Costochondritis, also known as Tietze syndrome, is an inflammation of the cartilage that connects a rib to the breastbone (sternum). This inflammation often causes chest pain that may radiate to the back or abdomen. Costochondritis is typically caused by some sort of injury, infection, or strain. It often goes away on its own after a few days or weeks. However, the chest pain associated with costochondritis can be concerning, leading many to wonder if it will show up on an x-ray. Below we will explore what costochondritis is, what causes it, its symptoms, and whether it shows up on x-rays.
What is Costochondritis?
As mentioned above, costochondritis is inflammation of the cartilage that attaches the ribs to the breastbone. This cartilage is important because it creates flexibility in the chest wall, allowing the ribs to move with breathing.
There are two types of cartilage that connect the ribs to the sternum:
Hyaline cartilage
This type of cartilage is found where the ribs attach directly to the sternum. It is very resilient but has little flexibility.
Costal cartilage
This cartilage extends from each rib and attaches it to the sternum. It has more flexibility than hyaline cartilage.
Costochondritis usually involves inflammation of the costal cartilage. However, sometimes the hyaline cartilage is also affected.
When the cartilage becomes inflamed, it can cause chest pain that feels similar to a heart attack. However, costochondritis pain is reproducible when pressing on the inflamed area. Heart attack pain typically is not affected by palpation.
What Causes Costochondritis?
There are several potential causes of costochondritis:
Injury
Any blunt trauma or injury to the chest area can cause inflammation of the cartilage. Examples include sports injuries, a hard hit to the chest, or even vigorous coughing.
Joint Dysfunction
Sometimes poor posture or improper mechanics of the thoracic spine and ribs can put extra strain on the costal cartilage leading to inflammation.
Infection
Infections involving the chest wall, like pneumonia, can sometimes spread to the costal cartilage.
Arthritis
Osteoarthritis or rheumatoid arthritis can cause inflammation in the joints between the ribs and breastbone.
Fibromyalgia
People with fibromyalgia commonly experience costochondritis due to the chronic widespread pain and tender points associated with this condition.
Strenuous Exercise
Exercising with poor form/mechanics or pushing too hard too fast can strain the intercostal muscles connecting the ribs to the sternum. This leads to inflammation.
Stress
Chronic anxiety causes a lot of muscular tension, including in the chest. This can exacerbate costochondritis.
Costochondritis Symptoms
The primary symptom of costochondritis is chest pain on the front of the rib cage. The pain may be sharp or dull, aching or stabbing. It can range from mild to severe.
Other associated symptoms include:
– Pain that radiates to the back, abdomen, or shoulders/arms
– Tenderness reproducing the pain when pressing on the sternum or ribs
– Difficulty taking deep breaths due to pain
– Feeling like the chest is tight or restricted
– Coughing, which exacerbates pain
– Upper back pain
– Pain after eating certain foods
– Emotional distress due to concerning chest pain
The pain caused by costochondritis often comes and goes. It may be worse with certain movements or body positions. Many people report pain that wakes them up during the night.
Costochondritis pain can mimic heart attack or angina. However, costochondritis usually involves a smaller area. Heart pain typically radiates down the arm. Costochondritis does not cause other heart attack symptoms like sweating, nausea, or shortness of breath.
Does Costochondritis Show Up on X-Ray?
Because costochondritis involves inflammation of soft tissue (cartilage), it does not show up on standard x-rays. X-rays only visualize bone.
The cartilage between the sternum and ribs has a very small diameter. It would be very hard to see on an x-ray even if cartilage did show up.
So a normal chest x-ray does not rule out costochondritis.
With that said, certain imaging modalities like CT or MRI scans could show inflammation around the costal cartilage. However, these advanced images are usually not ordered solely for diagnosing costochondritis.
The diagnosis is typically made based on classic symptoms and a physical exam. Palpating the painful area and reproducing the symptoms points to costochondritis.
When Might Imaging be Used?
While plain films don’t show costochondritis, they may be ordered to rule out potential mimics like the following:
– Rib fracture
– Herniated thoracic disc putting pressure on the rib heads
– Osteomyelitis (bone infection) of the sternum or ribs
– Spinal tumor impinging on a thoracic nerve root
If initial x-rays come back normal but severe symptoms persist, CT or MRI studies may be considered to further evaluate the sternum/ribs/chest wall.
Costochondritis Treatment
Since costochondritis is an inflammation issue, the goals of treatment are to reduce inflammation and relieve pain. Treatment approaches include:
Rest
Avoiding activities that aggravate symptoms allows the inflammation to calm down.
Ice Packs
Icing the chest wall for 15 minutes several times per day helps decrease inflammation.
OTC Medication
Anti-inflammatory meds like ibuprofen can provide relief. Acetaminophen or naproxen may also help costo pain.
Heat
Applying a heat pack to the chest may relieve muscle spasms.
Posture Correction
Improving posture decreases mechanical strain on the rib cartilage.
Massage
Gentle massage over the chest muscles can provide tension relief.
Chiropractic Care
Chiropractors adjust the thoracic spine and ribs to improve alignment and mechanics.
Steroid Injections
Corticosteroid shots into the cartilage reduce inflammation.
Topical Anti-Inflammatory Creams
Creams containing ingredients like arnica, turmeric, or DMSO can be rubbed on the chest.
Home Remedies for Costochondritis
There are also some home remedies that may help provide relief from costochondritis chest pain:
Epsom Salt Soaks
Soaking in warm water with epsom salts can relax chest wall muscles and decrease inflammation.
Essential Oils
Rubbing the chest with diluted essential oils like lavender, eucalyptus, or wintergreen may provide analgesic effects.
Turmeric Tea
Drinking turmeric tea has anti-inflammatory benefits which may decrease costochondritis symptoms.
Capsaicin Cream
Topical creams containing capsaicin offer natural pain relief by reducing substance P.
Boswellia
Boswellia serrata is an Ayurvedic herb with strong anti-inflammatory properties that may help costochondritis.
Acupuncture
Acupuncture treatments can provide pain relief and reduce inflammation.
Yoga and Stretching
Gentle yoga and chest wall stretches may provide relief by relaxing tight chest muscles.
When to See a Doctor
Mild cases of costochondritis will usually resolve with rest, ice, and OTC medication. However, you should be evaluated by a physician if:
– Pain becomes severe or persists longer than 1-2 weeks
– Symptoms are interfering with daily activities
– You are experiencing shortness of breath
– You have risk factors like older age, heart conditions, or diabetes
– Home remedies and OTC meds aren’t providing relief
Severe chest pain should always be evaluated emergently to rule out heart attack which can have similar symptoms.
Conclusion
Costochondritis, or Tietze Syndrome, is inflammation of the costal cartilage between the ribs and breastbone. It usually results from injury, infection, or overuse. Costochondritis can cause concerning chest pain but does not show up on plain x-rays since they only visualize bone. It is typically diagnosed based on reproducible tenderness over the inflamed cartilage. Most cases resolve with conservative treatment but severe or persistent pain should be evaluated by a doctor to rule out complications. Using a combination of rest, ice, medication, and home remedies can help manage symptoms.