Costochondritis

Diagnosis

To diagnose costochondritis, a healthcare professional performs a physical examination focused on your chest and rib area.

During the exam, your provider will:

• Press along the breastbone to check for tenderness or swelling.

• Move your rib cage or arms in specific ways to see if these motions reproduce the pain.

Because the pain of costochondritis can resemble that of heart disease, lung disease, gastrointestinal disorders, or osteoarthritis, your provider may perform additional tests to rule out more serious conditions.

Tests that may be ordered include:

• Electrocardiogram (ECG or EKG): To check for heart-related problems.

• Chest X-ray: To look for lung or rib abnormalities.

There is no specific laboratory or imaging test to confirm costochondritis itself — the diagnosis is made by excluding other causes.

Treatment

Costochondritis often improves on its own, though recovery can take several weeks or longer. Treatment aims to reduce pain and inflammation.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs):
  Examples include aspirin, ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve), and acetaminophen (Tylenol).

  • Note: Stronger prescription versions may be used if over-the-counter doses are insufficient.

  • Possible side effects: Stomach irritation, ulcers, or kidney damage.

• Narcotics:
  For severe pain, medications like tramadol may be prescribed.

  • Caution: These can be habit-forming and are used only short term.

• Antidepressants:
  Tricyclic antidepressants such as amitriptyline can help manage chronic pain, especially if it disrupts sleep.

• Anti-seizure drugs:
  Gabapentin (Gralise, Neurontin) may reduce nerve-related or chronic pain.

Therapies

• Stretching exercises:
  Gentle chest muscle stretches can help relieve tension and improve mobility.

• Nerve stimulation (TENS therapy):
  Transcutaneous Electrical Nerve Stimulation (TENS) uses a small device that sends weak electrical impulses through adhesive patches on the skin.

  • These impulses can interrupt pain signals, reducing discomfort.

Surgery or Other Procedures

If pain persists despite medication and therapy, your provider may recommend:

• Local injection:
  A combination of numbing medicine and a corticosteroid can be injected directly into the painful costochondral joint to reduce inflammation and provide relief.