Costochondritis (Tietze’s syndrome)

I’ve been asked –and consulted- about “rare chest pain” in several times. I could notice that people is always worried about any kind of chest pain because the fear of suffer a heart attack or a pulmonary problem. Chest pain is one of the most common symptoms that require medical attention. You –as physician- should always exclude this topics (cardiac and pulmonary) in the first place. You should keep in mind that there is a disease called costochondritis (Tietze’s syndrome) once you ruled out the main fear conditions (pulmonary and cardiac).

is an inflammation of the costo-sternal joint (rib-sternum) or it could be an inflammation between the costo-chondral joint (rib-rib cartilage). The group mainly affected is that woman over 40s.

Etiology (causes)
: Direct injury to the chest, viral infections (cold / flu), idiopathic (the cause cannot be found).

Its clinical manifestations: Pain, tenderness in those joints I already mention earlier. This pain and/or tenderness get worse when you touch the involved site or move in a certain direction.
The diagnosis it’s mainly a clinical one and the physician should always exclude a heart attack and other important things.

The gold-standard of treatment is NSAIDs (non-steroid anti-inflammatory drugs like aspirin, diclofenac, naproxen, ibuprofen, acetaminophen, etc.) for one or two weeks (this disease usually lasts for this period of time). Some patients respond well to putting a local heating pad.

You have to remember that when you have chest pain, you have to look for a health care provider immediately to exclude other serious conditions.


Jon Mikel Iñarritu, M.D.

Spanish (Español) article

59 thoughts on “Costochondritis (Tietze’s syndrome)”

  1. 11/06
    I have had costochondritis on my right side now for about 2 weeks. It started after a severe cold where I had horrible coughing spells. I thought I broke a few ribs. It hurts to breath. I have been taking Motrin around the clock and this helps, but if I miss a dose, the pain restarts again. Also I now have to use Icy Hot patches, which help me for 8 hours. Any type of movement seems to agrivate the condition. Also, to make matters worse, I have to sit at my computer for 8 hours straight a day, which I think is making it worse. I have decided to start doing some exercising today, nothing too strenuous, but I think this may have helped somewhat. I am a 50 year old female. I hope this goes away soon, as it is very debilitating.

  2. It can happen in women of all ages. I’m 23 and thought I was having a heart attack @ work one day. After xrays, ekg, blood work they ruled the rest out and this is it. I’m worried because i’m currently on the ortho evra patch, nexium, and klonopin. The ortho evra is what scares me most. After hearing all those things on the news, i’m ready to take it off. It’s on to day 2 now of feeling this horrid chest pain and the asprin and ice applied to my chest is working (i’m cold but it’s working) I can’t say i’ll be able to go pick up boxes but it did hurt to drive this morning so i’ve spent the day in bed. It hurts when I get up from bed. ARGH

  3. I hope the Doc will answer this…..
    Hi There…I’ll keep this brief as I know how busy you must be. Had been having some funny feelings in my chest since week 28 of my pregnancy. Feelings felt like a vibration or buzzing…drove me insane. This morped into pain that got so bad one night my husband took me to E.R. where they did ekg and echo…heart is fine. Diagnosed costo.
    I use haet and ice alternately, but they don’t do much. I am suffering so badly, most nights I am just in tears from the pain, and my Docs keep brushing it off…I think they think I’m being dramatic, which I am not. I have never even been to a hospital before this.
    I am 36, in perfect health even with the pregnancy (no anemia, b.p. is great) and have excercised every day up until this started. I am now 31 weeks pregnant and am beside myself with how much this hurts…I can’t lie down, as that makes the pain so much worse, and that buzzing too, which is maddening.
    Incidentally, I am a hairstylist, a very booked one! This is so sudden, but Dr. says he’s not sure if it is pregnancy related (upward push of baby on ribs?) The pain is so bad today that I wouldn’t have been able to go to work, but luckily I don’t work anyway on Tuesdays.
    What are your feelings on trying to push through the pain when I’m able to? I have not yet missed work, and feel I’m going to be in pain no matter where I am, so might as well be with people and take my mind off it. Pain is normally not that bad during the day, anyway.
    Any advice? I am so scared to give birth…if I had to do it right now I’d be incapable….pain in my chest too great, plus I cannot breathe very well most of the time.
    Any help would be greatly appreciated.


