By Laurence Schubert APAM
What is Costochondritis?
Costochondritis is a painful condition at the joints between the sternum and the ribs. There are 12 individual ribs that make up the rib cage, 7 of these attach to the sternum bone. Importantly, the ribs do not attach directly to the sternum, they attach via cartilage known as "œcostal cartilage". These are the areas that are affected by Costochondritis.
This condition is closely linked with Tietzeâ€™s syndrome but have key differences. Through modern Latin language, "itis"refers to inflammation, which is the main distinguishing factor between the two conditions. Tietze's syndrome does not have inflammation of the costal margin, whereas Costochondritis does.
What are the symptoms of Costochondritis?
Costochondritis is very painful and often debilitating. This condition is characterised by activity related pain and tenderness localised to the costochondral junction. Each presents differently but it is likely that pain will be elicited by activity/exercise, sneezing, coughing and deep breathing. Pain can refer to the back as well as the arms and shoulders. Due to the inflammation, increased redness, temperature increase and swelling of the cartilage may be present through palpation and observation. Symptoms can occur gradually and can take multiple months to settle down. Alternatively, red flags should always be ruled out as differential diagnosis may include cardiac pathology or tumour.
What Causes Costochondritis?
The exact cause of costochondritis is unknown; however, it is likely that patients who have increased inflammatory markers are at greater risk.
- Certain types of arthritis; particularly rheumatoid.
- Certain viruses such as tuberculosis and syphilis, or anything that increases joint inflammation.
- Trauma to the chest, e.g. from a fall or car accident.
- Tumours in the costal region.
- Physical strain from activities that involve strenuous exercise (secondary cause).
What is the Treatment for Costochondritis?
Costochondritis will involve medication to reduce the inflammation as well as physical therapy to reduce symptoms. It is important to re-assure the patient that this condition can be managed and that you shouldn't stop your activity completely, due to this condition. Local injections, topical or oral analgesics, as well as steroidal medication can be used.
Your physiotherapist can assist with physical therapy techniques in order to reduce the intensity and frequency of your symptoms. This can include trigger point therapy, cross fibre friction massage, mobilisation of the ribs/thoracic region and recommendation on activities to avoid. Stretching and progressive exercises are very likely to benefit this condition.
An assessment by your physiotherapist or health care practitioner is necessary in order to rule out any other more serious conditions and to identify the main problem(s).