Any new or unexplained chest pain is a frightening experience, immediately raising the specter of a heart attack. While chest pain should always be taken seriously and evaluated by a medical professional, it is important to know that not all chest pain originates from the heart. One of the most common causes of non-cardiac chest pain is a benign and treatable condition called costochondritis. This condition, an inflammation of the cartilage that connects the ribs to the breastbone, can cause sharp, alarming pain that often mimics more serious cardiac problems. Understanding what costochondritis is, why it happens, and how it is diagnosed can help alleviate the fear associated with this common ailment after life-threatening conditions have been ruled out.

Costochondritis is the inflammation of the cartilage that connects the ribs to the breastbone (sternum), an area called the costosternal junction.

Specifically, it affects the cartilage of the costosternal joints, which are the joints where the upper ribs attach to the breastbone. This cartilage, known as costal cartilage, provides a tough but flexible bridge between the bony ribs and the sternum. This flexibility is crucial, as it allows the rib cage to expand and contract with every breath.

Think of your rib cage as a protective, bony birdcage that must also be flexible enough to allow for breathing. The costal cartilage acts like the tough, rubbery joints or “gaskets” in this cage, connecting the ribs to the breastbone. They provide both strength and stability while allowing for slight movement. In costochondritis, these rubbery gaskets become inflamed, irritated, and tender. This inflammation is what causes the characteristic pain, which can be triggered or worsened by movement, deep breaths, or direct pressure.

It is important to differentiate costochondritis from a much rarer condition called Tietze’s syndrome. While both cause inflammation of the costal cartilage, Tietze’s syndrome is characterized by localized swelling and redness over the painful joint, which is a sign that is absent in costochondritis. Costochondritis involves pain and tenderness without any visible swelling (Cleveland Clinic, 2023).

In my experience, costochondritis is one of the most frequent and misunderstood reasons patients come to the ER fearing a heart problem, it’s painful, but thankfully not dangerous.

Costochondritis can occur without a clear cause called idiopathic costochondritis. However, it is believed that the inflammation is often the result of some form of minor trauma or strain to the chest wall.

While often idiopathic, several potential triggers and associated factors have been identified that can lead to the development of costochondritis:

• Physical Strain or Minor Trauma: This is a leading theory. Activities that put unusual stress on the chest wall can lead to micro-trauma and inflammation. This can include:
  • Heavy lifting or strenuous exercise.
  • Repetitive activities like rowing or weightlifting.
  • A direct blow to the chest, such as from a car accident’s seatbelt or a sports injury.
• Severe Coughing: Prolonged, forceful coughing spells associated with respiratory infections like bronchitis, pneumonia, or even whooping cough can significantly strain the costochondral joints and lead to inflammation.
• Infections: In rare cases, the costosternal joint itself can become infected, usually after surgery or from an infection that spreads through the bloodstream.
• Associated Arthritic Conditions: Costochondritis can sometimes be a feature of certain types of inflammatory arthritis, including:
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Psoriatic arthritis

Clinically, I look for recent physical activity, illness, or even a new exercise routine. These often precede a flare-up of costochondritis.

Costochondritis develops when the cartilage between the ribs and breastbone becomes inflamed. However, certain factors can increase a person’s risk.

Risk factors for developing costochondritis may include:

• Age and Gender: Costochondritis is most commonly diagnosed in adults over the age of 40 and is seen more frequently in women than in men (Mayo Clinic, 2024).
• Participation in High-Impact Activities: Sports or occupations that involve repetitive chest movements or the risk of a blow to the chest can increase the likelihood of developing the condition.
• Manual Labor: Jobs that require frequent heavy lifting or upper body strain.
• Having Certain Forms of Arthritis, such as those listed above.
• Conditions that Cause Chronic or Severe Coughing.

I often tell patients it’s like a joint sprain in your chest, it’s painful, but the cause is usually mechanical or inflammatory, not dangerous.

The hallmark symptom of costochondritis is localized chest pain, typically near the breastbone and often on the left side, which can be sharp, aching, or pressure-like.

The key signs and symptoms of costochondritis include:

• Localized Chest Pain: The pain is typically centered on the side of the sternum (breastbone). It most often affects the left side and involves more than one rib, usually between the second and fifth ribs.
• Character of the Pain: The pain is often described as sharp, aching, gnawing, or pressure-like.
• Pain Worsened by Specific Triggers: The pain is characteristically worse with movements that affect the rib cage. This includes:
  • Taking a deep breath or coughing.
  • Sneezing or laughing.
  • Lying, especially in certain positions.
  • Pushing or pulling with the arms.
• Reproducible Tenderness: This is the most important clinical sign. The pain of costochondritis can be reliably reproduced when a doctor presses firmly on the specific inflamed costochondral joints next to the sternum. This localized, reproducible tenderness is not a feature of cardiac chest pain.
• Pain Radiation: The pain can sometimes radiate from the chest to the back, abdomen, or down the arm, which is one of the primary reasons it is so often confused with the pain of a heart attack.

