When chest pain is “just” costochondritis

26 Dec

Costochondritis-7by Carolyn Thomas

Many female heart patients become familiar with the word “costochondritis” only while being misdiagnosed with the condition during an actual cardiac event, as in:

  • “My MD said it was just costochondritis and a  pinched nerve, because my ribs were sore.” (LH, age 51, New York: heart attack)
  • “At first, we looked at musculoskeletal causes. It had to be costochondritis; my chest wall seemed tender to touch, so I even had steroid injections in my chest wall.” (ZM, age 59, Arizona: heart attack, 12 stents, triple bypass surgery)
  • “Pains in chest radiating down arm and up to my chin. My GP reluctantly sent me to a cardiologist who was dismissive, said that my age was a big factor and that it was 99% likely to be just costochondritis as I also have fibromyalgia” (BT, age 42, U.K: heart attack, 90% blocked LAD coronary artery, two stents)  

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can often reproduce by pushing on the cartilage in the front of your ribcage.

Costochondritis can be extremely painful yet, mercifully, it’s relatively benign. Much of the medical literature suggests that it will usually go away on its own within a few days, but some patients report symptoms that can linger for weeks or even months. It can also be a recurring condition that appears to have little or no warning of onset. Pneumonia can be misdiagnosed as costochondritis. Many patients living with fibromyalgia or chronic fatigue syndrome complain of chest wall pain and restriction of movement, often identified by their health care providers as costochondritis.

Chest pain in adults is considered by most doctors to be a potentially serious sign of a heart problem until proven otherwise. Reporting chest pain usually leads to a battery of medical tests to rule out heart disease. If those tests are normal and your physical exam is consistent with costochondritis, your doctor may diagnose costochondritis as the culprit. It may, however, be difficult to distinguish between the two without specific testing. 

Never assume chest pain is “just costochondritis”.

Here’s an example: Emergency physician Dr. Seth Trueger described this study as one that “might be the coolest chest pain study ever done.”

The study found that when rheumatologists using the American College of Rheumatology criteria for diagnosing costochondritis evaluated patients in the E.R. complaining of chest pain:

“Six per cent of the patients the doctors diagnosed with costochondritis actually had an acute myocardiardial infarction (heart attack).”

(What rheumatologists were doing in the E.R. was not explained . . . )

Most (real) cases of costochondritis seem to have no clear cause. Occasionally, however, the diagnosis might be correlated with:

  • Injury. A blow to the chest
  • Physical strain. Heavy lifting and/or strenuous exercise
  • Arthritis. In some people, costochondritis has been linked to specific problems, such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
  • Joint infection. The rib joint itself can become infected by viruses, bacteria or fungi. Examples include tuberculosis, syphilis and aspergillosis.
  • Tumours. Non-cancerous and cancerous tumours also can cause costochondritis. Cancer may travel to the joint from another part of the body, such as the breast, thyroid or lung.

Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.  Sometimes patients with a severe cough can develop this as a result of continued coughing and rapid expansion/contraction of the rib cage.

This condition affects females more than males (70% versus 30%).

Kelly Young is a patient advocate, blogger, and president of the Rheumatoid Patient Foundation. She described costochondritis like this in her blog RA Warrior:

“As early as 1964, the journal ‘Radiology’ published a study explaining that the effects of Rheumatoid Arthritis on the rib joints “have not been adequately described in the literature.”[1] Mayo Clinic’s description of costochondritis makes it clear the word describes a symptom, pain or inflammation of the rib joints that can be caused by various illnesses.[2,3]

“The term is also confusing because there can be varying diagnoses with similar symptoms.”

But Kelly says that she has also read some skeptical articles about costochondritis symptoms, considered by some physicians as the garbage can diagnosis of hypochondriacs.

Costochondritis is not associated with swelling, as opposed to Tietze’s syndrome, where swelling is characteristic.  Tietze’s syndrome is an inflammation of the costochondral cartilages of the upper front of the chest that involves swelling around the joint, the ribs or cartilage near the breastbone. Redness, tenderness, and warmth can also be present, but a localized swelling is the distinguishing finding, although even swelling can be variable from patient to patient. The pain  can cause difficulty with sleeping, and even rolling over in bed is sometimes painful.

