Costochondritis is a condition that is caused by inflammation of the cartilage that surrounds the rib and is attached to the breastbone. This place where it meets is called the costosternal joint, and when it is inflamed, it can result in the sensation of severe, cutting, slit, or pressure-like chest pain. Usually, pain in costochondritis is limited to the front of your chest. However, it can also be felt across the back or in the belly.
Pain is often exacerbated by specific body movements, such as deep breathing or physical activity. Occasionally, patients can experience costochondritis as a symptom of chest wall pain. Although, it can be confusing due to the similarity of its symptoms with those of cardiac disease. However, it is usually safe and self-restricted.
While in the case of cardiac-related pain, pressure on the inflamed area of the chest can reproduce the pain, usually, a heart attack is not of immediate danger. On many occasions, it is not up for consideration even if it, indeed, has a chance to occur.
Costochondritis is a common form of chest pain, observe, in younger people and adolescents. However, it can also be found among individuals of all age groups. It is assumed that even though the patients are in the majority, up to 30% of patients diagnosed with non-cardiac chest pain are really found to have costochondritis in the emergency department. It is also true that a lot of them (even more than the actual figure) have not sought medical attention or just had mild symptoms. That may lead to some not-so-accurate self-treatment.
To be specific, costochondritis is observed more often in women than in men. Though there are manifold grounds pinpointing a higher incidence of the condition in female patients, the matter is yet to be illuminated. The range of possible explanations covers hormonal differences and the dissimilarity in physical activity between the two genders as the most prominent ideas.
Costochondritis may also be developed by athletes and others when they repeat movements involving the upper part of the body. The same may happen to those who are recovering from upper respiratory infections, especially the ones still coughing frequently. While the incidence of this condition is high, we still cannot talk openly about the epidemiological status of costochondritis. It is because there is a gap in the allocation of accurate information about the disease caused by a lack of extensive research.
There are many cases of costochondritis, which are termed idiopathic, because of the absence of an etiology. Nevertheless, the reasons for the inflammation that gives rise to the disease have been found. In this context, overexertion and repeated trauma are some of the most frequent reasons. Tasks including much toil, repetition of activity several times, or even an intensive workout putting too much pressure on the costosternal joints are the result of microtrauma and inflammation. This must be a carefully planned process. The rules need to be strictly followed if frequent activities are to be conducted.
While the effect of chest trauma due to a hit in sports like boxing or a car accident is a direct impact, the effect of a viral or bacterial infection, particularly one involving the upper respiratory tract, gets complicated. Such an infection can be chronic unless the physician intervenes. It is also highly likely that other forms of arthritis, including rheumatoid and spondylitis, are also the origin of the problem.
Within the last times, the reasons for costochondritis included surgeries and IV drug use, were rare. In the event of them occurring, it is found that the source of the infection is one of the most difficult issues in medicine. It may lead to the decision to carry out a drastic change in treatment. But disease related to fatigue maybe one of them.
Localised chest pain, the intensity of which may vary between slight to severe is the main characteristic of costochondritis. The patients commonly report this kind of pain as sharp, aching, or even pressure-like. Not like the pain in the chest due to heart of cardiac issue, which is usually-diffuse not-simulated and reproducible, the pain in costochondritis is painful when the area of injury is dared to be palpated.
Ordinarily the pain is present only on one side; though sometimes it is felt on both sides of the sternum. Usually it is felt more intensely with particular movements. These include raising the arms, turning the body, or when breathing deeply. The pain that some individuals could experience in the back, abdomen, or shoulders might mean that the clinical picture becomes more complex, and at the same time, increase the fear of cardiac involvement.
The presence of swelling is not constant; it can be absent or present. Swelling in conjunction with chest pain may be briefly described as Tietze syndrome, a very unusual but connected disorder. Additional symptoms might entail the chest being tender when it's touched, increased pain when coughing or sneezing, and a sensation of tightness across the wall of the chest. However, most symptoms that are more system-wide, like fever, chills, or losing weight, are usually not present unless there is an infection.
Diagnosis of costochondritis is typically based on clinical evaluation that is very much thorough, though. The medical doctor mainly cites the history of the patient and the physical examination to exclude sternum cartilage inflammations or more life-threatening problems. No specific tests are available. The diagnosis of costochondritis is largely based on the patient's description of the symptoms and the doctor's examination of the patient.
In the clinical setting, the doctor may use the palpation method to determine the point of tenderness along the costosternal, costochondral, or costovertebral junctions. Pain that is reproducible upon examination, particularly in the absence of other alarming symptoms, strongly points to costochondritis.
However, since chest pain can be a symptom of a heart attack or another serious illness such as pulmonary embolism, further testing might be necessary to confirm the diagnosis in some cases, especially if the presentation is atypical and risk factors for heart disease are part of the picture.
