Costochondritis
The ribs are joined to the breastbone by cartilage rather than bone, and that joint can become inflamed.
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Medicines commonly prescribed for Costochondritis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Normon S.A.Prescription not requiredDosage form: SUPPOSITORY, 100 mgActive substance: diclofenacManufacturer: Faes Farma S.A.Prescription requiredDosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Towa Pharmaceutical S.A.Prescription not required
The ribs are joined to the breastbone by cartilage rather than bone, and that joint can become inflamed. The result is a sharp pain in the chest that gets worse on a deep breath and on movement — alarming enough that most people start thinking seriously about their heart. Costochondritis is not dangerous and nearly always settles on its own, though rarely as fast as anyone would like. The difficulty lies elsewhere: an identical pain can come from several conditions where minutes matter. That is why this page does not open with treatment, but with how to tell the harmless from the urgent.
What it feels like
The pain is usually sharp, stabbing or aching, more often on the left, close to the breastbone, and sometimes spreading round to the side. It sits in one spot, and most people can point to it with a finger — something that rarely works with cardiac pain. Then its main giveaway shows itself: the pain changes with what you do.
- it worsens on a deep breath, a cough, a sneeze, a laugh;
- it answers back when you twist your body, reach upwards or lift a bag;
- it appears when you press a finger on the joint between rib and breastbone — that is the spot;
- it makes lying down uncomfortable, especially on the painful side, and often wakes you when you turn over.
Usually two or three neighbouring joints are involved, most often in the upper half of the breastbone. The skin above them is unchanged: no redness, no swelling, no heat. If instead there is a visible firm lump over the tender area, this is more likely to be its close relative, Tietze syndrome: it affects a single joint, is commoner in younger people and lasts longer, but it is treated the same way and is equally harmless.
One important caveat. The fact that pressing reproduces the pain does not on its own prove the heart is fine: a tender chest wall is also found in people who are having a heart attack at the same time. The sign helps, but it does not replace weighing up everything else.
Chest pain that means calling an ambulance
Call the emergency number (112 in Europe) rather than trying to last until morning if chest pain:
- presses, squeezes or feels like a weight, and spreads to the arm, neck, jaw, back or under the shoulder blade;
- comes with cold sweat, nausea, pallor, faintness or a sense of dread;
- lasts longer than fifteen minutes, or has appeared for the first time during exertion;
- started suddenly together with breathlessness, especially after recent surgery, a long flight, a plaster cast, pregnancy or a recent birth — that is how a clot in the lung artery announces itself;
- comes with coughing up blood, or with swelling and pain in one calf;
- arrived abruptly, like a tearing blow, runs through to the back between the shoulder blades and is very severe;
- goes with fever, chills, a productive cough or breathlessness that keeps increasing;
- followed an injury to the chest, particularly if breathing has become difficult.
Separately: if you already have known heart disease, are over forty, smoke, or live with diabetes, high blood pressure or high cholesterol, the threshold for calling should be lower. In that situation it is better to be seen for nothing than to work it out afterwards.
Why the cartilage becomes inflamed
In roughly half of cases no cause is ever identified: the pain arrives for no reason and leaves the same way. When a cause is visible, it usually comes from this list:
- a knock or bruise to the chest, including one you have already forgotten about;
- unaccustomed effort with the arms and shoulders: home repairs, a house move, lifting weight overhead, a new gym routine;
- a long, hacking cough — during bronchitis it punishes the chest wall as thoroughly as a barbell;
- a recent viral infection;
- joint and connective tissue diseases: rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, fibromyalgia;
- trouble in the mid-spine and in the joints between rib and vertebra, referring the pain forwards.
Infection of the joint itself stands apart — rare, but real. It is suspected when redness, swelling and heat appear over the ribs, the temperature rises and the pain grows day by day. It happens after chest surgery, with intravenous drug use and in people with weakened immunity, and painkillers are no longer the answer.
What else hurts the same way
Costochondritis is diagnosed once everything else has failed to fit, so it is worth knowing what that everything else is.
- Muscles and ribs. A strained intercostal muscle and a cracked rib give the same local pain. A crack is suspected after a fall or violent coughing, particularly in older people.
- Shingles. Burning pain along one rib appears several days before the rash, and in that gap it is easily taken for this condition. Blisters down one side of the chest settle the question.
- Gullet and stomach. Heartburn and reflux burn behind the breastbone and track with meals and posture rather than with movement.
- Lungs and pleura. Pleurisy and pneumonia also hurt on breathing in, but they add fever, cough and breathlessness.
- Anxiety. It does not invent the pain, but it fixes it in place: fear for the heart speeds up breathing, the muscles between the ribs tighten, the pain rises and the fear rises with it. The circle breaks far more easily once the heart has been checked.
- Rare but important. A tumour of the chest wall or a secondary deposit in a rib also begins as local pain. Warning signs are pain fixed in one spot that grows week after week, night pain that wakes you, weight loss, night sweats, unexplained fever and a previous cancer.
What helps
Costochondritis has no treatment of its own, and that is not a brush-off: inflammation of the cartilage subsides by itself, and everything depends on time and on not provoking it further. It usually clears within a few weeks, sometimes drags on for months, and in some people returns after physical effort.
- Drop for a while whatever movement reproduces the pain: bench presses, pull-ups, working with the arms overhead, carrying a bag on the sore side. Complete rest is not needed — walking and ordinary daily life only do good.
- Among medicines, anti-inflammatory painkillers help, including as a gel rubbed into the tender spot; if they are not tolerated, a plain painkiller remains. Which one suits you, especially with stomach, kidney or blood pressure problems, is best asked of a doctor or pharmacist.
- Warmth on the chest wall, from a heat pack or a warm shower, releases the muscle spasm around the sore area.
- If a cough is troubling you, treat it separately: while the chest is being shaken ten times an hour, the cartilage will not settle.
- Once the sharp pain eases, add gentle movements that open the chest, and work on posture. Hours spent hunched over keep the pain going as effectively as heavy lifting.
- Sleep on the good side or on your back, with a pillow supporting the arm on the painful side.
If the pain does not go away
See a doctor if nothing has changed after several weeks, if the pain is increasing, if fever or a lump over a rib appears, and equally if you are simply worried and want certainty about your heart. For long-lasting pain an injection of local anaesthetic together with an anti-inflammatory into the tender joint is sometimes offered: it does not cure the cause, but it breaks the pain cycle and lets you move again. Work with a physiotherapist also helps, taking load off the chest wall through posture and breathing.
There is a flip side to a story that drags on. If the pain has lasted months, behaves differently from before, or has had something new added to it, the diagnosis deserves to be revisited rather than treated the same way again. Costochondritis is a diagnosis of exclusion, and it offers no protection against something else turning up later.
Online consultation
A remote appointment settles the main question: whether what hurts looks like the chest wall, or whether the picture calls for an examination and tests the same day. The doctor will ask how the pain began, what changes it, what happened the day before, whether there is breathlessness, fever or cardiovascular risk, and will say what to do next. Online is also a convenient place to choose pain relief that fits the rest of your medicines, to work out which activities to drop and when to return to them, and to decide whether investigations are needed for pain that has already lasted months. The emergency features listed above are not assessed remotely: they mean calling an ambulance straight away.
This material is for information only and does not replace medical advice.
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