Pain in the chest

Costochondral tissue (costo = rib, chondral = cartilage) is the cartilage between the ribs and the breastbone (sternum).

Costochondritis occurs when this cartilage becomes inflamed and tender. Costochondritis is widely accepted as the most common cause of chest pain originating from the chest wall (i.e. not from an organ).

The costochondral tissue is at the side of the sternum, so the pain of costochondritis is felt just an inch or so from the center of the chest. Generally the third or fourth ribs are the most affected. However, any of the seven costochondral junctions may be affected. There are, of course, 12 ribs (in both men and women) but the lower ribs do not connect directly to the sternum. It is possible for the condition to affect the cartilage areas on both sides of the sternum, but usually it is on one side only.

The primary symptom of costochondritis is severe chest pain, which may vary in intensity. Costochondritis pain is usually worsened by activity or exercise. One of the most common symptoms is that the pain is present when taking a deep breath. This stretches the inflamed cartilage and can cause exquisite pain.

Costochondritis pain is usually localized to the chest, but may radiate to other areas. Because of the many nerves that branch away from the chest, pain may be experienced in the shoulder or arms as well.

The pain has been described as sharp, nagging, aching or pressure-like. The pain can be so intense it is common for some people to fear they are having a heart attack.

However, the pain of a heart attack is often more widespread, while costochondritis pain is focused on a small area. Heart attack pain usually feels as though it’s coming from under your breastbone, while costochondritis pain seems to come from the breastbone itself.

Don’t waste time trying to distinguish between the two. If you’re experiencing unexplained and persistent chest pain seek medical attention – chest pain is an emergency.

It can be very difficult to determine the cause of costochondritis. This condition is most frequently found in women above the age of 40, but can affect all ages and genders.

Costochondritis can develop as a result of a traumatic injury. A car accident where the driver’s chest strikes the seatbelt or steering wheel would be a prime cause. However, this condition can develop with no history of direct trauma.

Chiropractors have found that rib movement dysfunctions contribute to this condition. Ribs that experience altered movement change the functional ability of the joints, and create irritation. These joint problems can develop from past trauma, poor posture or repetitive actions.

Avoidance of activities that may strain or cause trauma to the rib cage is recommended to prevent the occurrence of costochondritis.

Modification of improper posture or ergonomics of the home or work place may also prevent the development of this condition.

Diagnosis is based on the patient history and examination. Palpation of the inflamed cartilage causes pain with pressure. Diagnosis is also dependent on the exclusion of other causes of chest pain (including the heart).

Costochondritis can’t be seen on chest X-rays or other imaging tests used to see inside your body. However, sometimes an X-ray will still be ordered to rule out other conditions.

The goals of treatment are to improve rib joint function, reduce inflammation and to control pain. To accomplish these goals your chiropractor will likely adjust the affect rib joints. If the swelling and pain are great, a combined approach with your medical professional may be required.

Nonsteroidal anti-inflammatory drugs are used, both orally and applied directly to the affect joints. Even ice can be an effective treatment choice. Additional treatment recommendations may include ultrasound and acupuncture to help reduce inflammation and pain.

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