Costochondritis

Also called Chest wall pain, Tietze's syndrome

Inflammation where the ribs meet the breastbone. A very common cause of chest pain, and the reassurance only works after the heart has been excluded.

What it is

Inflammation of the cartilage joining the ribs to the breastbone, causing sharp chest pain that is reproduced by pressing on the spot.

It is a common and benign cause of chest pain, particularly in younger adults and in women, and it often follows a viral illness, coughing, unaccustomed lifting or exercise, or a minor injury.

The features that suggest it are: pain that is sharp rather than heavy, localised to a spot the person can point to with one finger, worse on movement, deep breathing or coughing, and reproducible by pressing on the costochondral junction.

**None of that is enough to make the diagnosis at home.** Chest pain needs assessing, and cardiac pain can be atypical, particularly in women, in older people and in people with diabetes. The correct sequence is assessment first, reassurance second.

Once it is diagnosed, the reassurance is genuine and important, because unexplained chest pain generates enormous anxiety, and a cycle of pain, fear, muscle tension and more pain is easy to establish.

It usually settles over weeks to months. Tietze's syndrome is a related condition with visible swelling at the joint.

Signs you might notice

Sharp, aching or pressure-like pain at the front of the chest, usually on the left, over the upper ribs.

Pain the person can localise with one fingertip.

Tenderness when the spot is pressed. This is the characteristic finding.

Worse on deep breathing, coughing, twisting, lifting or lying on that side.

Sometimes spreading to the arm or back, which causes understandable alarm.

999: crushing or heavy central chest pain, pain with sweating, nausea or breathlessness, pain spreading to the jaw or arm, or pain lasting more than 15 minutes at rest. Assume a heart attack.

Urgent: chest pain with fever, coughing blood, breathlessness, or a swollen calf, which may be a pulmonary embolism or pneumonia.

How it can affect day-to-day life

The anxiety is a bigger problem than the pain for many people. Somebody who has had chest pain investigated often continues to fear the heart, and every twinge is re-examined. Being told clearly what the pain is, and that it is safe to move and exercise, is the treatment.

The pain can last months, which people are rarely warned about, and they then assume the diagnosis was wrong.

Anti-inflammatory tablets or gel, heat, and gentle stretching help. Avoiding all movement makes it worse.

Coughing illnesses are a common trigger, so it often follows a chest infection and is mistaken for the infection returning.

For anybody with a genuine cardiac history, the calculus is different and new chest pain should be assessed rather than attributed to the chest wall.

Supporting someone well

Get chest pain assessed. Do not diagnose this at home.

Once diagnosed, believe the diagnosis and resume normal activity; avoiding movement prolongs it.

Anti-inflammatory gel or tablets if suitable, and a heat pack.

Gentle stretching of the chest and shoulders.

Expect it to take weeks or months, and say so, so a slow recovery is not read as a wrong diagnosis.

Treat the anxiety directly if it persists; it is a normal response to chest pain and it responds to treatment.

Learn which features would mean calling 999, so there is a clear rule rather than constant uncertainty.

For anybody with known heart disease, get new chest pain assessed rather than assuming.

Where to get help

999 for features suggesting a heart attack.

A GP practice or urgent care for assessment of chest pain.

A pharmacist for anti-inflammatory gel.

British Heart Foundation on 0808 802 1234 for information on chest pain and what it can mean.