  4. Is this just a once a month exercise to answer the things posted on this sight? (Or maybe even longer?)

  5. I’m glad I came across this thread. At about age 24, I was dx with Costochondritis in 2001. It began as occasional flares and has since become permanent these past couple of years. Swelling is present (for at least 2 years now) and the pain flares and receeds almost depending on the weather. Winter is the worst for me. The location of pain/swelling is in the upper sternum- about rib 2-3. Having not found much relief other than what is already mentioned by the good doctor, I recommend to Priscilla and others to try to rest and to heal completely, if possible. I believe having to lift and carry my children as a young mother has caused my continual trauma, thus leading to a chronic condition. It really is debilitating…

  6. What is this disease???? It is causing difficulty breathing and seems to get slightly better and then flares up worse than ever! I am concerned about the Army’s response to this situation because their latest response to breathing difficulties (from the pressure from the ribs on the lungs) was to prescribe an inhaler. Does anyone really have a clue how to battle this or is my daughter just doomed to poor medical care because she chose to protect the other 94 % of the population? Perhaps i could find some help at, as time keeps ticking and things aren’t getting back to normal. She did have problems with a stomach ulcer in the month or so before this happened. From reading this page there seems to be a fairly strong suspicion on my part that there is a link between the two. Is there a way to treat this or is this just one more of those “mystery diseases” that has a name, but no effective treatment?

  7. Hi Doctor,

    Thanks for all of this information. I believe I have an undiagnosed thyroid condition, which has also added to many anxiety symptoms I now have. I have been doing intense computer work for about 4 months which wasn’t entirely ergonomically correct and seemed to have pulled by shoulder and neck. I also paint houses about 3 times a month. My question is this. Recently I feel as though my upper sternum and 2nd right rib is bigger, sticking out more. I don’t have pain, but I do have chest tightness (especially after eating) and burning in my chest and arms at times, seems like that occurs more when I’m anxious. I know that you said that tumors are not common in this area. But if I’m not really having pain, is that a sign that it could be a mass? I don’t feel a mass, I just feel like the area is sticking out more. Thank you.

  8. Hi,

    Just a quick question, I have had minor pain right under my right breast, where my underwire bra sits, and the pain seems to come and go when I breath. Sometimes the pain is worse then others. I have been to the doctor several times and he diagnosed me with inlfammation. This was a year ago, should I still be grappling with this. I was told to take a muscle relaxer and motrin three times a day, but I have two small children to take care of. When I do take the motrin and muscle relaxers at night, I do feel a little relief but to take them three times a day is impossible. Should I go back to the doctors, or just stop wearing bras? The pain really seems to get irriated when I wear the bras though.
    Your thoughts,
    Thank you

  9. Hello again doctor the gerd is now under complete control the erosions are healed. The chest pain still is there but i hope that tens will help this god willing

  10. Hi Jon! This is a follow up to the previous post. The GI doc said the bloat was caused by the acid reflux. The chest pain is caused by a moderate sized sliding hiatal hernia. He said basically the hernia is sliding in and out of the chest wall cavity which is causing the pressure of the chest as well as the costocondritis (localized to the breastbone), and some breathing difficulty.

    He did prescribe reglan (sp?) but that hasnt worked. He also prescribed donnatol to mix w/ the maloox but I am only to take it when all means have been exhausted. He wants to do the manometer (sp?) and the pH 24 hr test on Monday but I see a surgeon tomorrow which he has recommended (surgery).

    For the scope results: No yeast, virus, nor fungi was found. Barrette’s and pre Barrette’s have been ruled out! There is none!! BUT the small sliding hiatal turned out to be a ‘moderate sized’ instead.

    I will keep you posted on what the surgeon has said. What kind of surgery is done to correct sliding hiatals?

    TY so much for the reassurance during this time. You gave me a peace of mind. I can honestly say I am not as scared as I was prior to everything. I had stopped smoking and was 6 weeks free but then getting all the run around caused a lot of stress so I had gone back to smoking. However, I am 4 weeks free from smoking and I am very comfortable in this final quit. Thank you!!

