Do you feel pain in your chest when moving your arms, coughing, sneezing or breathing in deeply, that gets worse when you touch it? If so, it’s possible you may have costochondritis, inflammation of the cartilage of the upper ribs at the point they join the sternum.
The sternum is a flat bone that sits in the centre of the chest, starting just below the throat and ending just above the diaphragm. We have ten pairs of ribs that attach either directly or via cartilage to the sternum, and two pairs of floating ribs. By the way, it is a myth that men have more ribs than women; both genders have twelve pairs. The purpose of the rib cage is to protect the heart and lungs and it has to be mobile to allow movement as we breathe in and out. This is achieved by the presence of the cartilage which provides strength and cushioning but has slight elasticity.
Costochondritis is more common in women over 40 but can be seen in young children and adolescents, and people who participate in high-impact activities, have manual jobs or suffer allergies. In most cases there is no known cause. However, it can be as a result of recurrent microtrauma to the chest or a direct blow to that area; physical strain (lifting something heavy) or strenuous exercise; bouts of coughing; joint infection (bacterial, after surgery); fungal or viral (respiratory) infection; arthritis (osteoarthritis, rheumatoid arthritis, ankylosing spondylitis) or a tumour.
It is important to rule out any serious pathology as central chest pain can also indicate heart or lung disease, gastrointestinal problems or osteoarthritis. It also needs to be differentiated from Tietze Syndrome, which has very similar symptoms to costochondritis. Both cause pain on coughing and breathing deeply but the two conditions are very different. Tietze Syndrome causes visible inflammation where the ribs meet the sternum, unlike costochondritis where the inflammation is not visible. Although blood tests, X-Rays and MRIs are not able to identify costochondritis, they may be useful in ruling out any other pathology that may be causing the symptoms.
Costochondritis typically affects the second and fifth ribs and the symptoms may be similar to cardiac pain, with a sharp, dull pain. Although it can be present on both sides of the chest, it typically presents in the centre or to the left side of the chest, and can radiate to the back and stomach. One sign that it may be costochondritis is the constant tenderness at the front of the chest, that increases when touched. If there is pain and swelling to the second and third ribs which radiate into the arms, the symptoms may be due to Tietze Syndrome, especially if there is no apparent precursor such as strenuous exercise, injury or coughing.
In many cases costochondritis resolves on its own, over the course of several weeks, although it can take a year or more. The first step toward recovery is to rest and avoid strenuous exercise. If it has been caused by an infection, then antibiotic therapy may be suggested.
The next step is to control the pain; your doctor may suggest nonsteroidal anti-inflammatory medication. Heat and ice may also help to reduce localised pain. If the area feels stiff then use heat. But if the area feels hot and tender, try ice initially. If the symptoms have been caused by excess coughing and sneezing then treatment should focus on reducing those symptoms first. If the symptoms do not seem to be resolving by themselves, physiotherapy may help. Physiotherapists will use a range of modalities including acupuncture, electrotherapy and gentle exercise. If none of these conservative treatments works, your doctor may suggest a steroid injection. As a last resort, surgery may be suggested. Surgery involves removing the cartilage but this will only be explored in the event that all other treatments have failed.
If you have had this painful condition, it is possible that it will return in the future. The key is to stay fit and healthy, adding stretching and strengthening exercises to your workout routine. Prevention is always better than cure.