Costochondritis

Specialty: Musculoskeletal.

• Tietze syndrome
• costosternal pain
• costal chondritis
• sliding rib syndrome

Why it occurs

• Muscle overload or repetitive microtrauma of the chest wall (persistent cough, weight lifting)
• Direct trauma to the sternum or ribs
• Inflammatory spondyloarthritis (with involvement of costovertebral or costoterminal joints)
• Fibromyalgia or generalized myofascial pain
• Post-surgical fungal or bacterial infection of the costal cartilage (rare but serious)
• Tietze syndrome (with palpable local swelling of the costochondral junctions of the 2nd or 3rd rib)

Initial workup

Electrocardiogram (ECG) and serial troponins to rule out cardiac cause | Chest x-ray (PA and lateral) to assess lung parenchyma and rule out rib fractures | General analysis with acute phase reactants.

Standard management

• Ibuprofen — 600 mg every 8 hours orally, administered with a gastric protector such as omeprazole 20 mg
• Paracetamol — 1 g every 8 hours orally; first-line analgesic if there is a contraindication to NSAIDs
• Lidocaine 5% patch (applied to the painful area of ​​the chest wall for 12 hours a day).