  11. Hi,
    Looking for some guidance concerning my 19 year old. She has been suffering with pain on the left side of her chest and has gone to sick call and UCC due to breathing difficulties. The right side is somewhat tender, but not severe. The left side seems to hurt weather she does or does not do PT although PT does deem to aggravate it. The pain begins under the breast (left) and continues to the bottom of the rib cage it wraps around from the breast bone to the back. The most recent visit to sick call came back as a diagnosis of costocondritis. Just want to know if this seems consistent to someone with a more extensive knowledge of the disease. She is also currently having nausea and vomiting along with diarrhea, but this could be food related and has only been 24 – 48 hours. She did pull a muscle, but that was after the awelling existed and she says that pain is gone. Says there is some pain in the breast (left) but it is deep and unlike the breast tenderness one experiences during the menestral cycle. (i had also found info about IBC in my search and am trying to rule things out, but don’t wish to ignore any possibility.) In the three months that she has been in the armed forces things have been mostly denied and sometimes miadiagnosed so i’d appreciate another opinion.

  12. Kimberly: Definitively stressful situations increase the onset of synptoms of costochondritis. However, my advice is that you go to the doctor and to discard other possible causes.

    KT: Costochondritis may be due to radiation (even though it was radiated the left side). You could have costochondritis, but only your doctor can assure you that.

    ruth: There is no correlation between GERD and costochondritis. if lab works are ok I think you should ask for a referral to a rheumatologist (mainly due to low grade fever).

    Tracy: In fact, your symptoms doesn’t seem like costochondritis, are more likely to anxiety (excrutiating chest pain & shortness of breath). I would recommend you to ask for a referral to a psych.

    Wallace E. Mack: Why don’t you see a rheumatologist? I’m sure that he can help you.

  13. I have suffered with a nagging pain in my chest since 2004 and gone thru extensive different test and treatments with now relief an I really need some good advice as to what to do. I am currently taking celebrix and aciphex and local heat and donot get any relief for more than a few hours. I wear heat patches and take aspirin and still have now relief. I don’t know what to do. Can you help.

    Yours Sincerely
    Wallace Mack

  14. about six months ago I was diagnosed with acute bronchitis, which also caused Pleursy a few months later. In June I started experiencing extreme pain in my left arm and shoulder and also in my left side and middle of my chest and ribs. I had all the tests for possible heart problems done over and over again, which came out ok.I also had a very low pttasium count. Two days ago I went back to the emergency room with excrutiating pain and shortness of breath again, this time the doctor told me I had tietze’s disease. My question to you is how long does this usually last, can it reoccur, and can high anxiety bring it on. and how is it treated? this is very painful and very scary for me{I just turned 40} It feels just like a heart attack. Please reply thank you Tracy

  15. I’ve been reading the postings on Costocondritis and Tietze syndrome (disease) and find it fascinating– of course since I suffer myself. Things are always more fascinating then !! I’m waiting for some lab results from my doctor (its been a week… I’m not dead so it must be good news). I’m 47 and have OA of my hands and feet- Lately with generalized muscle pain and fatigue. Doesn’t fit fibromyalgia symptoms. Also, costocondritis which I’ve had several times before. (Also hx of GERD…that’s weird to see on here so much. I wonder if there’s a correlation). Because of GERD have trouble with NSAIDS. Doc put me on disalcid which is helping the condritis a bit, but nothing else… and I’ve had low grade temps now several times this week since starting it– which seems weird since its an antipyretic as well as antiimflammatory. So here’s a question… if the lab works comes back ok… or borderline as it has over the past ten years… should I still ask for a referral to a rheumatologist or just figure I’m getting old and I should shut up and put up???

