Costochondritis: Rapid Evidence Review

 

Am Fam Physician. 2021 Jul ;104(1):73-78.

  Patient information: See related handout on costochondritis.

Author disclosure: No relevant financial affiliations.

Costochondritis is a common cause of chest pain. It most commonly occurs in adults between 40 and 50 years of age, with a slight predominance in women. Although musculoskeletal and other chest wall conditions are the most common etiology for chest pain presenting to primary care, an initial differential diagnosis should include cardiovascular, psychogenic, pulmonary, gastrointestinal, and miscellaneous or unknown sources (more to less common, respectively). Additionally, physicians should remain vigilant throughout the workup because a notable portion of patients with chest wall tenderness to palpation may also have acute myocardial infarction. After a musculoskeletal or chest wall source is determined, differential diagnosis includes costochondritis, muscle trauma (including postoperative) or overuse, arthritis, fibromyalgia, neoplasm, infection, herpes zoster, Tietze syndrome, painful xyphoid syndrome, and slipping rib syndrome. The diagnosis of costochondritis is largely based on history and a physical examination that demonstrates reproduction of pain through palpation of the parasternal region of the chest wall, performance of a crowing rooster maneuver, and/or a crossed-chest adduction maneuver. Although high-quality evidence is lacking, treatment options include local application of heat, oral or topical nonsteroidal anti-inflammatory drugs, lidocaine patches, capsaicin cream, physical therapy, and acupuncture. Most patients will have complete resolution of symptoms in a few weeks' time with conservative therapy. Recalcitrant cases may respond to corticosteroid injections.

Costochondritis is a commonly encountered condition in primary care that is characterized by chest wall pain from inflammation in the costochondral joints. It most commonly occurs in adults 40 to 50 years of age. This article reviews the best available patient-oriented evidence for costochondritis.

Epidemiology

  • The most common age for costochondritis is middle age (between 40 and 50 years

The Authors

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TIMOTHY MOTT, MD, is the program director of the South Baldwin Regional Medical Center Family Medicine Residency Program, Foley, Ala....

GREGORY JONES, MD, is the associate program director of the South Baldwin Regional Medical Center Family Medicine Residency Program.

KIMBERLY ROMAN, MD, is a faculty member of the South Baldwin Regional Medical Center Family Medicine Residency Program.

Address correspondence to Timothy Mott, MD, South Baldwin Regional Medical Center, 1613 N. McKenzie St., Foley, AL 36535 (email: timothy_mott@chs.net). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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