Costochondritis

What is it?

Benign inflammation at costochondral junctions produces localized tenderness and anterior chest wall pain.

Commonly affected: 2nd–5th costochondral junctions (often multiple)

How it develops

1. Repetitive Strain/TraumaCough, exercise, minor trauma trigger
2. Cartilage MicroinjuryMicroinflammation at junction
3. Local InflammationPain sensitization without swelling
4. Self-Limiting CourseResolves over weeks to months

Symptoms

• Focal tendernessPalpation reproduces pain at junctions
• Anterior chest painSharp or aching anterior chest pain
• Worse with breathingWorsens with deep breath or cough
• Movement-related painWorse with arm raise or trunk rotation
• No visible swellingUnlike Tietze, no swelling

How it is examined

• Palpation reproduces painTenderness at 2nd–5th costochondral junctions
• Crowing rooster maneuverArm abduction + neck extension reproduces pain
• Normal cardiopulmonary examNormal heart/lung exam; must rule out cardiac cause
• No swellingNo redness, warmth, or swelling

Imaging

Chest X-ray usually normal; diagnosis is clinical — imaging only to exclude alternatives.

• Normal findings
• Normal lungs/mediastinum
• To exclude other causes

Not routinely required; CT/MRI only to exclude tumor/infection.

• Usually normal
• Exclude neoplasm if persistent
• Rule out infection

When surgery is considered

Rarely needed (refractory cases only)

Procedures that may be discussed

• Local corticosteroid injection
• Local lidocaine injection

Outlook

Most resolve spontaneously in weeks to months.