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).
Tests used to rule out conditions with a similar presentation.
Non-steroidal anti-inflammatory drugs are the first line of treatment.
Costochondritis is inflammation of ≥1 costal cartilages. It is a self-limiting condition that typically presents with insidious onset pain and tenderness around the second to the fifth costochondral joints.
History and exam
Key diagnostic factors
- presence of risk factors
- chest pain
- chest-wall tenderness
Other diagnostic factors
- chest-wall swelling
- female sex
- Hispanic ethnicity
- age >40 years
- sternotomy wound infection
- intravenous drug use
1st investigations to order
- non-steroidal anti-inflammatory drug trial
Investigations to consider
- local anaesthetic and corticosteroid trial
- chest x-ray
- CT chest
- MRI chest
- wound or blood cultures
Fadi Badlissi, MD, MSc
Medical Director of the Musculoskeletal Medical Unit
Department of Orthopedics & Division of Rheumatology
Beth Israel Deaconess Medical Center
Assistant Professor of Medicine
Harvard Medical School
FB declares that he has no competing interests.
Don Aspegren, DC, MS
Assistant Clinical Professor
Department of Rehabilitation
University of Colorado School of Medicine
DA declares that he has no competing interests.
Richard Wakefield, BM, FRCP, MD
Senior Lecturer in Rheumatology
Section of Musculoskeletal Disease
Leeds Institute of Molecular Medicine
Chapel Allerton Hospital
RW declares that he has no competing interests.
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