  16. I have been having chest wall (or rib) pain on the right side for several months. Granted, I have been dealing with a lot of recent stress, I can’t help but wonder if that could really bring all this on. I am 38, female, with 2.5 year ago history of breast cancer on left side which I had a lumpectomy plus radiation to cure. I have had neumorous tests over this time, many chest x-rays, a MRI, bloodwork, etc to rule out every ache and pain. They tell me I’m cancer free. This pain I have is agravated by bending, stooping, sometimes reaching, stretching, and lifting any weight. It creates a sharp muscle type pain. Even if I don’t sit up straight, I get the pain at times. I don’t feel like I am having a heart attack and there is no shortness of breath… it seems to be all brought on by movements. When I press on my ribs, I can’t create the pain… it just feels more deep. I’m taking 600 ml of Motrin round the clock for 3 days now to see if it helps. I can tell when it’s time for another dose because the pain in more prevelent. Should I be worried about cancer? (even though it was on the left side as with my radiation treatments). Do I have costrocondritis? I should point out that I do not exercise and have been leading a very sedentary lifestyle (something I want to change if this pain can go away).

  17. About 8 weeks ago I was diagnosed with costo chondritis. However symptoms presented themselves on the right side of my upper trunk radiating to underneath the unerardm, left breast and upper left trunk in my bak directly beneath my scapula.
    It did go wawy briefly, however has reutrned. I have had a chest xray and approxiamately 1 year ago when i had underwent spianl fusion L4 l5 & S1. So i am in fairly good health. It is possible for stress to increase the onset of synptoms with Costo Chondritis. Or is there possible something else I ahould have my Physician looking for.


  18. Traci:

    First of all your doctor have to stablish the cause of that bloating, I’ll order a feces culture and a fecal parasitoscopic exam, because the main cause of colitis is infection.

    I don’t think that the bloat is the cause of the rib pain. The hiatal hernia certainly can cause chest pain, but it depends on its size (and yours is small).

    You could have three conditions at the same time: costochondritis hiatal hernia colitis.

    Let your gastroenterologyst do the work-up.

    Thanks for your visit and your comment and get well soon.

  19. I have noticed I have the symptoms of the breastbone / rib inflammation. It’s hard for me to breath in and there is what feels like pressure. They diagnosed as costocondritis back in June and then I became sick.

    I was recently dignosed w/ a sliding hiatal hernia and a belly button hernia. Tho the radiologist said they were small, it shouldnt bother me. I have a scope tomorrow w/ the GI doc and to boot, for the last 30 days (w/ only 4 days of non bloat) I had been extremely bloated. It felt like all of my guts were being pushed into my chest cavity.

    I have had the usual chest xrays, barium swallow, blood work, EKG. Everything but the barium swallow came out normal. The pain is in the breastbone area, and directly to the right of the breastbone, and it will follow the arch of the right breast.

    Could the bloat I had, cause this? or the sliding hiatal hernia? I jsut know I am tired of the pain.

    Your thoughts?

  20. Michelle:

    It’s not normal this case that you are describing.

    If your rib is “growing” or has a mass, you have to go to an orthopaedic surgeon, it could be a bunch of things (like a cyst, a benign tumor, a malignant, etc). My recommendation is that you visit an orthopeadist right now.

    Thanks for your visit and your comment.

  21. Carl:

    Exercise often increases this type of pain.

    If anti-inflammatories doesn’t help, why don’t you visit your doctor. I mean, since I’m unable to examine you I can’t recommend you certain type of treatment.

    Often lidocaine and steroids locally injected. improves and diminishes the pain and inflammation.

    Best regards,

  22. About a month ago I had an ultrasound on my 3rd rib on the lefthand side – it was enlarged, and though not painful it looked and felt very odd. Xrays were clear, as was a scan. I was told by my Dr that it *wasn’t a tumour so don’t worry about it*.

    Now, 4-6 weeks later, my next rib down is also enlarged..and seems to be “growing”. I don’t have pain unless I really press on it, and wonder if it is tietzes syndrome…??

    Is there anything more I should be doing or will my ribs continue to expand one by one?!


  23. Hi. My condition is very similar to Darren’s. I do not really have sensitivity to touch. In fact, the pain in my chest has never been extremely bad. It started when I was lifting weights extensively. It got so bad that I could not look over my right shoulder to back up my car (during this time is when the pain was its worse, but still wasn’t excruciating). Unfortunately, I kept working out and it got worse. I could feel it most during bench press, shoulder press, and dips. Finally I had to stop lifting weights completely about 3 years ago. The condition got much better but would never completely leave. Certain movements cause a slight bit of pain – like moving my right arm across my body at shoulder height. I have been taking anti-inflammatories and they seem to help but not completely get rid of it. I would like to start working out again but I am afraid that it will get progressively worse again. Do you think a cortizone shot would help? I have also read of a successful study using a combination of 15 mg of triamcinolone hexacetonide and 1 ml of 2% lidocaine -injected locally. ( Do you think this would help? I am 38 years old and would answer “no” to all of the questions you asked Darren.
    Thank You very much,

  24. Sanchia:

    Thanks again for visiting.