Usually, an electrocardiogram is the most typical test. It is carried out to rule out heart problems as the cause of the chest pain. By connecting small sensors to the skin, the ECG records the electrical activity. This way, it can detect heartbeats, arrhythmias, and any functioning disorders of the heart. The fact that an EEG shows no abnormalities together with the experience of chest pain means that the latter has its source of origin in the muscles or bones, such as costochondritis, which is highly likely.
A chest X-ray is sometimes also ordered to evaluate the lungs, heart, and bones. Although one of the characteristics of costochondritis is the not-to-appear-on-the-X-ray feature, still the examination is because it helps to exclude such causes as rib fractures, pneumonia, or tumors. Sometimes, Tietze syndrome is associated with swelling, which might also be visible in the X-ray.
Where clinical judgment suggests that there may be some heart involvement despite the results of the initial tests, an echocardiogram which is a non-invasive examination can be recommended. An echocardiogram facilitates a non-invasive visualization of the heart's overall structure, working and will be able to eliminate the possibility of pericarditis, valvular diseases, and other heart disorders that may give rise to similar symptoms as costochondritis.
Blood tests are not commonly used to diagnose costochondritis. However, they can be beneficial to have if one doubts a potential infectious cause. Infection and autoimmune diseases can cause an increase in the inflammation marker levels. These include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). If there is a question of septic arthritis of the costosternal joints, then blood cultures might be obtained.
Most treatments for costochondritis are usually conservative and focus on reducing inflammation and pain. Almost all the cases resolve within several weeks to several months if the care is right.
Needless to say, rest, and avoiding activities that may worsen pain are initial steps in the treatment of the condition. Patients are often advised to stop moving the upper body and not do the heavy lifting. It should last until the symptoms get reduced.
Naproxen and ibuprofen, which are NSAIDs, are widely used to reduce the severity of inflammation and pain. These drugs help control the body's inflammatory response, thus relieving the pain. NSAIDs increased to prescription strength may be required in certain circumstances if the over-the-counter options do not work.
Physical therapy can be very essential in the treatment of this disease, particularly when it lasts for long. Therapists might use exercises that stretch the chest muscle to bring back its normal elasticity and strength the surrounding muscles. Physical treatments such as manual therapy, heat, and posture correction are also common methods. These are used to remove stress from the costosternal joints.
The corticosteroid injection directly into the affected costosternal joint is very helpful. It is true in patients with severe or refractory costochondritis and provides great relief. The treatment can immediately reduce inflammation, which eases pain, and the patient can return to normal life sooner.
Transitioning between heat and ice at the site of injury can be a beneficial way to manage the pain. Ice, in general, is only the best thing to use in the beginning stages to reduce inflammation. The heat warms the muscles and provides better blood flow during healing.
TENS therapy is often considered in case of a chronic situation. This type of stimulation uses low-voltage electric shocks to stop pain signals and at the same time stimulate the body to produce natural painkillers. This treatment is associated with symptomatic relief and lacks the side effects of the medications.
Chest pain can generate a high amount of anxiety. Therefore, psychological support or counselling would be appreciated by those people especially, who are still experiencing symptoms even after healing. Stress management techniques, such as mindfulness, cognitive-behavioral therapy, and relaxation exercises, can also help boost the endpoint.
There are a number of factors that can be activated by something that results in or makes worse the symptoms of costochondritis. The common triggers are local musculoskeletal injuries such as a direct blow to the chest and chest muscle strain (from weightlifting) of the upper chest region.
Moreover, the movement of the chest while performing different physical exercises like pulling, punching, and pushing can cause musculoskeletal injury to the chest that. That, in turn, results in inflammation of the costosternal joints. People who do sports that require a lot of upper arm and shoulder movement are the ones that seem to be easily at risk of recurrence of the symptoms, e.g., tennis, or weightlifting.
Respiratory infections, including repeated coughing, are responsible for the majority of chest discomforts the patients are experiencing. It is the frequent coughing that causes the joint and the cartilage to repeatedly move in and out of synchronization, scuffing off the perichondrium. This explains why the patient feels pain. Amidst the allergic reactions that occur over a long term, the same allergies that cause rashes or hives may also induce coughing fits and chronic sneezing, which in turn are triggers for the costosternal joint inflammation.
There are some environmental triggers that some patients have claimed to be related to the occurrence of the symptoms. An example is being exposed to extremely cold weather. The fact that cold air induces chest wall muscles to contract tightly can not only cause inflammation but also strain the painful ribs cartilage more severely.
Certain medical procedures, like what patients do during chest surgery, CPR, or even the healing processes of broken bones, are things that could traumatize joints, especially when performed improperly, and thus, become primary triggers of the costochondritis symptoms. Once the patient recognizes and stays away from the triggers that cause the disease, then on their way, they have already mastered the art of medically managing and preventing the recurrence of the disease.
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