Costochondritis

Costochondritis
Classification and external resources
The costal cartilages
ICD-10	M94
ICD-9	733.6

Costochondritis is a benign inflammation of the costal cartilage, which is a length of cartilage which connects each rib, except the eleventh and twelfth, to the sternum. It causes pain in the chest that can be reproduced by pressing on the affected area between the ribs. This pain can be quite excruciating, especially after rigorous exercise. While it can be extremely painful, it is considered to be a benign condition that generally resolves. Though costochondritis appears to resolve itself, it can be a recurring condition that can appear to have little or no signs of onset. Treatment options are quite limited and usually only involve rest and analgesics but in a very small number of cases cortisone injections and even surgery are sometimes necessary. It is recommended that costochondritis patients should refrain from physical activity to prevent the onset of an attack.^[1]

Costochondritis symptoms can be similar to the chest pain associated with a heart attack. Unexplained chest pain is considered a medical emergency until cardiac issues can be ruled out.^[1]

Severe costochondritis is referred to as Tietze's syndrome. The two conditions were initially described separately, the sole difference being that in Tietze's Syndrome there is swelling of the costal cartilages. It is now recognized that the presence or absence of swelling is only an indicator of the severity of the condition. It was at one time thought to be associated with, or caused by, a viral infection acquired during surgery, but this is now known not to be the case. Most sufferers have not had recent surgery. Costochondritis often results from a physical strain or minor injury, but the true causes are not well understood.^[1] A mild form of the disorder is not uncommon in pregnancy. In these circumstances it is thought to be caused by the upward pressure of the abdominal organs and the growing uterus as well as the tendency of the pregnant woman's breathing to involve more use of the chest muscles since the diaphragm's movement is more limited.

Differential Diagnosis

• Cardiac:
  • Coronary artery disease
  • Pericarditis/myocarditis
  • Aortic aneurysm
• Gastrointestinal:
  • Gastroesophageal reflux disease
  • Gastritis
  • Esophagitis
• Musculoskeletal:
  • Fibromyalgia
  • Rib fracture
  • Ankylosing spondylitis
• Psychogenic:
  • Anxiety disorder
  • Panic disorder
  • Hyperventilation
• Respiratory:
  • Pneumonia
  • Pneumothorax
  • Pleuritis
• Other:
  • Herpes zoster
  • Drug abuse

Epidemiology

Exact incidence is unknown; in studies it ranges from 10% to 30% of people with chest pain in an emergency department.

See also

• Costochondral cartilage

References

1. ^ ^{a b c} Beers, Mark (2006). "Chapter 5". The Merck Manual of Diagnosis and Therapy (18th ed.). Merck Research Laboratories. ISBN 0911910182. 

External links

• About.com
• NetDoctor
• MayoClinic.com
• Costochondritis and Tietze Syndrome