costochondritis

(chest wall pain syndrome, costosternal syndrome)

A benign inflammation (not serious) of the upper costochondral (rib-cartilage) and sternocostal (cartilage-sternum) joints.
Most patients are affected in multiple ribs on a single side, typically at the 2nd-5th ribs.
It predominantly affects women over 40 years of age and some among adolescents.

(Symptom)
• Primarily, chest pain.
• Not present with heat, erythema, or swelling of the affected area.
• Not present with tachycardia, hypotension, radiating pain, shortness of breath, fever, nausea, or a productive cough.

(Diseases with chest pain)
Many disorders cause chest pain or discomfort. They may involve the cardiovascular, gastrointestinal, pulmonary, neurologic, or musculoskeletal systems.
Common causes:
• chest wall disorders: Involves muscle, rib, or cartilage.
• pleural disorders
• gastrointestinal disorders: E.g. gastroesophageal reflux disease, esophageal spasm, ulcer disease, cholelithiasis.
• stable angina
Immediately life threatening:
• acute coronary syndromes: I.e. acute myocardial infarction and unstable angina.
• thoracic aortic dissection
• tension pneumothorax
• esophageal rupture
• pulmonary embolism

(Causes)
Not known exactly but possibly:
• microtrauma (repetitive minor trauma)
• repetitive coughing
• strenuous physical activity
• infection (in rarer cases): Mostly, caused by Actinomyces, Staphylococcus aureus, Candida albicans, and Salmonella. Rarely, caused by Escherichia coli.

(Diagnosis)
• Predominantly, done based on clinical examination (physical examination) including medical history
Examples of the physical exam to see if the pain is worsened or reproduced:
- - crowing rooster maneuver: Costochondritis with a positive test result.
- - hooking maneuver: Slipping rib syndrome with a positive test result.
- - scarf test (cross-body adduction test, horizontal adduction test): Sensitized acromioclavicular joint such as in osteoarthritis with a positive test result.
• To rule other serious conditions out. Because chest pain is considered a symptom of a medical emergency.
Differential diagnosis (to rule out for chest pain):
• Tietze syndrome: Present with heat, erythema, or swelling of the affected area.
• more serious cases: Present with tachycardia, hypotension, radiating pain, shortness of breath, fever, nausea, or a productive cough.

(Treatment)
• rest: It is considered a self-limited condition that will resolve on its own.
• pain management
- - manual therapy
- - heat
- - ice
- - pain relievers: E.g. nonsteroidal anti-inflammatory drugs (NSAIDs).
- - intercostal nerve blocking injection (in cases with persistent discomfort): A combination of corticosteroids and local anesthetic.
It may be recurrent and last weeks to months, however, refractory cases can persist to over a year.