    I still believe that the best option is to visit a rheumatologist and in the mean time you can apply local heat pads in order to reduce the tenderness.


  25. Dan:

    First of all, you are not old at all… years are relative.

    Pyoderma gangrenosum is not an infection by itself, it is an ulcer (like those in your large bowel) that reflect an internal disease -in your case, could be explained by the UC-. It occurs in 5% of patients with ulcerative colitis. This skin manifestation by itself could be involved in pulmonary infiltrates (could mimic a pneumonia or pleuresy) and arthralgias (joint pain).

    Pyoderma gangrenosum reatment often needs to include a several week course of high dose prednisone or intralesional steroids and topical or systemic antibiotics.

    So far we can conclude that maybe -just maybe-, your chest pain and other symptoms could be explained by the Pyoderma gangrenosum.

    My recommendation is to involve a multidisciplinary team (surgeon or gastroenterologist for the UC, dermatologist for the Pyoderma and rheumatologist for the chest pain).

    I hope that you find this information useful.

    Thanks for your visit and best regards,

  26. Appreciate your response!

    I was seeing a pulmonary specialist for the sarcoidosis, but have not been since remission three yrs now. I will also need to find an alternative to the corticosteroids for the Costochondritis.


  27. Thank you for the reply . . .
    I’ve had UC for 30 years — it runs in my mother’s family. I took sulfasalzine (3 grams) everyday until recently when I began taking Corazal, which has improved my symptoms a great deal. I have a colonoscopy every two to three years. They’ve all shown some scarring, but nothing else.

    Two years ago, I was bitten on the back by a brown recluse spider and spent a week in the hospital. My wound turned to gangrene and now I have a bacteria in my body called pyrodema gangrenosa (sp?). I have skin flare-ups from it. While in the hospital (two months ago), I contracted pneumonia and was found to also have pleursy.

    I had an electrocardiogram two months ago and it showed a healthy heart. In fact, the doctors commented on how fit I am for being so old.

    I have not seen a rheumatologist. I am currently seeing a surgeon. I had a bone scan on 8/18/06 and I have an appointment with the surgeon today.

    I use an eleptical trainer everyday for 1/2 hour. It seems that the heavy breathing causes my sternum tenderness to increase, but not while I’m working out. The spots are tender to the touch and seem to worsen if I’m lying on my back.

    Thanks again, Dan

  28. Dan:

    Where were those multiple lesions?

    There is strong relation between inflammatory bowel disease (ulcerative colitis) and articular manifestations, so I ask you: have you seen a rheumatologist?

    It is also often to note improvement taking corticosteroids and NSAID.

    The tender spots are painfull when you touch them? Do you feel the pain everytime or just when you are sleeping or excersizing? Have your doctors performed an electrocardiogram?

    How long have you been since diagnosed of ulcerative colitis?

    Heat pads will work reducing tenderness and, subsequently, pain. Before trying steroid local injection I suggest you to discard every other cause of that pain.

    Thanks for visiting and best regards,

  29. I’ve had severe pain in my upper sternum for about a year. It is so bad, I was hospitalized for a week last month. A bone scan showed multiple lesions and the doctors suspected cancer, but tests ruled it out. While in the hospital, I had a flare-up of ulcerative colitis, for which I take a medication called Corazal. I’ve also been taking prednizone for a month, which has helped reduce the sternum pain.

    The pain subsides with NSAID and the prednizone meds, but comes back strong once the dosage wears off. I have two tender spots, one right and one left of the sternum where the ribs connect. I’ve had swelling in the middle of the sternum between the two tender spots.

    The pain is both an ache and sharp, accute strikes. I frequently wake up from the throbbing, which I can feel each time my heart beats.

