Clinical recommendation	Evidence rating	Comments
The diagnosis of costochondritis is largely based on history and a physical examination that reproduces pain on direct palpation of the parasternal region and/or with provocation maneuvers such as the crowing rooster or crossed-chest adduction.41	C	Case series for study of diagnosis
Validated clinical prediction rules are available to assist in distinguishing chest pain caused by coronary artery disease in the primary care and emergency department setting, but they should be used to support, and not replace, clinical judgment.1,12,43–45	A	Systematic reviews of validated clinical decision rules
Acupuncture, physical therapy, and corticosteroid injections may be considered for the treatment of costochondritis in patient with recalcitrant symptoms.47,49,50	C	Expert opinion
Local application of heat, oral or topical nonsteroidal anti-inflammatory drugs, capsaicin cream, and lidocaine patches are first-line therapies for patients with costochondritis.3,29–31	C	Usual practice and expert opinion