Costochondritis

• Etiology/Pathophysiology
  • Inflammation of the costochondral or sternocostal junctions.
  • Usually idiopathic; associated with physical overuse, trauma, or recent viral URI.
  • Differentiate from Tietze Syndrome: Costochondritis has no palpable swelling, whereas Tietze Syndrome presents with localized swelling/edema.
• Clinical Features
  • Chief Complaint: Sharp, aching, or pressure-like anterior chest wall pain.
  • Aggravating Factors: Deep inspiration, coughing, or movement of the upper body.
  • Physical Exam (Key Finding): Reproducible tenderness to palpation over the involved costochondral joints (most commonly ribs 2–5).
  • Absence of erythema, heat, or swelling.
• Diagnostics
  • Clinical Diagnosis: Based on Hx and reproducible tenderness.
  • Rule Out ACS: In pts >35 years or with cardiac risk factors, must exclude Acute Coronary Syndrome (ACS) first.
    • ECG: Normal.
    • Troponins: Negative.
  • CXR: Generally normal; used to rule out bony pathology or pulmonary causes if Sx are atypical.
• Treatment
  • Reassurance: Self-limiting condition.
  • Pharmacologic: NSAIDs (e.g., ibuprofen, naproxen) or Acetaminophen.
  • Refractory: Local anesthetic/steroid injection (rarely needed).
• Differential Diagnosis
  • Acute Coronary Syndrome (MI/Unstable Angina): Pain is usually substernal, exertsional, not reproducible by palpation.
  • Tietze Syndrome: Palpable swelling + tenderness.
  • Pericarditis: Positional pain (relieved by leaning forward), friction rub, diffuse ST elevation.
  • Pulmonary Embolism: Dyspnea, hypoxia, tachycardia.