When chest pain is “just” costochondritis

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 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”.

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.

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

If you are a physiotherapist or massage therapist, please watch this video and read this 2017 research paper from Zaruba and Wilson.

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.

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. 

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*  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.

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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).

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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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199 thoughts on “When chest pain is “just” costochondritis

  1. At this exact moment I am (hopefully) getting over Costochondritis.

    It came on in a span of 8 hours and it first presented itself on September 25th. I work at a meat locker and regularly lift and carry 50 lbs so I have a fairly muscular build. I gotta tell ya, that these have been some of the most painfully agonizing days I have ever, in my entire life, had to deal with and for so long! I have never had to take off so much time for an illness!

    It feels as if my muscles are actually being pulled off my bones every time I make the slightest move! I couldn’t even hold my cellphone. There was no way to even manage the pain, it was so constant and intense that nothing touched it! I haven’t ever cried…no, bawled! So much for so long either.

    I finally went to the hospital Monday morning. They checked for heart issues but I feel did a good job making the correct diagnosis. However, I’m a little miffed because getting any pain pills at all is just a pipe dream now thanks to the opioid crisis.

    I finally went back to my job on Friday but physically I should be nowhere near anything that weighs more than a loaf of bread. Please pray that it leaves as fast as it came! God help me, please!!

    Liked by 1 person

    1. Christine, this sounds like it’s been a nightmare for you! I do hope the symptoms ease up for you. I hate to imagine you going back to lifting 50lb weights, though. Heavy lifting and/or strenuous exercise is a known culprit in costo. Continued lifting cannot be good for healing.

      Meanwhile, make sure you watch the videos from physiotherapist Steve August in this article (this one includes some recommendations for some gentle exercises you can do at home).

      Best of luck to you… hang in there.

      Like

    1. I’m not a physician, Mary, but my understanding is that, except when costochondritis occurs as a result of infection after surgery – when you might be more likely to see redness, swelling, or discharge at the incision site – that the symptoms you mention – fever, phlegm, red welts – would not be typical of costochondritis.

      See your physician for a medical opinion…

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  2. I have had sudden chest pains diagnosed as costochondritis all my life. The doctors said I would grow out of it. For as long as I could remember, the chest pains would reoccur every 1-2 months. The pain would be located either either on the left or right side of my chest. When the pains trigger, it makes it difficult to breathe. Breathing when I have these chest pains only makes things worse. I have no clue if it’s legitimately costochondritis or another condition.

    Liked by 1 person

    1. Hello Aliah – I don’t know how old you are now, but if you’ve been having these symptoms ALL YOUR LIFE, it appears you have NOT grown out of them. I think it’s time to get a second opinion.

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  3. Recently this week, I’ve had severe pain to chest area, thinking could be heart or lung related, I went to Urgent Care which did an EKG, results negative, was sent to ER, they did an X-ray, CT and labs, all negative, was sent home with Flexeril.

    This pain goes in to the left shoulder, up the left side of neck, pain with breathing. I breathe shallow because it hurts so much to breathe..doing my own research after knowing heart and lungs were good.

    I’ve come to conclusion of Costochondritis. Everything I’ve read about it now fits. I’ve had no injury to bring it on..nothing, illnesses or otherwise – but it is extremely painful.

    Dr. Appointment coming up Tuesday. I have found since that being in a room that is moist, bathroom where air is heated and moist… sure helped to alleviate pain along with heating pad to chest.

    Liked by 1 person

      1. My cardiologist said I have costochondritis, but my family doctor disagrees and I am confused. My problem started 5 months ago, when I started to experience chest pressure every time I would lie flat. Lying flat or leaning back triggers chest pressure, heavy breathing, and a squeezing pain. The symptoms keep getting worse and worse until I sit up and lean forward for relief. I feel no pain as I go about my day; the discomfort only appears when I lean back. I have learned to sleep in an elevated position but when my symptoms flare up, I cannot even lean back an inch and sleeping becomes impossible.

        The process of figuring this out has also been very exhausting. I’ve had blood work done, ecg, echocardiogram, xray, and all results came back negative. The cardiologist concluded that I have costochondritis but my family doctor disagrees, considering it doesn’t hurt me to breathe and the pain is only triggered by a certain position. However, my family doctor does not have any answers at the moment. She told me she will think about it and get back to me in 2 weeks.

        Any thoughts? Do all people with costochondritis have the same experiences with regards to symptoms?

        PS I have tried tecta and that did not work for me

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        1. Dueling doctors – there’s a confusing dilemma. Which one is correct?

          I’m not a physician so cannot comment on your specific experience, but I can say generally that when people are trying to tell the difference between whether symptoms are due to a cardiac event or to acid reflux, one of the key differences is that lying down makes no difference to the former symptoms but is commonly very uncomfortable in the latter. Lying flat means your throat and stomach are basically at the same level, making it easy for stomach acids to flow up your esophagus, causing heartburn. But many people with costochondritis also report that their pain may be made worse by a particular posture, such as lying down.

          I hope that your doctor thinks of something during the two weeks and you’ll soon be finding relief.

          Like

        2. Hi Doua and Carolyn.

          Since all the tests for anything dire like the heart have come back clear (a good thing!) let’s assume it really isn’t that. Carolyn’s right – that plus the pain coming on when you lie down gives two likely answers: acid reflux or costochondritis.

          Carolyn’s explained the acid reflux possibility. The costo option arises from my New Zealand physiotherapist understanding of costo as NOT a “mysterious inflammation” but strain, pain and localised inflammatory response at the joints where your ribs hinge onto your breastbone, caused by lack of movement at the rib joints round your back.

          You get pain on lying with costo like this because your body weight on my the ribs round the back further strains the already strained rib joints on your breastbone.

          There’s a simple home test you can do for this tight rib bit. It’s on the Costochondritis page It’s not completely conclusive on its own but if you have an obvious restriction turning towards your painful side, then that’s probably what is going on. More info and how we fix it on the Costo page.

          Hope that helps clarify things for you. The tight or immobile rib joints won’t show on X-ray because that’s a still photo and can’t show whether the hinges can move or not, which is the important bit functionally.

          Cheers,
          Steve August (B.A.,Dip.Physio.).

          Liked by 1 person

          1. Once again, thank you Steve for weighing in here. I hadn’t yet watched the newer video on your Costochondritis page (oh my goodness, what fabulous scenery you have there in New Zealand, and what a great idea to film your presentation on top of a mountain!).

            The idea that costo starts off as a mechanical problem in the BACK, not just an inflammation in the chest that can be “fixed” with anti-inflammatory drugs is a concept that I hope will be better known soon.

            Thanks for doing your part…

            Like

        3. Go have your pancreas checked. My dad had this happen and was having problems with his pancreas. The only way to relieve was leaning forward.

          Like

    1. Good luck. I hope you feel better soon, I been having pain since September and I still cant find a solution. I wish you the best

      Like

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