Crucially, as mentioned before, costochondritis does not cause visible swelling, redness, or warmth over the painful area. The presence of swelling would suggest Tietze’s syndrome or another condition.

Patients often say, “I thought I was having a heart attack,” and I reassure them, if pressing on your chest recreates the pain exactly, it’s very likely musculoskeletal.

Diagnosis is clinical, based on symptoms and physical examination. Any patient presenting with new-onset chest pain will undergo an emergency evaluation to ensure their heart and lungs are healthy.

The Emergency Room Workup: If you go to an emergency room for chest pain, you can expect doctors to perform several tests immediately to rule out a heart attack:

• Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart and can detect signs of a heart attack or other cardiac problems.
• Blood Tests: A blood sample will be taken to check for cardiac enzyme levels, such as troponin. These enzymes are released into the bloodstream when the heart muscle is damaged.
• Chest X-ray: This imaging test helps doctors rule out other causes of chest pain, such as pneumonia, a collapsed lung (pneumothorax), or a rib fracture.

Making the Diagnosis: Once these urgent and serious conditions have been ruled out, a doctor can focus on diagnosing costochondritis. This means that after excluding other potential causes of the pain, the diagnosis is made based on the patient’s history and the findings of the physical exam. The classic finding of localized, reproducible tenderness when the doctor presses on the costosternal joints is the key to making a confident clinical diagnosis of costochondritis. No further imaging or testing is usually required.

Clinically, the key is reproducible tenderness without other systemic signs. If pushing on the chest causes the same pain, it points strongly toward costochondritis.

Costochondritis often resolves on its own, but treatment focuses on relieving pain and reducing inflammation.

1. Self-Care and Lifestyle Modifications (First-Line)

 For most people, simple home care measures are enough to manage discomfort.

• Rest: The most important step is to avoid activities that strain the chest wall and worsen the pain. This means temporarily refraining from strenuous exercise, heavy lifting, or sports.
• Heat or Ice Therapy: Applying a heating pad or a warm compress to the painful area can help relax the muscles and relieve aching pain. An ice pack can reduce inflammation and numb the area. Some people find it helpful to alternate between the two.
• Gentle Stretching: Gentle stretching exercises for the chest muscles can be beneficial, but they should be done carefully and without causing sharp pain.

2. Over-the-Counter (OTC) Medications

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): This is the mainstay of medical treatment. OTC medications like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) are highly effective at reducing both the pain and the underlying inflammation.
• Other Pain Relievers: If NSAIDs cannot be taken, acetaminophen (Tylenol) can help with pain but does not reduce inflammation.
• Topical Medications: Creams, gels, or patches containing NSAIDs or other analgesics like lidocaine or capsaicin can be applied directly to the painful area.

3. Prescription Treatments

If the pain is severe or does not respond to OTC treatments, a doctor may recommend stronger therapies.

• Prescription-strength NSAIDs.
• Physical Therapy: A physical therapist can guide you through a specific program of stretching and strengthening exercises to improve posture and relieve strain on the chest wall.
• Corticosteroid Injections: For persistent, localized pain, a doctor can inject a corticosteroid medication combined with a numbing agent directly into the inflamed costochondral joint. This can provide significant and rapid relief of the inflammation.

I’ve seen patients go from anxious ER visits to complete relief within days once they understand the condition and manage it with rest, meds, and better posture.

Costochondritis is a common and benign cause of chest pain that can nevertheless be a source of significant pain and anxiety. It is a simple inflammation of the cartilage that connects the ribs to the breastbone, often arising without a clear cause. The most critical step for anyone experiencing new or unexplained chest pain is to seek an immediate medical evaluation to rule out a heart attack or other life-threatening conditions. Patients often share that just knowing it wasn’t their heart brought them peace and with a few adjustments, their pain gradually faded away.

1. American College of Rheumatology. (2023). Costochondritis. Retrieved from https://rheumatology.org/patients/costochondritis
2. Cleveland Clinic. (2023). Costochondritis. Retrieved from https://my.clevelandclinic.org/health/diseases/21113-costochondritis
3. Mayo Clinic. (2024). Costochondritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175