Costochondritis

Medically Reviewed by Shruthi N on May 29, 2024
Written by Lori M. King, PhD
6 min read

Costochondritis (pronounced cos-toe-kon-DRY-tis) is inflammation of the cartilage that connects your ribs to your sternum. Your sternum (or breastbone) is the flat bone in the middle of your chest that protects your heart, lungs, and major blood vessels. 

 

Costochondritis is one of the most common causes of chest pain. The pain can be severe, and some people will mistake it for a heart attack. But it’s typically harmless and usually goes away without any treatment. However, you should take any chest pain seriously, especially if your pain doesn't get better in a couple of days. If you have chest pain, go to your doctor and get checked for heart disease.

You may also mistake costochondritis for a rare condition called Tietze syndrome. Costochondritis and Tietze syndrome are similar in that both cause inflammation, but they are different in the following ways:  

  • Tietze syndrome usually affects the cartilage of ribs higher up your chest, closer to your shoulders. This is most often at the second or third ribs. On the other hand, costochondritis usually affects ribs two through five, lower down your chest.

  • Tietze syndrome causes swelling at the inflamed area (where your ribs and breastbone meet) that you'll be able to feel on the outside of your body. You likely won't have that with costochondritis.

​​​​​​​Fortunately, costochondritis and Tietze syndrome are diagnosed and treated the same way.

In most cases, doctors don’t know exactly what causes costochondritis, but here are some things that can lead to it: 

  • Infections in your chest
  • Repeated minor trauma to your chest wall
  • Coughing or vomiting too hard
  • Doing intense physical activity, like working out or playing sports, without taking time to rest and recover
  • Doing physical activity that you don't normally do, like increasing the intensity of your workout too fast or moving furniture
  • Inflammatory diseases that affect your joints and spine, such as arthritis. Costochondritis can sometimes be a sign of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or other conditions that affect your cartilage.
  • Tumors. These can move from joints and other parts of your body and settle in your chest.
  • Using IV drugs

Costochondritis pain locations

You will usually have pain in your chest. The pain may:

  • Be concentrated on the left side of your breastbone
  • Be sharp, aching, or feel like pressure
  • Affect more than one of your ribs
  • Radiate to your arms and shoulders
  • Get worse when you take a deep breath, cough, sneeze, vomit, twist, or stretch your trunk muscles
  • Get worse when you hug someone, exercise, or lie down on your affected side

Common infection symptoms

Symptoms of an infection include redness, swelling, and heat at the affected rib. You won't usually have these as symptoms of costochondritis; you are more likely to have them with Tietze syndrome.

How long does costochondritis last?

In most cases, your symptoms will last from a few days to a few weeks. In rare cases, they may last for several months.

Signs you need to call a doctor

Call your doctor if you have any of the following:

  • Trouble breathing
  • Fever
  • Symptoms of an infection
  • Continuing or worsening pain despite medication
  • Nausea
  • Sweating
  • Dizziness

Signs you should go to the emergency room

Go to a hospital's emergency room if you have a hard time breathing or any of the following. They’re not usually caused by costochondritis:

  • High fever that doesn’t get better with fever reducers such as acetaminophen or ibuprofen
  • Signs of infection at the tender spot, such as pus, redness, increased pain, and swelling
  • Persistent chest pain of any type when you also have nausea, sweating, or pain in your left arm. These may be signs of a heart attack. If you’re not sure what’s causing your chest pain, go to the emergency room.

Groups that may have a higher risk of developing costochondritis include:

  • Athletes who play contact sports

  • People with physically demanding jobs

  • Women and people assigned female at birth (AFAB)

  • People of Hispanic ancestry

  • People above the age of 40-50

 

The symptoms of costochondritis can be the same as those in more serious conditions, such as a heart attack. Your doctor will do tests to rule out these more serious conditions before they diagnose you with costochondritis. 

Some tests your doctor may run include:

A physical exam where they feel your chest and ribs to determine the intensity level of your pain and where you feel it the most. Also, they will look for signs of infection such as redness or swelling around your ribs.

A blood test to check for infections or other issues.

Imaging tests to rule out other causes of rib or chest pain, such as:

  • Chest X-ray

  • CT scan

  • MRI

  • Ultrasound

  • EKG

Home Remedies for Costochondritis

These home remedies may provide relief from costochondritis:

  • Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
  • Using heat or ice to relieve pain
  • Avoiding unnecessary exercise or activities that make your symptoms worse or avoiding contact sports until your symptoms improve
  • Doing stretching exercises

Costochondritis medications

Your doctor may suggest the following:

  • Prescription-strength NSAIDs
  • Narcotics like hydrocodone/acetaminophen (Norco, Vicodin) or oxycodone/acetaminophen (Percocet, Roxicet, Tylox) can help with extreme pain, but, as with any narcotics, there’s danger of becoming addicted to them.
  • Steroids. Your doctor can give you a corticosteroid shot directly into a painful joint, but that’s considered something of a last resort.
  • Tricyclic antidepressants or cyclic antidepressants like amitriptyline can help ease pain, but they also can have side effects like weight gain and drowsiness. 
  • Antiseizure drugs, usually gabapentin (Neurontin), may help with costochondritis.
  • Infectious (bacterial or fungal) costochondritis should be treated with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another 2 to 3 weeks. You should see a doctor during recovery, and then once a year. 

Surgery for Costochondritis

You may need surgery to remove the sore cartilage if other treatments don’t help. Your doctor can refer you to a surgeon.

Costochondritis stretches

Stretching may help reduce your pain and stretch your chest. A few stretches that may help include:

Doorway stretch. Stand facing an open doorway and raise your arms to the sides. Bend your elbows at a 90 degree angle. Rest your forearms against the wall with your elbows at shoulder height. Lean forward through the open doorway to stretch your chest muscles. Hold for 30-60 seconds. Repeat 10 times.

Rolled towel or foam roller stretch. Lie down on your back with a rolled towel or foam roller under your midback (around the level of your shoulder blades). Bend your knees and keep your arms out to your sides with your elbows bent at about a 20 degree angle. Hold for 20 seconds. Repeat 10 times.

Sphinx pose. Lie on your stomach and support yourself on your elbows. Open your chest, arch your back, and stretch upwards and backwards. Hold for 10 seconds. Relax all the way down with your face to the floor for 20 seconds. Repeat 10 times.

Repeat these stretches daily for 6 weeks, then three times a week for 6 more weeks.

Because inflammatory costochondritis has no definite cause, there is no good way to prevent it.

Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. Most people will recover fully.

Infectious costochondritis responds well to IV antibiotics and surgery, but recovery may take a long time.

Costochondritis is inflammation of the cartilage that connects your ribs to your breastbone. It's one of the most common causes of chest pain. The pain can be severe, and some people will mistake it for a heart attack. It’s typically harmless and usually goes away without any treatment. You can ease your pain and help yourself heal by taking ibuprofen or naproxen, using a heating pad or cold pack, avoiding activities that make your symptoms worse, and doing stretching exercises.

Is costochondritis dangerous?

No, it's not usually dangerous or a sign of something serious.

What is the best treatment for costochondritis?

Costochondritis usually gets better on its own. Your doctor will likely recommend you rest, stretch, and take NSAIDs for pain.