Possible causes of costochondritis

The fact is that the cause of costochondritis is classified as 'idiopathic', which means that there is no identifiable cause for the condition, in most cases. 

Traumatic injury

The most common cause of costochondritis that can be attributed to a source is costochondritis as the result of a traumatic injury. For example, car accidents in which the driver strikes the steering wheel with his chest. Repetitive minor trauma has also been proposed as a common cause of costochondritis. [3]

Viral infections

Viral infections, mainly upper respiratory infections, have also been identified as a cause of costochondritis. 

Bacterial infections

This happens mostly to people who use IV drugs or who have had surgery to their upper chest. After a surgery, the cartilage can become more prone to infection, because of the reduced blood flow in the region that has been operated on.

Fungal infections

Fungal infections are rare causes of costochondritis.

Fibromyalgia

The fact is that recurring costochondritis could be a symptom of fibromyalgia. People with fibromyalgia often have several tender spots. The upper part of the breastbone is a common tender spot.

Pain from other areas of your body

Many people are not aware that pain signals can sometimes be misinterpreted by the brain, causing pain in places far away from the place where the problem occurs. The doctor might call this a "referred pain." Pain in your chest can sometimes be caused by problems with the bones in your spine compressing the nerves.

Vitamin D Deficiency

Research indicates that chest pain and costochondritis are associated with vitamin D deficiency. [4]

Differential Diagnosis

There is only one condition that could be wrongly interpreted as a costochondritis and it is a heart attack or myocardial ischemia. That’s why there are some useful tricks that every patient should know about telling the difference between these two conditions! [5]

• The pain of a heart attack is often more widespread, while costochondritis pain is focused on a small area.
• Heart attack pain usually feels as though it's coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself.
• Heart attack pain may worsen with physical activity or stress, while the pain of costochondritis remains constant.

The fact is that patients should not waste time because every chest pain is an emergency.

Other problems to be considered:

• Pericarditis
• Pleurodynia
• Polychondritis
• Fibromyalgia

As we already mentioned, Tietze’s syndrome is also very similar to costochondritis. However, it exhibits swellings at the rib-cartilage junction and costochondritis has no noticeable swelling. Neither condition involves pus or abscess formation.

Tietze’s syndrome usually affects the junctions at the second and third ribs and the swelling may last for several months. The syndrome can develop as a complication of surgery on your sternum months to years after the operation.

When to Seek Medical Help?

If a person feels some of the following symptoms, he or she should definitely seek help:

• Trouble breathing
• High fever
• Signs of infection such as redness, pus, and increased swelling at the rib joints
• Continuing or worsening pain despite medication

The following symptoms are generally not associated with costochondritis:

• High fever not responding to fever-reducers such as acetaminophen (Tylenol) or ibuprofen (Advil)
• Signs of infection at the tender spot such as pus, redness, increased pain, and swelling
• Persistent chest pain of any type associated with nausea, sweating, left arm pain, or any generalized chest pain that is not well localized

These symptoms can be signs of a heart attack. If you are not sure about your condition, go to the emergency department.

Diagnosis of Costochondritis

Physical examination

Your doctor should first conduct a physical exam to diagnose costochondritis. He should ask the patient to describe the pain and what influences it or triggers it. The pain of costochondritis can be very similar to the pain associated with heart disease, lung disease, gastrointestinal problems, and osteoarthritis. The doctor will also palpate along the breastbone for areas of tenderness or swelling.

Radiological imaging

Costochondritis generally can't be seen on chest X-rays or other imaging tests used to see inside your body but your doctor may order these tests or others to rule out other conditions.

Lab Studies

No specific studies exist for costochondritis. The clinical scenario and the most likely differential diagnoses should guide lab orders.