    I am a 60-year-old man (a former marathoner) in top physical condition. I work out daily with a Bowflex and eliptical trainer.

    The pain is like nothing I can describe — it is so severe, that it keeps me from normal activities. The doctors I see just give me pain medications and scratch their heads. Would any kind of physical therapy be beneficial? What about a cortizone injection?

  30. Sanchia:

    1. In your very particular case, it is very important to monitor Sarcoidosis. Joint, bone and muscle (as well as other organs) may be involved in sarcoidosis. Relapse occurs in 16% to 24% of patients with sarcoidosis.

    2. This pain you have, could be a sequelae of sarcoidosis. Your doctor has to rule out this possibility.

    3. High blood pressure is often aggravated by corticosteroids.

    4. Definitely you need to go to a rheumatologist (also other specialists in order to treat your disease(s) in multidisciplinary way).


  31. Hi Dr.

    I need help!. I am a 44 yr female who has Sarcoidosis (in remission three yrs). Before the Sarcoid went in remission I developed Costocondritis. Within the last six months I have been getting a severe attack every six weeks. I have have been to a heart specialist and did a stress test and everything is ok. My BP has been extremely high and is now on two different pills to control. My Dr. has been giving me Cort shots for paid and inflamation. I think I need to go to a specialist as this is happening too often.


  32. Jen:

    How high is your CPR?

    Is your doctor a primary care physician? If your answer is yes, my advise to you is to go with a rheumatologist.

    You have some findings of inflammation, this could be costochondritis, but only your doctor could confirm this.

    Best regars,

  33. Hi,

    I am a 21 year old female and for the last few years I have had what I have been calling “chest infections” that pop up every few months. Basically according to my doctor, my chest wall becomes inflamed, but there is nothing to do but take anti inflamitories until it goes away (usually 5 days). During this time I am restricted in my breathing (extremely painful) and movement (almost any movement increases the pain). I have had rib problems in the past but only lower, I have started physio therapy tho thinking that this is Costochondritis ( unconfirmed by my doctor but I will see him soon and ask him about it ) because there is swelling in my upper chest. My collar bone is also out of place ( kind of pushed back and down a little, to the point where one is visible and the other (affected area) is not.) Also, my CR-P is extremely high. Any insight would be awesome~ thanks.

  34. Nina:

    I don’t think you should worry. It could be a xiphoidalgia (or xiphodinia) which is another syndrome characterized by local discomfort and tenderness over the xiphoid process of the sternum (the bottom part of the sternum). Symptoms are aggravated by eating a heavy meal or bending or twisting movements and it could be associated with resumption of heavy work or cough.

    The treatment of choice is analgesics or local injection (anesthetic steroid)


  35. Jeannette:

    I’m sorry, I didn’t notice your earlier comment.

    Reading on what you commented us, it could be a Tietze’s syndrome which is a benign, painful and localized swelling of the costoesternal joints. Most often involves the area of the second and third ribs and only this area is involved.

    The best way to know if this is the cause of your symptoms, is to apply digital pressure in the area, and if the pain that you described is reproduced.

    You should visit your orthopedist again and ask him to give you other treatment with NSAIDs or local steroid injections.

    I agree with him, it isn’t good to get chiropractic, specially with that lower spine issue.

    Best regards,

  36. Hello about 9 months ago i noticed a pain in my sternum area. It only seems to occur following certain postures.When it happens I cannot fully turn my upper body and i sometimes have a popping in the sternum area that temporarily relieves the pain. The pain is located approximately in the center of my chest. Ive also noticed only recently that i have a bone slightly petruding just right of the sternum its not visually noticeable. As far as health goes i dont have any other symptoms I am 23 female and i exercise regularly. Is there any thing i should be very worried about? Thank-you:)

  37. Darren:

    In order to rule out rheumatologic origin of pain, I would like to order a rheumatologic lab profile.

    If nothing else is found, I will agree with your GP.


  38. Thanks for your reply
    How old are you? – 27
    Do you have another symptomatology like fatigue,
    fever, hands or fingers pain, low back pain or something else? – no
    Is this area swollen? Is it hot, red? – NO
    Have you ever suffered any trauma on this area? – No

    Again any help would be appreciated

  39. Dear Darren:

    How old are you?
    Do you have another symptomatology like fatigue, fever, hands or fingers pain, low back pain or something else?
    Is this area swollen? Is it hot, red?
    Have you ever suffered any trauma on this area?

