Chest pain from the joints and cartilage of the rib cage, not the heart. But only after the heart has been ruled out.
What is costochondritis?
Inflammation where the ribs meet the breastbone. It is a common cause of chest pain in younger and middle-aged adults.
It also follows the force of a seat belt in a crash. That is why it shows up in accident patients.
What are the symptoms of costochondritis?
- Sharp or aching pain at the front of the chest.
- One spot hurts when you press on it. This is a key sign that sets it apart.
- Worse with deep breaths, coughing and twisting.
- Often follows a crash, a cough illness or lifting you are not used to.
How is costochondritis treated?
- Cardiac causes must be excluded first. New chest pain belongs in the emergency room, not a clinic.
- Local injection when one joint is the source.
- Anti-inflammatory treatment and changes to activity.
- Physical therapy for how the upper back and ribs move.
To get checked, call us or request an appointment.
What usually gets missed
The key step is ruling things out, not naming the problem. New chest pain needs a heart check first. Costochondritis is what remains after that is done. It is not a label to grab at the start.
Once heart causes are ruled out, the key sign is pain you can bring back by pressing. Chest wall pain that returns when we press one costochondral junction (the spot where a rib joins its cartilage) comes from muscle and joint. Pain that cannot be brought back that way does not.
How long does costochondritis last?
Most cases settle within weeks to a few months with anti-inflammatory treatment and changes to activity.
Chest wall pain after a seat-belt injury takes longer. Sometimes it warrants a targeted injection or intercostal block (numbing the nerve that runs under a rib). This is most true when pain limits deep breaths.
When this becomes urgent
Chest pain that is new, or comes with shortness of breath, sweating, nausea, or pain into the jaw or arm, is a heart emergency until the heart is ruled out. Call 911. Chest pain with fever, or after significant trauma, also needs urgent assessment, not a clinic visit.
Why it happens
Inflammation where the ribs meet the sternum (breastbone) causes sharp pain at the front of the chest. Pressing on the sore joint brings it back. It is usually worse with deep breaths, coughing or twisting. It often follows upper-body effort you are not used to, a cough that will not quit, or a chest wall injury.
What gets mistaken for costochondritis?
The key point: chest pain is not assumed to come from muscle and joint until heart and lung causes have been considered. Pain that returns when pressed is a good sign. But it is not enough on its own, most of all with heart risk factors. Anyone with new chest pain and any risk should be checked for those causes first.
Where medication fits
Medicine is a bridge, not a destination. It makes the wait bearable until the source is found and treated. Its role should shrink as treatment works. We review every drug you already take in full, including anything from other doctors, because the real risk sits in drug interactions (how drugs affect each other), not in any single one.
Common questions
How do I know it is not my heart?
You cannot tell from home. Chest pain that is new, or that comes with shortness of breath, sweating or arm and jaw pain, is a 911 call. Costochondritis is a diagnosis made after heart causes are ruled out.
This is set out in Thoracic and Mid-Back Pain.
How long does it take to settle?
Often weeks to a few months. Treatment at the sore spot can shorten a stubborn case once the diagnosis is certain.
The detail is in Intercostal Nerve Block.
What does costochondritis feel like?
Sharp or aching pain at the front of the chest, with one spot that hurts when you press on it. That tenderness to pressure is the key feature. It gets worse with deep breaths, coughing and twisting. Because the pain sits in the chest, new chest pain always needs the heart ruled out first. Costochondritis is what remains once that is done.
What is the main cause of costochondritis?
Inflammation where the ribs meet the breastbone. It often follows lifting or upper-body effort you are not used to, a cough illness with a cough that will not quit, or a chest wall injury. It also follows the force of a seat belt in a car crash. That is why it shows up in accident patients. Pain after a seat-belt injury usually takes longer to settle.
How do you fix costochondritis?
First, the heart is ruled out. New chest pain belongs in the emergency room, not a clinic. After that, most cases settle within weeks to a few months with anti-inflammatory treatment and changes to activity. Physical therapy works on how the ribs and upper back move. When one joint is clearly the source, a local injection or an intercostal nerve block can shorten a stubborn case.
Sources
- Expert Panel on Thoracic Imaging et al. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 2021. PubMed 34794596
- Johansson MS et al. Incidence and prognosis of mid-back pain in the general population: A systematic review. European journal of pain (London, England), 2017. PubMed 27146481
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
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