Rib pain or pain felt in the chest wall is usually caused by an inflammatory condition called costochondritis in the cartilage part where the rib bones are attached to the breastbone. This problem may also be referred to by names such as costosternal syndrome, chest wall pain, or costosternal chondrodynia. If the pain is accompanied by swelling, it is called Tietze’s syndrome. Costochondritis causes localized chest pain that is exacerbated by finger pressure on the affected rib or cartilage tissue. Although the cause cannot always be determined, it can be triggered by excessive use of the arms. This condition, which can often go away on its own without any treatment, may cause concern as it can be confused with heart-related pain.
How Is Costochondritis Recognized?
Chest pain in adults is considered to indicate heart problems until proven otherwise. Various tests, such as blood tests and EKG, may be needed to rule out heart problems in a person with chest pain. Patients who complain of chest pain and are therefore evaluated by cardiologists are generally evaluated by a pulmonologist if no cardiac pathology is detected. In the absence of a lung-related problem, they are referred to physical therapy and rehabilitation outpatient clinics in terms of musculoskeletal system pathologies. It should be noted that sometimes stomach and biliary tract problems can also be felt as chest pain. At least one fourth of patients who come to the emergency department with chest pain are diagnosed with chest wall pain, which indicates that the problem is related to the musculoskeletal system. When it is seen that the person does not have heart or lung disease as a result of the examinations and the physical examination is compatible, the diagnosis of costochondritis can be made.
Costochondritis is more common in women than men. It is more common after the age of 40. Often the cause cannot be determined. There is no specific test for diagnosis. Sometimes it may have developed as a result of infection or thoracic surgery. Gallium scintigraphy can be performed if the suspicion of infection is high. In case of infection, values associated with inflammation increase in blood tests. Chest pain may also be due to a lung infection. To evaluate this, X-ray film is taken for the Lung.
Tietze syndrome can sometimes be expressed as costochondritis. However, the two situations are different. In Tietze syndrome, the pain begins suddenly, radiates to the shoulder or arms, and persists for several weeks or months. In addition to pain and tenderness in the joint area of the rib, swelling also occurs. It is a rare problem. Tietze syndrome most commonly affects the 2nd and 3rd ribs, while costochondritis most commonly affects the 4th, 5th and 6th ribs. Tietze syndrome is more common in young people and affects men and women equally.
What Causes Costochondritis?
Costochondritis is an inflammatory event, that is, it develops as a result of the activation of the immune system. Repeated exposure of the chest wall to minor traumas, overuse of the arms, viral respiratory tract infections can initiate the inflammatory process. The inflammatory process does not always indicate a microbial contamination. For example, in viral respiratory tract infections, the immune system activation in the cartilage tissue may be from the virus itself or from the strain of the tissue due to excessive coughing. More rarely, bacterial infections can cause this problem. Those who use intravenous drugs and those who have undergone thoracic surgery are at risk for bacterial costochondritis. Bacterial infection may cause redness, swelling and inflammatory discharge.
Rheumatic conditions such as osteoarthritis (joint calcification), rheumatoid arthritis, and ankylosing spondylitis can also cause costochondritis. Costochondritis can occur as a result of the spread of cancers such as breast, thyroid, and lung cancer.
How Does Rib Pain Due to Costochondritis Symptom?
Chest pain associated with costochondritis usually begins after exercise, mild trauma, or an upper respiratory tract infection. The pain may be blunt or sharp, stabbing in character. It is usually felt on the anterior surface of the chest wall. It is more common on the left side. It can spread to the back or abdomen. Pain may occur with deep breathing, coughing, or movement of the trunk. Tenderness by pressing on the joints of the rib bone, called the costochondral junction, is indispensable for the diagnosis of costochondritis. There is no discernible swelling or abscess in costochondritis.
What Are Other Musculoskeletal Causes of Chest Wall Pain?
Lower rib pain syndromes, back vertebrae and pain originating from the joint of the vertebrae with the ribs (costovertebral joint), sternalis syndrome, stress fractures, xiphoidalgia, spontaneous sternoclavicular subluxation, fibromyalgia, rheumatoid arthritis, ankylosing spondylitis and other rheumatoid arthritis (rheumatoid arthritis) associated with spondyloarthrosis (other spondyloarthritis) diseases. , sternoclavicular hyperostosis, systemic lupus erythematosus, septic arthritis of the chest wall, relapsing polychondritis, osteoporotic fractures, sickle cell anemia, cancers.
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When to Seek a Doctorate?
Although costochondritis is generally not a serious problem, it can be confused with a heart attack. It is necessary to consult a doctor in cases such as shortness of breath, high fever, signs of infection such as redness, pus, swelling in the painful area, nausea, dizziness, sweating. Continuous chest pain accompanied by nausea, sweating, pain in the left arm or general chest pain whose location cannot be described can be a symptom of a heart attack. In cases of suspected heart attack, it is necessary to apply to the emergency room.
How Is Costochondritis Treated?
Simple painkillers containing acetaminophen or pain relievers from the non-steroidal anti-inflammatory group can be used for treatment. To relieve pain, TENS can be performed from local cold or hot application and physical therapy methods . It is recommended to avoid movements or exercises that increase the complaints. Stretching exercises can be helpful. If the pain is not relieved by medication and is severe enough to limit daily life, injections containing local anesthetic and steroids can be made. Infectious costochondritis requires antibiotic treatment.