Best Practice Case Studies-Case 119 Asset 3 Costochondritis: Rapid Evidence Review

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Costochondritis is a common, usually self-limited cause of chest wall pain caused by inflammation of the costochondral joints. It most often affects adults aged 40 to 50 years and is slightly more common in women. In primary care, chest wall pain represents a substantial share of chest pain visits, and costochondritis accounts for a meaningful portion of these cases.<br /><br />Diagnosis is based mainly on history and physical examination, but clinicians must first rule out dangerous causes of chest pain such as acute myocardial infarction, pulmonary embolism, pericarditis, pneumonia, aortic dissection, and gastroesophageal reflux disease. Typical costochondritis presents as bilateral parasternal pain worsened by deep breathing, coughing, or stretching, usually involving the second through fifth costochondral or costosternal joints. Pain is reproducible with palpation and may also be provoked by maneuvers such as the crowing rooster maneuver or crossed-chest adduction. Unlike Tietze syndrome, costochondritis does not usually cause visible swelling or edema.<br /><br />There is no specific lab, imaging, or ECG test that confirms costochondritis. Testing should be directed toward excluding other diagnoses; ECG is often appropriate, and imaging may be used if trauma or dyspnea is present.<br /><br />Treatment is conservative. Common first-line options include rest, heat, oral or topical NSAIDs, capsaicin cream, lidocaine patches, physical therapy, and acupuncture, though high-quality evidence is limited. Refractory cases may benefit from corticosteroid injection, but evidence is insufficient to recommend this routinely.<br /><br />Most patients improve within a few weeks with conservative care. In one study, 91% recovered after three weeks, and recurrence was uncommon at about 4% over two years.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 119

Topic Chest

Keywords

costochondritis

chest wall pain

costochondral joints

parasternal pain

physical examination

differential diagnosis

NSAIDs

Tietze syndrome

corticosteroid injection

conservative treatment

4th Edition

4th Edition, Case 119

Chest