Condition	Diagnostic considerations	Treatment principles
Arthritis of sternoclavicular, sternomanubrial, or shoulder joints	Tenderness to palpation of specific joints of the sternum; evidence of joint sclerosis can be seen on radiography	Analgesics, intra-articular corticosteroid injections, physiotherapy16,17
Costochondritis	Tenderness to palpation of costochondral junctions; reproduces patient's pain; usually multiple sites on same side of chest2	Simple analgesics; heat or ice; rarely, local anesthetic injections or steroid injections16,17
Destruction of costal cartilage by infections or neoplasm	Bacterial or fungal infections or metastatic neoplasms to costal cartilages; infections seen postsurgery or in intravenous drug users; chest computed tomography imaging useful to show alteration or destruction of cartilage and extension of masses to chest wall; gallium scanning may be helpful in patients with infection	Antibiotics or antifungal drugs; surgical resection of affected costal cartilage; treatment of neoplasm based on tissue type7,8
Fibromyalgia	Symmetric tender points at second costochondral junctions, along with characteristic tender points in the neck, back hip, and extremities, and widespread pain2,16	Graded exercise is beneficial; cyclobenzaprine (Flexeril), antidepressants, and pregabalin (Lyrica) may be beneficial18
Herpes zoster of thorax	Clusters of vesicles on red bases that follow one or two dermatomes and do not cross the midline; usually preceded by a prodrome of pain; postherpetic neuralgia is common19	Oral antiviral agents (e.g., acyclovir [Zovirax], famciclovir [Famvir], valacyclovir [Valtrex]); analgesics as needed for pain; may require narcotics or topical lidocaine patches (Lidoderm) to control pain19
Painful xiphoid syndrome	Tenderness at sternoxiphoid joint or over xiphoid process with palpation20	Usually self-limited unless associated with congenital deformity of xiphoid; analgesics; rarely, corticosteroid injections20
Slipping rib syndrome	Tenderness and hypermobility of anterior ends of lower costal cartilages causing pain at lower anterior chest wall or upper abdomen; diagnosis by “hooking maneuver”: curving fingers under costal margin and gently pulling anteriorly—a “click” and movement is felt that reproduces patient's pain2,12	Rest, physiotherapy, intercostal nerve blocks; or, if chronic and severe: surgical removal of hypermobile cartilage segment12
Tietze syndrome	A single tender and swollen, but nonsupportive costochondral junction; usually in costochondral junction of ribs two or three1,2	Simple analgesics; usually self-limiting; rarely, corticosteroid injections2,16
Traumatic muscle pain and overuse myalgia	History of trauma to chest or recent new onset of strenuous exercise to upper body (e.g., rowing); may be bilateral and affecting multiple costochondral areas; muscle groups may also be tender to palpation2	Simple analgesics; refrain from doing or reduce intensity of strenuous activities that provoke pain2,16