Costochondritis: Symptoms, Types, Causes and Treatment

Costochondritis is a frequently misunderstood cause of chest pain, often mistaken for more serious cardiac or pulmonary conditions. However, for those affected, it can be both distressing and disruptive to daily life. This article explores costochondritis in depth—covering its symptoms, types, causes, and treatment—drawing on recent research and clinical experience to provide clear, actionable information for patients and healthcare providers alike.

Symptoms of Costochondritis

When costochondritis strikes, it can generate alarm due to its chest pain, which is sometimes severe and easily confused with heart problems. Understanding its typical symptoms is essential for early recognition and proper reassurance.

Symptom	Description	Typical Location	Source(s)
Chest pain	Sharp, aching, or pressure-like pain	Lower ribs, upper breastbone	2,3,9
Tenderness	Pain increases with palpation/touch	Costochondral junctions	2,9
Worsening with activity	Pain aggravated by movement or specific positions	Sitting, reclining, or overuse	2,9
No swelling	Absence of visible swelling (unlike Tietze syndrome)	Chest wall	2,3

Table 1: Key Symptoms

Chest Pain: The Hallmark Feature

The most prominent symptom of costochondritis is chest pain, often described as sharp, aching, or pressure-like. It is typically localized to the area where the ribs attach to the breastbone (sternum), most often affecting the third or fourth ribs, but any of the first seven costochondral junctions can be involved. The pain is usually unilateral (one-sided), though it can occur on both sides in rare cases 2,3,9.

Tenderness and Reproducibility

A distinguishing feature is that the pain is reproducible: pressing on the affected area of the chest wall elicits or worsens the discomfort. This tenderness helps set costochondritis apart from cardiac causes of chest pain, which are not typically tender to the touch 2,9.

Pain Triggers and Aggravators

The pain of costochondritis often increases with certain activities or postures—such as sitting, reclining, or deep breathing. Physical activity or stress can exacerbate symptoms. Some patients report that the pain intensifies with coughing, sneezing, or upper body movement 2,9.

Absence of Swelling

Unlike Tietze syndrome, another chest wall condition, costochondritis does not cause visible swelling over the affected joints. This absence of swelling is an important diagnostic clue 2,3.

Types of Costochondritis

Costochondritis is not a one-size-fits-all condition. Distinguishing between its different forms—and related disorders—is important for both diagnosis and management.

Type	Key Features	Distinction Point	Source(s)
Idiopathic (IC)	Pain & tenderness, no swelling	Most common, self-limited	3,4,9
Atypical	Persistent, recurrent, or chronic	Lasts longer, more complex	4,10
Infectious	Follows infection, trauma, or surgery	Rare, often severe	6,7,11
Tietze Syndrome	Pain with swelling	Visible swelling present	2,3

Table 2: Types of Costochondritis

Idiopathic Costochondritis

The majority of cases are idiopathic, meaning they arise spontaneously without a clear cause. Idiopathic costochondritis (IC) typically presents with chest pain and tenderness at the costochondral junctions, but no swelling. It commonly affects women and tends to be more frequent in the winter and spring months 3.

Atypical Costochondritis

This form refers to cases where symptoms are persistent, recurrent, or do not resolve within the usual timeframe (typically weeks). Atypical costochondritis can cause prolonged discomfort, heightened anxiety, and increased healthcare utilization. It may require more advanced interventions, such as physical therapy or manual manipulation 4,10.

Infectious Costochondritis

Rarely, costochondritis can be caused by an infection, especially following trauma, surgery, or in immunocompromised patients. Both bacterial and fungal pathogens have been reported, such as Candida albicans and Aspergillus flavus. Infectious cases often need aggressive treatment, including surgical debridement and antibiotics 6,7,11.

Tietze Syndrome

While often confused with costochondritis, Tietze syndrome is a distinct entity characterized by both pain and visible swelling of the rib cartilage. The swelling is non-suppurative (not pus-forming) and usually affects a single joint 2,3.

Causes of Costochondritis

Understanding the underlying causes of costochondritis can help with prevention and tailored treatment. While many cases are idiopathic, research has identified several potential triggers and contributing factors.

Cause	Description	Risk Factor/Trigger	Source(s)
Unknown (Idiopathic)	No clear cause identified	Most cases	3,4,5
Overuse/Strain	Repetitive upper body movement	Sports, heavy lifting	9,10
Trauma	Direct blow or injury to chest	Accidents, falls	6,10
Infection	Bacterial or fungal invasion	Surgery, IV drug use	6,7,11
Neurogenic Factors	Nerve-related inflammation	Possible spinal involvement	1,5
Post-surgical	After chest or cardiac surgery	Sternal wound complications	7,11
Seasonality	Higher incidence in winter-spring	Linked to respiratory infections	3

Table 3: Causes of Costochondritis

Idiopathic (Unknown) Origin

For most patients, the exact cause of costochondritis remains unknown. These idiopathic cases are the most common and can occur in otherwise healthy individuals with no clear precipitating event 3,4.

