Costochondritis is a pathology that produces severe chest pain, as occurs with some cardiovascular or pulmonary diseases. However, it is a benign picture.
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Costochondritis is a pathology that produces severe pain in the chest that tends to be confused with serious or urgent situations. For example, it usually requires a differential diagnosis with a condition of cardiac or pulmonary origin.
It is also called the costo-sternal syndrome . What happens is an inflammation in the area of union of the ribs. The problem is not only the ease of confusion, but also, the pain can be very powerful.
What is Costonchondritis?
Costochondritis is an inflammatory process that occurs in the cartilage that connects the ribs . It can also affect the junction between the sternum and the ribs or the sternum and the clavicles.
According to a study published in the journal Nursing , almost a third of patients who come to the emergency room for chest pain suffer from costochondritis. This data is one of the most relevant, since it indicates the ease with which it can be confused with other entities. For example, with heart or lung pathologies.
It can also be confused with rib fractures, spinal disorders, or shoulder injuries . The reason is that costochondritis can vary in its location. The most common is that it occurs only on one side of the chest.
It is important to emphasize that this pathology is self-limited. In other words, it generally resolves on its own in a matter of weeks or months. The pain that occurs can appear both at rest and during movements and there is usually no swelling.
Tietze syndrome
Tietze syndrome is a special form of costochondritis. What happens is that the pain appears isolated and is localized in the second or third intercostal space.
The inflammation that occurs leads to swelling that is visible to the naked eye. In some cases, redness may even appear in the area. The pain is intermittent.
The problem is that this process can damage the intercostal nerve that is located in that space. This nerve innervates a large body territory that includes intercostal muscles and others located in the back. Therefore, when it is damaged, it leads to muscle contractures in different places.
The confusion of this pathology with other more serious ones complicates the work in the guards when the patients present with the discomfort.
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What are your causes?
As explained in an article published in Pediatric Emergency Therapeutic Protocols, costochondritis is not a disease exclusive to adults, but can also affect children. In most cases, both in childhood and in adulthood, the exact cause is not known.
However, as specialists from the Mayo Clinic explain , it is more common in women over 40 years of age. In contrast, Tietze syndrome usually affects young adults or adolescents.
One of the most frequent causes is trauma. Any blow that occurs in the area can lead to an inflammatory process. Similarly, strain the rib cage as well. For example, coughing loudly for a long time.
There are other disease processes and diseases that are associated with costochondritis. Rheumatoid arthritis or osteoarthritis, any infection that spreads and affects the chondrocostal junction, and tumors. They can be metastases that lodge in the area, coming from a malignant tumor of the breast or lung.
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Symptoms of costochondritis
A study published in the Journal of the Spanish Pain Society explains that costochondritis is characterized by intense chest pain. It usually appears in the anterior area of the chest and radiates through the sternal region. The problem, as we have been pointing out, is that this pain can be confused with other pathologies, such as myocardial infarction.
This is because it sometimes spreads to the back, neck, or abdomen. When trying to palpate the area of injury, the discomfort increases. It also affects several different ribs, which increases the area of sensitivity.
However, the most common location is next to the sternum, near the sixth intercostal space . In Tietze syndrome it is more superior, close to the second rib. In these cases there are usually respiratory problems, since the fact of trying to inspire aggravates the pain.
Diagnosis of costochondritis
When someone goes to the emergency room with chest pain it is essential to make a good differential diagnosis. The problem is that there is no specific test to diagnose costochondritis.
Hence, in the first place, it is essential to take a good medical history and identify the risk factors of that person . In addition, complementary tests can be performed that help rule out other etiologies.
The electrocardiogram is useful to know the electrical activity of the heart. An X-ray may also be ordered to rule out rib fractures or lung problems. Physical examination is basic. If someone has chest pain and there is swelling near the second rib, it may point to Tietze syndrome.
Other imaging tests, such as MRI or CT scan can help . However, due to their high cost and risk of irradiation, they should be reserved for cases in which there are doubts.
The electrocardiogram is performed for differential diagnosis and thus rule out cardiovascular pathologies.
How is it treated?
As Rady Children’s specialists explain , costochondritis can cause very intense pain, but it is usually harmless. In most cases this discomfort disappears in one or several weeks .
Therefore, treatment is usually based on reducing this pain through different medications. The most used are non-steroidal anti-inflammatory drugs , such as naproxen or ibuprofen. However, they may not be enough to alleviate the discomfort.
Hence, in some cases, drugs with greater potency are used. For example, paracetamol can be combined with certain tranquilizers, such as oxycodone. The problem is that the side effects of these drugs are frequent and it is preferred to reduce their use, since they can lead to dependence.
When costochondritis becomes chronic and the pain becomes permanent over time, it may be necessary to resort to medications for chronic pain. The most used are gabapentin and amitriptyline .
Other treatments for costochondritis
When medications fail to control pain, infiltration can be beneficial. It is a procedure in which an anesthetic drug and a corticosteroid are administered to the area of inflammation. In this way the process is reduced.
It can be more or less effective and its effects last for weeks or months. This is why many people require more than one infiltration. It should be the doctor who decides whether it is indicated or not.
Tips for Coping with Costochondritis
Costochondritis is a benign pathology, but it causes a lot of pain in those who suffer it. Also, it is normal for it to cause fear or uneasiness when it appears. Therefore, it is always essential to consult a doctor.
The treatment of this pathology is based on reducing pain. It is recommended to combine it with physical therapy to stretch the contracted muscles or to stimulate the area through currents.
In the same way, the ideal is to stay at rest to avoid movements that aggravate the pain . Finally, at home, you can apply hot or cold compresses to try to reduce discomfort.
