Costochondritis
A Common Cause of Chest and Upper Abdominal Pain

All ribs connect to the breastbone (the sternum) by means of a cartilage. When this cartilage becomes inflamed, it causes this sharp to dull nagging pain referred to as costochondritis.

Even though this condition usually causes chest pain, it is a common cause of upper abdominal pain too. For some unknown reasons, it causes upper left abdominal pain pain than it causes on the right side. The pain could spread to the back, and upper arm or shoulder.

Because costochondritis can mimic a heart attack, it is important that you seek urgent medical attention to exclude a heart attack if you suffer with this type of chest pain or upper abdominal pain that spreads to the shoulder and arm.

If such inflammation of the cartilage end of the ribs is accompanied by swelling of the cartilage which may also lead to bruising of the skin over the ribs, it is called Tietze syndrome.

Symptoms of Costochondritis

Costochondritis is more common in those between 20 and 50 years of age, though it tends to peak in the 40's. It is also more common following an infection of the upper respiratory tract, usually caused by viruses. If you suffer with fibromyalgia, you are also more likely to have this condition.

The symptoms of costochondritis include:

• History of cough, cold, runny nose plus or minus fever in the preceding days, week or two

• Chest or upper abdominal pain, worse on coughing, sneezing or taking in deep breathes

• Sharp or dull nagging continuous pain that could spread to the side and to the back

• Pain can be reproduced by pressing on the rib or over the margins of the ribs in the affected area.

The most affected ribs are usually the 2nd to the 7th ribs here, in any other or combination.

Only some of the above symptoms may be present. The likelihood of this diagnosis is more important if any of the associated causes discussed below is present.

Causes of Costochondritis

• An episode of viral infection of the upper respiratory tract (cold virus)

• Following any major surgery / operation

• Presence of fibromyalgia

• Sports or vigorous exercise injuries

• Intravenous drug use

• Chronic cough

• Heavy lifting

It could also occur "out of the blue" without any warning or predisposing factor.

Diagnosis of Costochondritis

After a thorough history to see if a cause or predisposing factor can be identified, a physical examination is necessary.

The most important findings on physical examination will be reproduction of pain on the chest wall or upper abdomen by apply pressure on the ribs.

It is important that other causes of chest or upper abdominal pain be excluded as the cause of the pain by carrying out some tests. Commonly requested tests that may be requested in the diagnostic work up for costochondritis will include:

1. Blood tests. This will include Full Blood Count (Complete Blood Count - CBC). It may show raised levels of white blood cells, as a crude marker of inflammation or infection.

   A blood test for Cardiac enzymes (like troponin) may also be done to exclude a heart attack.

2. Chest X-ray. This is to exclude the possibility opf a broken rib. It also help to exclude the possibility of a pneumonia as the cause of the chest or upper abdominal pain.

   Other things to look out for in a chest radiogram is the possibility of a pneumothorax - air in the chest wall, outside the lungs.

3. ECG (EKG). This is to exclude a heart attack

Other test that may be done in specialized center include MRI, gallium radionuclide, and ultrasound scanning.

Treatment of Costochondritis

In severe cases however, the use of simple pain killers like paracetamol (acetaminophen) on it own or in conjunction with medications like ibuprofen or diclofenac (NSAIDS), helps. Steroids like prednisolone and other rheumatological medications like sulfasalazine has been found to shorten the duration of symptoms. Such medications are best prescribed by expert rheumatologist.

In the presence of fibromyalgia, adequate sleep, brisk exercise, as well as the use of antidepressants like amitriptylline or duloxetine for prolonged costochondritis pain has been found to be very helpful to some.

References:

• Cubos J, Cubos A, Di Stefano F. Chronic costochondritis in an adolescent competitive swimmer: a case report. Journal of Canadian Chiropractic Association. 2010 Dec;54(4):271-5.

• ANNE M. PROULX, DO, and TERESA W. ZRYD, MD, MSPH. Costochondritis: diagnosis and treatment. Wright State University Boonshoft School of Medicine, Dayton, Ohio. Journal of American Family Physician. 2009 Sep 15;80(6):617-20.

• Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Archive of Internal Medicine. 1994;154(21):2466-2469.

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