    Primary or secondary neoplasms (tumors) infrequently involve the chest wall.

  40. Hello

    I am getting pain on movemet in my rib / sternum area. My GP has diagnosed Costochondritis but I do not get pain when touching my chest which apparenty is consistent with Costochondritis. The pain is there with certain movements such as leaning forward or moving my right arm across my chest. The Anti inflammatory drug I have been described has not worked. This pain has been with me now for just under a year and a chest xray did not show up anythings.
    Any advice on what I should do next would be most apprciated, I van;t help but think this oculd be something more sinister like a tumor. Thanks

  41. I have been doing some research on a popping sound in my chest. I have stumbled across the term costochondritis but I am not sure this fits the symptoms I am having. I am having a dull chest pain on the right side of my chest. When I arch my back my chest pops but the seems to remain. Is popping of the chest related to this problem? I dont know if it makes a difference but I am currently taking zoloft. Any help would be appreciated.

  42. Hello, almost 3 years ago I started to notice that one of my ribs on my right side (maybe # 2 or #3)close to the sternum was protruding. Now it’s even more noticeable, the rest of my ribs on the right side and also my left are all following in the same way. They all feel ‘misaligned’. I’ve had xrays & a Ct scan & blood work all neg. My grandmother had pagets disease & my test for that came back neg. I used to get chiropractic adj & that made me feel a little better, but I went to an orthopedist who told me not to go anymore, he said my lower spine has early signs of degenerative disks & chiropractics would make it worse. Daily I feel an ache or a sharp pain where the ribs meet the sternum. Sometimes I feel a ‘pop’ with certain movements. I had a heel spur recently & took advil continuously for a month. It helped the heel spur but not the rib pain. I would appreciate any wisdom you would share.

  43. VAL KELLY: Thats nice, I think that poultice could work on relief symptoms.

    CLINT: As I say to you the other day, I’ll treat the advanced GERD you have and later treat the costochondritis.

    SUSAN: Your case is very specific. First of all, I’ll order an upper GI ultrasound to rule out a gallbladder disease, if nothing is found in that study I’ll think about the possibility to perform a HIDA scan of the gallbladder. Remember Susan, you have to rule out other diseases, the last thing you are going to figure it out is costochondritis. I don’t think that the spleen is causing that rib pain, mostly because (as you say so) the pain is on the right side too.

    I rather prefer to not try larger doses of NSAIDs because the myeloproliferative disease.

    It is not common to have chronic costochondritis. I think (if every other cause is ruled out) that you may have one of the “lower rib pain syndromes” wich are characterized by pain in the lower chest or upper abdomen, a tender spot on the costal margin, and reproduction of the pain by pressing on the spot. In ome reports, hypermobility of the anterior end of a costal cartilage has been implicated, possibly related to indirect trauma due to lifting or twisting. Painful lower rib syndromes have been found in 3-5% of patients referred to some gastroenterology practices. A majority of patients with this condition are women, with in mid-40s. The pain persists in 70% of patients followed for an average of 4 years from diagnosis. One-third of patients undergo further evaluations for other causes of pain, even after a definitive diagnosis is made. Reassurance and mild analgesics are useful in most patients, with local anesthetic injections, and rarely, rib resection used in a few reported cases.

    Please let me know what happened with you.


    Jon Mikel Iñarritu, M.D.

  44. Dear Dr. Inarritu,
    I’m a 40 year old female. I have had rib/sternum pain for almost a year; no cause found. The pain is reproducible by pushing on the very inside point, both sides, where the ribs meet the sternum, sometimes higher up on the sternum itself, and across the ribs at the bottom edge up to the middle. More severe on the left side. Pain also in the upper abdomen, mostly on the right side–I can press into my abdomen and make it hurt, couple inches below my right ribs. Can also radiate to my back, slightly.

    Pain all around is worse upon exertion (exercises with twisting motion are out), although sometimes it is delayed (for instance, I had a very bad cough last week, but only this week is the rib pain worse).