Possible treatments include heat or ice, and medications to reduce the inflammation*.  And until there is improvement in your symptoms, avoid unnecessary exercise or contact sports activities.

And as Kelly Young sums up about her own bouts with costochondritis:

“Like other joint inflammation, costochondritis is eased by rest, NSAIDs*, ice or heat, and prednisone. Pain medications can help manage severe costochondritis. And if it is persistent, steroid injections can be used.

“Usually, as with other joints, the inflammation subsides to a more manageable level in a few days.

“I’m counting on that because the only other solution I can think of is to not breathe. It hurts too much!”

.

*  CAUTION:  Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them.
1  Alpert M, Feldman F. The rib lesions of rheumatoid arthritis. Radiology. 1964 May 82: 872-875
2  Mayo Clinic. Costochondritis. 2012 May 6.
3  HealthHype.com. Severe costochondritis – causes, symptoms, treatment. 2010 May 9.
4  Flowers LK. Medscape. Costochondritis. 2012 Apr 13.

Q:  Have you ever experienced costochondritis?

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29 Responses to “When chest pain is “just” costochondritis”

  1. Hannah June 14, 2015 at 9:53 pm #

    I’m fifteen years old and was diagnosed with chronic costochondritis two years ago.

    I was doing dishes when I suffered my first attack. It was sudden; I hadn’t moved anything heavy, no quick movements that could’ve caused injury. It was an abrupt mixture of a burning, throbbing, and tightening pain right under my breasts on my ribcage; the pain radiated to my stomach and my back. It felt like someone had stabbed me underneath my sternum. My father quickly took me to the nearest hospital, where I was diagnosed with it and was sore for months, as well as trouble getting a proper inhale.

    My symptoms and flareups have eased considerably over the last couple of years. I still experience flareups around my menstrual cycle, random stabs of pain usually in a few of my left ribs or left breast, right over my heart. It’s a bit scary considering I feel tremors and tightness over such a critical area, and reading this article has definitely expanded my awareness. My breasts are sore and tender as well as my back and the pain sometimes runs through my arms and legs. Even under my armpits are extremely tender. The only way I can describe the discomfort is like a spear going through my back at any angle where the pain is: pain starting from one side directly to the other in the same spot. It almost feels like my chest is covered in bruises or starting to bruise.

    The odd thing about my condition is that my father suffered with the same thing starting around my age, peaking in his early twenties and then slowly dying down. He’s now forty-five, saying that he still has slight pain but has become accustomed to it. However, there is no scientific link to costochondritis being genetic.

    Is there any way to calm the pain and ease the severity of flareups without NSAID’s? I take Aleve but it usually does nothing. My mother suggested cortisone shots as well. I feel like the pain will never die down, nothing seems to work anymore.

    Liked by 1 person

    • Carolyn Thomas June 15, 2015 at 4:30 am #

      Hello Hannah and thanks for sharing your story here. I’m so sorry you have had to go through all of this pain, especially at your age – but it’s interesting that your Dad also suffered the same symptoms. Some scientists suggest there may indeed be a genetic predisposition. I’m not a physician so cannot comment specifically on your case, but I can tell you that there have been some studies suggesting a link between costochondritis and other inflammatory conditions (arthritis, fibromyalgia, irritable bowel syndrome, for example) and possibly even Vitamin D deficiency. If there is a Pain Clinic near you, consider asking your physician for a referral (pain self-management is an important skill taught by most pain specialists). Best of luck to you…

      Like

    • paul June 17, 2015 at 1:19 pm #

      Hi
      Here is my recommendation of what to do, having gone through the same symptoms after a heart attack.

      Muscles develop a memory and just need a little jog to forget the spasms they create. Like driving a car your legs muscles do the work automatically or riding a bike, so the more pain they create the more normal the muscles believe it is correct.
      Find a Musculoskeletal Doctor, write a list of all your symptoms and give it to them to read, as they will start asking questions which can drag you off track and you will forget to mention things.

      When you are about to go to the appointment, get a pen or some small Band-Aids and mark or put them on the sore spots. Tell the doctor you want a local anesthetic injected into all the hot spots that you have found and the muscles around the area, including the muscle between the shoulder blades and the muscles that come down from the side of you neck to the top of your shoulders, they usually have knots in them which can also cause light headedness.

      Then wait till the next morning and it should have helped, once the muscles have relaxed your state of mind will relax and so will the body. You may have to go back for a little tweaking from time to time. You won’t need to take any drugs, which I found nothing worked anyway.

      Good Luck
      Paul

      Like

      • Carolyn Thomas June 17, 2015 at 9:43 pm #

        Paul, it’s important to remember that costochondritis is generally unrelated to cardiac pain following a heart attack, so what worked for you (local anaesthetic) may have nothing to do with costochondritis.

        Like

  2. Steve Davis June 13, 2015 at 5:48 am #

    I used to workout in cable crossover machine in the Gym and one day I pulled little heavy weights. After 2 days I felt chest discomfort so bad that I ran to ER. There was nothing in the EKG and doctor gave me a few medicines including Aspirin. The other day I felt chest discomfort again in the office. I ran to the ER a second time but nothing came up in the EKG.

    After that I went to a cardiologist; he ran many tests like stress test, heart ultrasound, heart CT Scan. The result was 0% blockage of arteries with mild heart valve leak. Cardiologist said it’s normal. Cholesterol level was high to 225 and LDL 130 so he put me to 20 mg Lipitor medication.

    After 2 months of Lipitor I started feeling low blood pressure. I was not able to exercise after that and getting shocks in chest in movement. I complained to the doctor and he reduced the Lipitor dose to 10 mg with CoQ10 medicine. Doctor said there is no heart issue.

    But I remained as it is with chest pain in center. I cannot bend down to lift any object or weight from ground because I feel heavy pain in whole chest from center. In the morning I cannot wake up and roll over in bed as my chest gives me unbearable pain in center when moving my position and waking up from my bed. I am not sure where to go to find the cause and which doctor will do the treatment. I am left with chest pain forever.

    Like

    • Carolyn Thomas June 13, 2015 at 6:25 am #

      Steve, I’m not a physician so cannot comment on your specific case. But I can tell you generally that when symptoms strike suddenly after what looks like a specific incident in the gym, that seems a good place to start investigating – especially since all of your tests don’t seem to indicate a cardiac source for pain that is affecting your daily quality of life. Consult your family doctor right away for referrals to solve this mystery. Something is causing your symptoms – you and your doctor need to find out what that is. Best of luck to you…

      Like

  3. Susan P May 26, 2015 at 11:20 am #

    I’ve been diagnosed multiple times with costochondritis and/or pleurisy. I have an aching, sore feeling in my chest along my bra line under both breasts – but more prevalent under my right breast. I’ve had multiple EKG’s and my gallbladder has been tested, so it isn’t either of them. I do have fibromyalgia and some sort of internal inflammation (my doctor hesitates to call it rheumatoid arthritis yet), but this chest pain has lasted for almost a year, off and on. It is very frustrating because nothing seems to be being done.

    Liked by 1 person

    • Carolyn Thomas May 26, 2015 at 1:07 pm #

      Hi Susan – my understanding is that if this were costochondritis, treatments that work include rest, ice/heat, anti-inflammatory/pain medications, or even (as Kelly Young has found) steroid injections for severe cases. Go back to the doctor who diagnosed you for a comprehensive treatment plan. Do not accept “nothing can be done” for an answer!

      Like

    • Carole July 29, 2015 at 11:40 pm #

      I haven’t been able to wear a bra without pain for over 40 years. I know how you feel. The pressure from the band under the bra is too much. I was labeled with fibromyalgia in 1989, but suffered years before that. Luckily I am only a B cup and found ways to wear clothes in the winter to disguise my missing bra, but summer is harder. I never tried cortisone shots along bra line, because I never thought of it. They did help immensely in other areas. You might want to try it. I may check it out for myself now! :) Good luck!

      Liked by 1 person

      • Carolyn Thomas July 30, 2015 at 6:11 am #

        40 years of pain is a long time, Carole! Thanks for sharing your experience here, and best of luck to you…

        Like

  4. Marsha May 11, 2015 at 10:47 pm #

    Year 2013, my doctor told me that I have costochondritis, and the pain was there. My doctor give me pain relievers and after that the pain would come back and radiate in my right upper back. Year 2014, I go back to the doctor and he told me that I have scoliosis as seen in my x-ray… The pain is there… what can I do?

    Like

    • Carolyn Thomas May 13, 2015 at 7:50 am #

      Marsha, please make an appointment with your doctor to review a full treatment plan for your symptoms – no matter what the diagnosis. Do not leave that appointment until you understand all the details of your diagnosis. Best of luck to you…

      Like

  5. Shoshanna April 23, 2015 at 3:38 am #

    I’m only 15 and I’ve had Costochondritis since I was 8 and they diagnosed me with it last year…

    It’s very painful, for me it’s like mini heart attacks and it aches and sometimes the pain radiates to my stomach or back but it usually is under my left or right breast bone. However the pain actually has hurt pretty much everywhere around my breast bone, sometimes the pain is attached to my breathing though. I went to the doctor after being in severe pain for a whole week straight and he ended up popping my bone back in place. I stopped drinking caffeine and I stopped working out my arms because they both make my Costo hurt bad… Inhaling smoke is really bad too, and I just don’t do workouts except cardio that doesn’t include my arms at all.

    Liked by 1 person

    • Carolyn Thomas April 23, 2015 at 5:25 am #

      Hello Shoshanna and thanks for sharing your story here. Seven years is a long time to wait for an accurate diagnosis! You’ve modified a few strategies that work to relieve symptoms (caffeine, workouts) but next time, do NOT wait a full week before seeking medical care for severe pain. Best of luck to you…

      Like

  6. Janine December 17, 2014 at 2:52 pm #

    I have now been living with infectious costochondritis for the past 3 months,after getting gastritis.

    I am in so much pain practically every day, it really is debilitating, I can’t do much in a day, I have to rely on my family a lot, I have been off work now for 4 months and fear I may have to give up my job, as have been told this is a long term illness for me.

    One doctor said it’s the worse case of costochondritis he has ever seen in all his 25 years as a doctor. I am at my surgery every other week, as the painkillers stop working after a while. So I go back for stronger ones. If I have 2 good days then it comes back with a vengeance. Am also on antidepressants to help me cope with the pain, but it’s not letting up. I honestly think the doctors are running out of things to do for me. And my 13 year old daughter is fed up with having a mum who is in chronic pain.

    It just seems like not a lot is being done research wise. Not that I would but I can seriously understand why people who live with chronic pain take their own lives.

    Like

    • Carolyn Thomas December 17, 2014 at 4:29 pm #

      Thank you Janine for sharing your costrochondritis story here. It is not surprising at all that you are depressed – few people understand that living with pain can change your entire personality. If you have access to a pain clinic near you, please ask your doctor for a referral. Meanwhile, I’m keeping fingers crossed that your symptoms will start to ease up very soon.

      Liked by 1 person

  7. Amy November 2, 2014 at 4:25 pm #

    I was diagnosed with costochondritis Feb 2013. After 10 months of trying different medications and therapies I finally had it controlled enough to go back to work. It continued to bother me but I was able to tolerate the pain.

    Then today I ended up in emergency department with what felt like a heart attack. After 3 1/2 hours on heart monitors and heavy pain meds, they ruled it to be my costochondritis. Everything I read says that this condition only lasts days or months. Where can I find more information on this condition and what things I could encounter with it? It doesn’t look like it is going away anytime soon for me.

    Like

    • Carolyn Thomas November 2, 2014 at 4:38 pm #

      Amy, I’m so sorry to hear your story. This sounds just awful! You were smart to go to Emergency – as you never want to assume that symptoms are “just” costochondritis. Here’s what I’d do if you haven’t done so already: do a search on the WomenHeart online support community – just type in costochondritis into the search box called Search This Community in the upper right corner. You’ll get dozens of discussion topics on this subject. Best of luck to you…

      Like

      • Amy November 2, 2014 at 4:41 pm #

        Thank you I will certainly check that out. =)

        Like

  8. Jo October 14, 2014 at 7:02 am #

    I have 8 stents in. Lately, I have symptoms of what I think is “costochondritis.” It feels more like sore chest wall pain rather than the chest pain I had before when I had my heart attack. It actually hurts when I try to speak long sentances. My chest starts squeezing and hurting as I speak and until I take a breath it is like a crescendo of pain-soreness. Today it was rather bad so I just ate 3 junior baby aspirins. If there is a doc out there, I wanted to know, is there such a thing of chest wall pain from the stents I may have? Has this ever been discussed or recorded. Sometimes the pain is sharp and sore in my chest. I keep thinking it is the actual stents hurting….is this possible?

    Like

    • Carolyn Thomas October 14, 2014 at 7:36 am #

      Hello Jo – I’m not a physician so of course cannot comment on your specific symptoms. But I can tell you that in general, something docs call “stretching pain” is common in recently-stented patients. If your stents were implanted some time ago, however, please see a doctor about your pain.

      Like

  9. Ralph Beckett, MD December 30, 2013 at 10:12 am #

    When I went to medical school 35 years ago, the teaching was to be very careful with the diagnosis of costochondritis. Because 50% of the time, chest pains are actually something else. This should be an expected piece of knowledge in any health care providers’ brain.

    On the other hand, I have seen many patients who have undergone extensive (and unnecessary) cardiac evaluations without the slightest consideration of something besides heart problems. Two cardiac caths before the diagnosis of costochondritis is inexcusable. This problem cuts both ways.

    Liked by 1 person

    • Carolyn Thomas December 30, 2013 at 12:35 pm #

      Good point, Dr. B: in either case, non-cardiac issues can cause chest pain – and cardiac issues can have no associated chest symptoms at all.

      Like

  10. Anne December 26, 2013 at 7:22 am #

    Good article. Heart patients need to check in with their cardiologist before using NSAIDs as they raise the risk of coronary damage.

    Like

    • Carolyn Thomas December 26, 2013 at 7:38 am #

      Thanks for this reminder, Anne. Studies have found that, among those who had already had one heart attack, people who took the painkillers called NSAIDs (non-steroidal anti-inflammatory drugs) such as Vioxx, Bextra, Aleve, Advil, Motrin, etc. were at >40% higher risk of having a second heart attack compared with those who did not take them.

      Like

      • Magda December 26, 2013 at 8:33 am #

        Good article. In addition to heart disease, I also have this from a car accident where I was injured by the seatbelt. I often have swelling and pain, but no doctor has diagnosed it. I had to learn to tell the difference since doctors often dismiss it and tell me to take an anti-inflammatory. I usually suffer through or use ice, since I don’t want to take risks with the NSAIDs.

        Like

        • Carolyn Thomas December 26, 2013 at 9:26 am #

          Thanks Magda – I hope your symptoms improve over time.

          Like

          • Dr. Barbara Keddy December 26, 2013 at 7:13 pm #

            I have both – heart disease and chronic costochondritis. I have lived with the latter for many decades because of fibromyalgia. Because this can mimic a heart attack it causes me great anxiety. My HA presented as the classic chest pain and it was a few minutes before I realized this was different than what I had been living with for many years.

            However, flare-ups are anxiety provoking! Almost a year now and the constant pain in my chest, neck, jaw stirs up the same questions: is it fibro? costochondritis? another HA? I’ve come to the conclusion I have to live with the uncertainty- the challenges of daily living! :-(

            Like

            • Carolyn Thomas December 26, 2013 at 7:42 pm #

              Hello Barbara and thanks so much for sharing your unique personal experience. When I was writing this post, I was so surprised to learn that 60% to 70% of those with fibromyalgia may also have symptoms of costochondritis, too. One report suggests that such people might find themselves “with an ice pack on your chest and a heating pad on your back at the same time.”

              Like

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