[Abstract]

            • 17. Goldhaber SZ. Pulmonary embolism. N Engl J Med. 1998 Apr 17;339(9417):93-104.[Abstract]

            • 18. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000 Mar 23;342(12):868-74.[Abstract]

            • 19. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG Clinical Guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.[Abstract][Full Text]

            • 20. Bass C, Mayou R. Clinical Review. ABC of psychological medicine: chest pain. BMJ. 2002 Sep 14;325(7364):588-91.[Abstract][Full Text]

            • 21. Katon JW. Clinical practice: panic disorder. N Engl J Med. 2006 Jun 1;354(22):2360-7.[Abstract]

            • 22. Fricchione G. Generalized anxiety disorder. N Engl J Med. 2004 Aug 12;351(7):675-82.[Abstract]

            • 23. Whooley MA, Simon GE. Managing depression in medical outpatients. N Engl J Med. 2000 Dec 28;343(26):1942-50.[Abstract]

            • 24. Fioravanti A, Tofi C, Volterrani L, et al. Malignant lymphoma presenting as Tietze's syndrome. Arthritis Rheum. 2002 Jun 15;47(3):229-30.[Abstract][Full Text]

            • 25. Thongngarm T, Lemos LB, Lawhon N, et al. Malignant tumor with chest wall pain mimicking Tietze's syndrome. Clin Rheumatol. 2001;20(4):276-8.[Abstract]

            • 26. McVeigh C, Cairns A. Diagnosis and management of ankylosing spondylitis. BMJ. 2006 Sep 16;333(7568):581-5.[Abstract][Full Text]

            • 27. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990 Feb;33(2):160-72.[Abstract]

            • 28. Gabriel SE, Jaakkimainen L, Bombardier C. Risk of serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs: a meta-analysis. Ann Intern Med. 1991 Nov 15;115(10):787-96.[Abstract]

            • 29. Garcia Rodriguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994 Mar 26;343(8900):769-72.[Abstract]

            • 30. National Institute for Health and Care Excellence. Non-steroidal anti-inflammatory drugs. Feb 2018 [internet publication].[Full Text]

            • 31. Lanas A, Ferrandez A. NSAID-induced gastrointestinal damage: current clinical management and recommendations for prevention. Chin J Dig Dis. 2006;7(3):127-33.[Abstract]

            • 32. National Institute for Health and Care Excellence. Osteoarthritis: care and management. Dec 2020 [internet publication]. [Full Text]

            • 33. Zapatero J, López Longo J, Monteagudo I, et al. Costal chondritis in heroin addicts: a comparative study with postsurgical chondritis. Br J Dis Chest. 1988 Oct;82(4):341-6. [Abstract]

            • 34. American College of Radiology. ACR appropriateness criteria: nontraumatic chest wall pain​. 2021 [internet publication].[Full Text]

            • 35. Emery P, Zeidler H, Kvien TK, et al. Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: randomized double-blind comparison. Lancet. 1999 Dec 18-25;354(9196):2106-11.[Abstract]

            • 36. Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA. 2000 Sep 13;284(10):1247-55.[Abstract][Full Text]

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