Costochondritis is an inflammation of the upper costochondral and sternocostal joints that causes chest wall pain and difficulty breathing and probably caused by repetitive minor trauma. May account for up to a third of cases presenting to emergency departments with chest pain.
Typically there is an insidious onset with a history of the pain worsening with movement and being in certain positions. The pain is worse when taking a deeper breath. There could be a history of bouts of coughing or a lot of lifting that might have triggered the microtrauma. Diagnosis is typically one of exclusion and the ruling out of potentially serious conditions.
Differential diagnosis: myocardial infarction; angina pectoris; pleurisy; Tietze syndrome (get swelling of the costal cartilages; generally affects 2nd or 3rd rib); pneumothorax; pulmonary embolism; non-displaced rib fracture
Treatment:
Typically self-limiting, so reassurance and education about the benign nature.
Avoidance of strenuous activity in the short term and gradually increase in the long term.
Heat packs on chest may give some relief.
Pain relief and NSAID’s.
If not responsive to NSAID’s, may consider local anesthetic and corticosteroid injections
Physical therapy if refractory (trigger point therapy; thoracic manual therapies; mobilizations; dry needling). Stretching of pectoral muscles might be helpful.
Occupational therapy to evaluate if workplace posture is an issue.
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