Costochondritis: Sore Ribs, Chest Wall Pain and How It Differs From the Heart

What it involves

MedlinePlus explains that all but your lowest two ribs are joined to the breastbone by cartilage, and that this cartilage can become inflamed and painful. That condition is called costochondritis, and MedlinePlus calls it a common cause of chest pain. It also warns that the pain can be similar to the pain of a heart attack.

Who this is for

• Patients with sore, tender chest pain that gets worse when they breathe deeply or cough
• Patients who strained their chest by heavy lifting, hard exercise or a long bout of coughing
• Patients who want a heart check to confirm that chest wall pain is the explanation
• Patients with chest pain that keeps coming back after an emergency visit found nothing urgent

What to expect

• Questions about where the pain sits, what brings it on and any symptoms like breathlessness or sweating
• A physical exam, pressing along the point where the ribs meet the breastbone
• An EKG or other tests if your history leaves any question about the heart
• A plan for comfort care, with follow-up if the pain does not improve

Safety first, then the diagnosis

MedlinePlus is unambiguous that anyone with chest pain should call 911 or go to the local emergency room right away, because costochondritis can feel like a heart attack. A chest wall explanation is something you and a provider arrive at after the dangerous causes have been considered, not before. If the pain is crushing, spreads to the arm or jaw, or comes with shortness of breath, sweating or fainting, do not wait for an appointment. The chest pain guide sets out which situations are emergencies.

What the pain tends to feel like

The usual symptoms on MedlinePlus are sharp pain at the front of the chest wall that may move to the back or stomach, pain that increases with a deep breath or a cough, tenderness when you press where the rib meets the breastbone, and less pain when you stop moving and breathe quietly. That mix of reproducible tenderness and pain that changes with movement and breathing is what leads a provider toward the chest wall. A provider weighs all of this together with your age and risk factors.

Possible causes

MedlinePlus says there is often no known cause. When one is found, it may be a chest injury, hard exercise or heavy lifting, a viral infection such as a respiratory infection, strain from coughing, an infection after surgery or from intravenous drug use, or some types of arthritis. Because coughing is on that list, a cough that lingers after a cold can sometimes leave the chest wall sore; the persistent cough guide covers the cough itself.

How a provider confirms it

MedlinePlus says your provider takes a medical history and does a physical exam, checking the area where the ribs meet the breastbone. If that area is tender and sore, costochondritis is the most likely cause of the pain. A chest x-ray may be done if symptoms are severe or do not improve with treatment, and your provider may order tests to check for other conditions, such as a heart attack. An EKG, which the practice lists among its services, is one common tool; the EKG page explains what it records.

Treatment is about comfort

MedlinePlus says costochondritis most often goes away on its own in a few days or weeks, though it can take up to a few months, and treatment focuses on relieving pain. It suggests hot or cold compresses, avoiding activities that make the pain worse, and over-the-counter pain relievers like ibuprofen or naproxen. It advises talking with a provider before using them if you have heart, kidney or liver disease, high blood pressure, or a history of stomach ulcers or internal bleeding. Acetaminophen may be an option if your provider says it is safe, and stronger medicine or physical therapy may be recommended in some cases.

When to come back

For someone already diagnosed, MedlinePlus says to contact your provider if there is trouble breathing, a high fever, signs of infection such as pus, redness or swelling around the ribs, pain that continues or worsens after taking pain medicine, or sharp pain with every breath. Pain that returns in a new pattern, or that now comes with exertion, also deserves a fresh look rather than an assumption that it is the same old problem. There is no known way to prevent costochondritis, since the cause is often unknown.

Sources

• MedlinePlus — Costochondritis