What is Costochondritis?
Costochondritis is chest pain. It is a pain of the chest wall which includes the rib bones, sternum in addition to muscles. It is important to keep in mind that the rib cage has cartilage between the ribs. Like any connective tissue, it is subject to inflammation.
Let’s break down the word.
- “Costo”means rib
- “chondro” means cartilage
- “itis” means inflammation.
Sometimes chest wall pain follows an injury such as a fall. Other times, especially with young women, there is no specific cause of costochondritis
Costochondritis pain is a non-cardiac chest pain. It is usually described as sharp, and local. (This is different from heart pain which is crushing, squeezing chest tightness).
Quickcare or ER?
Red Flags that will send you to the ER:
- Shortness of breath is the key indicator of an ER visit.
- Severe pain should also lead you to an ER
- Heart risk factors like diabetes, high blood pressure or heart disease
What will your doctor ask?
Your doctor will want to know your symptoms. A symptom is your description of your condition to your doctor. It is your story.
Answering the following questions will help your doctor understand.
- Key question: Do you have any shortness of breath?
- How bad is the pain?
- Where do you hurt? Is the pain sharp or dull?
- Does it get worse with movement?
Most patients with costochondritis will have a sharp pain in the chest that gets worse with movement or deep breaths
What will your doctor look for?
Your doctor will look for signs. A sign is an objective finding that a doctor discovers on examination.
Looking for a punctured lung is absolutely essential.
Here are four ways:
#2 Also, on exam, the chest wall area will have a crunchy, spongey feel. Kinda like pushing on Rice Krispies.
#3 A punctured lung may demonstrate diminished or absent breath sounds.
#4 A Chest xray will look for signs of a punctured lung.
What is your doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
The first thing a doctor is thinking is making sure there is not a punctured lung (pneumothorax). There is a ton of information just by staring at the patient for just a few seconds.
Now we can move on to the oxygen level. A simple finger monitor with an oxymetry machine will tell us the oxygen level.
If there is any concern of heart pain, then an EKG (electrocardiogram) is important.Lastly, a chest xray will look at the lungs, ribs and heart. Leaking air from the lungs to the chest wall has a unique appearance. Notice the blackened lung on the xray to the right.
Another consideration is an infection between the lungs and the chest wall. This area is called the pleural space. If pus settles into the pleural space, then it is called empyema.
What is the treatment of Chest Wall Pain?
If there is only a bruise, then simple pain medications are needed. I like to prescribe naproxen 550 mg twice a day. I prescribe narcotics such as Norco for the night since rolling onto the affected side is very painful.
Even if the xray shows broken bones, it would be the same treatment-pain medications. Some doctors add on a brace or large ace wrap for the chest. It can be comforting. But it is not a cure.
How long will you be sick?
Chest injuries take a long time to heal.
I describe to my patients the following way….. What if you sprained your wrist and then moved it up and down all day? It would take forever to heal.
That is what is going on with an injured chest wall. With every breath, the ribs move up and down. Up and down.
I tell patients that they will be hurting for at least two weeks.
If the lung is punctured, then it could be even longer.
Let me tell you a story
So, she took bicycling. It looked fun. It seemed safe when wearing a helmet. She had some fear of falling while going down a hill. But, she never thought she would fall while trying to get on the bike.
Wham! Her chest hit right on the pedal as she tried to mount.
She came to the clinic holding her chest. “It hurts when I breath,” she said.
In Bertha’s case, the pain was local, sharp and got worse with breathing. She had no shortness of breath.
Let’s look at Bertha’s breathing
Look at how Bertha is sitting.
Is Bertha having difficulty making full sentences?
Luckily, Bertha had no overt difficulty breathing. Just pain with breathing. The pain that was controlled with pills.
After two weeks, she was back on the saddle again for another ride in the hills
I hope this helps