Costochondritis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Oct 2024

Last updated: 28 Oct 2024

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.

Definition

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 and could be recurrent.

History and exam

Key diagnostic factors

chest pain
chest-wall tenderness

Full details

Other diagnostic factors

chest-wall swelling

Full details

Risk factors

microtrauma
female sex
age >40 years
sternotomy wound infection
intravenous drug use

Full details

Diagnostic tests

1st tests to order

nonsteroidal anti-inflammatory drug trial

Full details

Tests to consider

local anesthetic and corticosteroid trial
chest x-ray
CT chest
MRI chest
wound or blood cultures

Full details

Treatment algorithm

ACUTE

inflammatory

infectious

Contributors

Authors

Fadi Badlissi, MD, MSc

Attending Physician

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

Boston

Disclosures

FB has been reimbursed by ANI Pharmaceuticals and Janssen and Amgen for attending an advisory board meeting.

Peer reviewers

Don L. Goldenberg, MD

Emeritus Professor of Medicine

Tufts University School of Medicine

Boston

Disclosures

DLG declares that he has no competing interests.

Richard G. Chang, MD, MPH, FAAPMR

Associate Program Director

Sports Medicine Fellowship

Assistant Professor of Medicine

Icahn School of Medicine at Mount Sinai

New York

Disclosures

RGC declares that he is the President of the New York Society Of Physical Medicine and Rehabilitation (2023-2025), is State Advocacy Chair and a Health Policy and Legislative Committee member for the American Academy of Physical Medicine and Rehabilitation, and is a Health Policy Division and Ultrasound Education Committee member for the Spine Intervention Society.

Richard Wakefield, BM, FRCP, MD

Senior Lecturer in Rheumatology

Section of Musculoskeletal Disease

Leeds Institute of Molecular Medicine

Chapel Allerton Hospital

Leeds

Disclosures

RW declares that he has no competing interests.

Differentials
- Acute coronary syndrome
- Pleuritis
- Pulmonary embolism
More Differentials
Guidelines
- Appropriateness criteria: nontraumatic chest wall pain
More Guidelines
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Costochondritis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

inflammatory

infectious

Contributors

Authors

Fadi Badlissi, MD, MSc

Disclosures

Peer reviewers

Don L. Goldenberg, MD

Disclosures

Richard G. Chang, MD, MPH, FAAPMR

Disclosures

Richard Wakefield, BM, FRCP, MD

Disclosures

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice