by Carolyn Thomas ♥ @HeartSisters
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 often 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”.
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.
In New Zealand, physiotherapists like Steve August (see his detailed comments below) not only suffered himself for seven years with costochondritis after a serious climbing fall, but has been successfully treating the backs of his costochondritis patients manually for the past 30 years with non-drug, non-invasive physiotherapy, as he discusses in his video. Yes, you read that right: it is the back that is treated.
He sees costochondritis as often a straightforward musculoskeletal mechanical problem in which the costovertebral rib joints at the back are somehow jammed. This requires the anterior rib joints around the front to work excessively to compensate, leading to irritation, then to the inflammation that doctors call costochondritis.
Watch Steve’s second video in which he describes:
- exercises and treatments recommended by New Zealand physiotherapists to unlock the rib hinges in the back to ease the symptoms of costochondritis
- massage therapy for affected shoulder muscles
- how to stretch tight, scarred muscles in between the ribs
- gentle stretching exercises you can do at home to help open up the ribcage
- use of anti-inflammatory gel to apply on the rib hinges at the front of your chest
This condition affects females more than males (70% versus 30%).
“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.” 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.
READER COMMENT: “Thanks for this article. I did have “just” costochondritis, but wound up in the ER four times feeling like I was having a heart attack. Turned out my diabetes medication was inhibiting my body’s production of DAO enzyme, thus giving me histamine intolerance. My body was inflamed head to toe with multiple symptoms. I switched to insulin and went on a low histaine diet and am getting better. Also, most of my “menopause” symptoms went away too. Take good care!” Melinda (August 15, 2021)
Besides physiotherapy as New Zealand physiotherapists treat this condition, possible treatments include heat or ice, and medications like NSAIDs to relieve pain and reduce inflammation*.
And until there is improvement in your symptoms, avoid unnecessary exercise or contact sports activities.
* 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. If you’re in this group, do NOT take NSAIDS before talking with your physician.
NOTE FROM CAROLYN: I wrote much more about diagnosis and misdiagnosis in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).
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?