Costochondritis (sternal pain): symptoms, causes and treatment

Costochondritis is the inflammation of the cartilage that connects the ribs to the sternum bone, which is a bone found in the middle of the chest and is responsible for supporting the clavicle and ribs.

This inflammation is perceived through pain in the center of the chest, the intensity of which varies according to movements involving the trunk, such as taking a deep breath or looking behind you. Often, this pain can even be felt as a sensation of pressure, which can end up being mistaken for a heart attack. Find out more about how to recognize the symptoms of a heart attack.

Costochondritis is a common and mild inflammation that normally does not need treatment, as it disappears naturally. However, if the pain worsens or persists for several weeks, it is recommended to consult a general practitioner, who may recommend the use of an analgesic or anti-inflammatory.

Main symptoms

The main symptoms of costochondritis are:

• Fine, sharp or pressure-like pain in the middle of the chest;
• Pain that worsens with movement;
• Pain when coughing;
• Pain when breathing;
• Shortness of breathe;
• Sensitivity of the region to palpation.

Under normal conditions, the rib cartilages allow the lungs to move during the respiratory process, but when they are inflamed, the movement becomes painful. In general, the pain is usually limited to one region, mainly the left side, but can radiate to other parts of the body, such as the back and abdomen.

How to confirm the diagnosis

The diagnosis of costochondritis is made based on the patient’s symptoms and previous illnesses, physical examination and radiological tests that rule out other causes of chest pain, such as electrocardiogram, chest X-ray, computed tomography and magnetic resonance imaging. Check out other causes of chest pain.

Possible causes

Some situations that may increase the risk of costochondritis are:

• Pressure on the chest, such as that caused by the seat belt during sudden braking, for example;
• Bad posture;
• Trauma or injury to the thoracic region;
• Strenuous physical activity;
• Deep breath;
• Sneezing;
• Cough;
• Arthritis;
• Fibromyalgia.

In more serious cases, costochondritis may be associated with chest tumors, causing difficulty breathing and swallowing, weight loss, fatigue, hoarseness and chest pain.

In the later stages of pregnancy, a woman may feel some chest discomfort, which may worsen with exertion and result in shortness of breath. This occurs because of compression of the lungs by the enlarged uterus.

How to differentiate from Tietze syndrome

Costochondritis is often confused with Tietze syndrome, which is a disease also characterized by pain in the chest region due to inflammation of the thoracic cartilage. What differentiates these two conditions is mainly the swelling of the affected joint that occurs in Tietze syndrome.

Tietze syndrome is less common than costochondritis, appears equally frequently among men and women, appears in adolescents and young adults and is characterized by a lesion on a single side accompanied by swelling in the region. The possible causes, diagnosis and treatment of Tietze syndrome are the same as for costochondritis. Learn more about Tietze syndrome.

How the treatment is carried out

The initial recommendations for treating costochondritis pain consist of resting, applying a warm compress to the region and avoiding movements that could worsen the pain, such as lifting heavy objects or playing impact sports. However, gentle stretching exercises that alleviate symptoms may also be recommended, guided by a doctor or physiotherapist.

In some cases, the use of analgesics or anti-inflammatories, such as Naproxen or Ibuprofen, may also be indicated, always under medical supervision, to relieve pain. In more serious occasions, the doctor may recommend injections to inhibit the nerve causing the pain. Furthermore, depending on the type, degree and recurrence of pain, physiotherapy may be indicated.