Costochronditis: Overview

Alternative names: Tietze Syndrome, Slipping Rib Syndrome.

Costochondritis is the inflammation of the cartilage where the ribs attach to the breastbone (sternum).

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Causes and Development

The cause of this condition is generally unknown but it can be the result of trauma to the rib cage, a viral infection or part of an inflammatory disease.

Costochondritis may be caused by hypermobility of the anterior end of the costal cartilage.  Most often, the tenth rib is the source of pain because, unlike ribs one through seven which attach to the sternum, the eighth, ninth and tenth ribs are attached at the back to each other by loose, fibrous tissue.  This provides increased mobility, but a greater susceptibility to trauma.

Costochondritis is also more likely to occur in the lower ribs because of the poor blood supply to the cartilaginous tissue and ligaments.  Injury to the cartilage tissue in the lower ribs or the sternocostal ligaments in the upper ribs often does not completely heal naturally.

The ribs are attached in the front, as well as in the back of the body.  A loose rib in the front is likely also to be loose in the back.  Unexplained upper back pain between the shoulder blades and pain in the rib vertebrae are likely due to joint laxity and/or weakness in the associated ligaments.

Signs and Symptoms

Initially the symptoms may feel like those of a heart attack: pain moving from side to side of the chest and to the arms and neck.  Some sufferers find it more difficult to breathe, but there is usually no reason for alarm when the cause of these symptoms is costochondritis.

During the acute phase, pain is usually worse and it hurts to breathe, wear a bra or move suddenly.  Eventually the pain subsides to a dull, constant ache or tenderness in the ribs.  The symptoms often disappear within two months but may take up to a year or even become a chronic condition.  When chronic, the pain seems to come and go with sudden movements or lifting heavy objects.

Stress may contribute to the pain because it makes the muscles tense.  Other things that hurt are lifting, pushing, pulling, sneezing, coughing, long hours of driving or using the computer, repetitive motions and caffeine.  Cold, rainy and humid weather also make some sufferers feel worse.  Even sinusitis, with the associated nose blowing can be the initial event that results in this chronic chest pain.

On This Page


Signs, symptoms & indicators of Costochronditis:

Symptoms - Cardiovascular

Symptoms - Respiratory

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Recommendations for Costochronditis:



Nonsteroidal anti-inflammatory medications (e.g. Motrin, Advil) help decrease the pain and the inflammation, which is the primary problem.  Check with your doctor before taking NSAIDs as they have potential side-effects.

Conventional Drug Use

Cortisone shots are one way of reducing the inflammation of costochondritis but repeated injections are not recommended as they are said to weaken the cartilage after extended periods of use.

Invasive / Surgery


Prolotherapy, by strengthening the ligaments involved, provides definitive results in the relief of the chronic chest pain of costochondritis.

Physical Medicine


Exercise, deep breathing, and strain on the muscles of the chest may worsen the pain and slow the healing process.

Cold Applications (Cryotherapy)

See the link between Costochondritis and Hot Applications

Hot Applications (Thermotherapy)

Ice packs or heating pads – whichever technique helps to decrease the pain – may help you to better manage the pain of costochondritis.

Skin / Topical

DMSO Topically

DMSO applied to the area of pain may reduce both the pain and the inflammation of costochondritis.

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