Mechanical and Overuse Factors

Repetitive upper body movements or strain—such as those seen in athletes, manual laborers, or individuals who perform heavy lifting—can lead to microtrauma of the costochondral joints. This may set off inflammation and pain 9,10.

Trauma

A direct blow or injury to the chest wall, such as from an accident, fall, or even forceful coughing, can initiate costochondritis. In rare cases, trauma may also set the stage for infectious costochondritis 6,10.

Infection

Although rare, costochondritis can be caused by infection. This is more likely following surgery (especially cardiac procedures involving the chest), in intravenous drug users, or as a complication of systemic infections. Both bacterial and fungal organisms have been implicated in such cases 6,7,11.

Neurogenic Inflammation

Recent reports suggest that neurogenic or nerve-related inflammation may play a role in some cases. Positive responses to manual therapy targeting the spine and posterior rib joints suggest a more complex mechanism than just local cartilage inflammation 1,5.

Post-surgical and Other Triggers

Costochondritis may develop as a complication of chest or cardiac surgery, particularly if wound healing is impaired or infection occurs 7,11. Additionally, there is evidence to suggest a seasonal trend, with higher rates in winter and spring, possibly related to respiratory tract infections 3.

Treatment of Costochondritis

Effective management of costochondritis aims to relieve pain, reduce inflammation, and restore function. Treatment is often conservative, but persistent or complicated cases may require more intensive interventions.

Approach	Method/Detail	Efficacy/Notes	Source(s)
NSAIDs/Acetaminophen	Pain and inflammation relief	Mainstay, variable results	9,12
Physical Therapy	Stretching, mobilization, OMT	Shown effective, esp. chronic	4,10,12
Activity Modification	Avoid overuse, rest	Essential part of recovery	9,12
Local Injections	Corticosteroid or anesthetic	For severe/refractory cases	8
Sulfasalazine	Immunomodulatory therapy	For recurrent cases	8
Surgery/Debridement	Removal of infected or necrotic tissue	For infectious cases	6,11
Reassurance	Patient education	Reduces anxiety, unnecessary tests	9,8

Table 4: Treatment Approaches

First-Line: Medications and Conservative Care

Most cases of costochondritis respond to non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, which help control pain and inflammation. Patients are advised to rest, avoid activities that exacerbate symptoms, and apply local heat as needed 9,12.

Physical Therapy and Manual Techniques

For patients with persistent or recurrent symptoms, physical therapy—including stretching exercises, osteopathic manipulation, and soft tissue mobilization—has demonstrated significant benefit. Studies show that targeted stretching exercises can reduce pain more effectively than medications alone. Manual therapy and instrument-assisted techniques may also help address underlying rib or spinal dysfunction, particularly in atypical or chronic cases 4,10,12.

Injections and Advanced Therapies

In severe cases, local injections of corticosteroids or anesthetic agents can provide relief. For individuals experiencing recurrent episodes, immunomodulatory medications like sulfasalazine have shown promise 8.

Infectious and Surgical Management

Infectious costochondritis requires prompt surgical debridement and often a course of antibiotics or antifungals. Surgical intervention is also necessary in cases where there is necrosis or failure to heal with conservative management 6,11.

Reassurance and Education

Because the pain of costochondritis can mimic serious cardiac conditions, patient reassurance and education play a crucial role. Early diagnosis and clear communication reduce anxiety and help prevent unnecessary hospital admissions and investigations 9,8.

Conclusion

Costochondritis is a common but often misunderstood cause of chest pain. Recognizing its symptoms, understanding its types and causes, and knowing the range of effective treatments can empower patients and clinicians alike. Timely identification and targeted management can minimize distress, prevent unnecessary procedures, and restore quality of life.

Key points covered:

• Symptoms: Costochondritis presents with reproducible chest pain and tenderness, typically without swelling.
• Types: Ranges from idiopathic (most common) to atypical, infectious, and Tietze syndrome (which includes swelling).
• Causes: Most cases are idiopathic, but mechanical strain, trauma, infection, neurogenic factors, and post-surgical complications can contribute.
• Treatment: Conservative approaches (NSAIDs, physical therapy, stretching) are first-line; injections, immunomodulation, and surgery are reserved for refractory or infectious cases. Early diagnosis and patient reassurance are vital for optimal care.

By staying informed, individuals can better navigate this benign but often worrisome condition—and return to their daily activities with confidence.