Causative & risk factors
Some cases of costochondritis have no preceding cause. Most of them are caused due to an injury to the chest, heavy physical lifting or presence of tumors. These causes lead to wear and tear and inflammation of the costochondral. Underlying conditions of the joints such as osteoarthritis, ankylosing spondylitis or severe infections can also cause costochondritis.
Clinical presentation
A sharp pain is felt in the front portion of the chest. The pain is usually stabbing in character and is worse from any movement, coughing or even breathing deeply. The pain is better on rest and on taking shallow breaths.
The 4th, 5th and 6th ribs are more commonly affected. The affected portions are tender to touch.
Investigations
Costochondritis is a clinical diagnosis based upon the patient’s symptoms. When the affected cartilage is pressed upon, it produces pain while coming back to its normal position (rebound tenderness).
It is very important to rule other causes (cardiac or gastric) of chest pain by performing a chest X-ray and an ECG.
Treatment
Costochondritis is a self limiting disease i.e. it disappears on its own. The pain however can last for several months. Anti-inflammatory drugs are prescribed to the patient. If the pain is very severe and not responding to anti-inflammatory drugs, anti-depressant drugs may be prescribed.
Certain severe cases may need injections of steroids or anesthetic drugs. An intercostals nerve block can be injected to relieve the pain for several weeks or months.
Several non-medicinal techniques can be tried to reduce the intensity of pain. These include hot fomentation, ice packs, stretching exercises, acupuncture and Transcutaneous electrical nerve stimulation (TENS).