    X-rays are normal, blood work is normal (except for slightly high platelets–see below). Had a CT scan which was normal, except it did show slightly enlarged spleen, and further tests show I have a mild myeloproliferative disorder (another story). Neither my GP nor my hematologist think the spleen is causing my rib pain (especially since I have pain on the right side, too), but do you think the spleen could be pressing from the inside to cause costochondritis?

    NSAIDs do not seem to help, although I admit I have not tried a large dose regularly…don’t really want to do that to my liver if I don’t have to.

    This has gone on so long…how common is it for people to have costochondritis chronically?

    Thanks in advance,

  45. I saw the rheumatologist today and with my symptoms he agreed it is chronic costochondritis. And he said the truth is there are some treatments, but they do not always work. This disease is very idiopathic in nature and he likens the pain I feel to a phantom limb type of pain. My brain is sending pain signals when it should not and he is starting me on skelaxin and lidocain patches. I asked him if the best course would be to block the signal to give the hyper state time to rest and he agreed that may work. No matter how many mental doctors I would see this is not a mental issue just a cross wire so we will see. Also he happens to play poker with my gi doctor.
    Also a good way to reduce spasms would be magnesium but it could cause a lose stool so ask a doctor .
    Also i was reading about left chest pain gerd can present this way, also the best way to see a costo cartlige problem would be with a ct scan x-rays are goos about 2% the best thing you can due is use what you know to rule out what is left occam’s razor. By telling my doctor today what i do know he was able to pinpoint a better treatment i find wrting it down and handing it to the doctor helps the best.

  46. My daughter said that as I laid the application on the affected area it felt uncomfortable and added to the pressure she was feeling. She fell asleep with the poultice on so we dont know how long she was able to tolerate the discomfort. Next morning however I noticed she was able to move around a bit more. She was also able to attend her classes. Her condition has eased greatly in the last day. It is hard to say whether it is due to the poultice or not. She was unable to tolerate the anti-inflamatory drugs though and took nothing else for the pain. I very simply used a slice of bread with a teaspn of epsom salts spread over it. I poured hot water over it to melt the salts laid it on a cloth, let it cool to hand hot and placed it on the sore area. I feel that if it was not the poultice that helped it cerainly didn’t do her any harm.

  47. LISA: Do you have fatigue, sleep & mood disturbances, headaches, irritable bowel disease? what tests and results do you have?

    VAL KELLY: For muscular spasm, application of local heat may be healpful, if no muscle spasm is present, application of cold improves the swelling. If there is no improvement with the traditional approach, the doctor should use another kind of medications such as muscle relaxants, antidepressants, anticonvulsivants and local corticosteroid+anesthetic injections. If the patient does not improve always remains the possibility of intercostal nerve block (algology specialist) and psychiatric evaluation.
    Please tell me if the symptoms improve with that poultice.


    Jon Mikel Iñarritu, M.D.

  48. My 19 year old daughter seems to be suffering with the same symptoms. Casualty doctor diagnosed COSTOCHONDRITIS.
    Trouble is pain killers do not relieve the pain nor do anti inflamatory drugs (Ibuprofen). This seems to be the only treatment on offer. I am going to try making her a warm poultice of bread and epsom salts to try to draw off the inflamation. I will let you know how it works. It may be able to help others.

  49. i was reading on the chest wall pain, I’ve had chronic chest pain in the left side from clavicle to beloe nipple area for 2 years. it started with aggressive exercise to get slim. excrutiating chest pain and the drs have run every test except anything to do with fibramyalga i’ve had neck urgery for bulging disk, rotator cuff repair for small tear, and none helped chest pain what kind if tests should be run?

  50. Thanks for being such a nice doctor. I feel if more of the doctors are willing to think out the issues with a patient not giving the the god complex. But a human element to the person who is in pain. By the way nsaid’s do not help me i wish they did. Once i am better i am going to go to school and try to get the best grades to be a doctor
    Va con el dios mi nuevo amigo.

  51. Dear Clinton:

    1. You have CLEAR indications for antireflux surgery. Contrary to what you been told, one indication of antireflux surgery is poor control of symptoms with pharmacologic therapy. Another is to have those lesions that you have in your esophagus. If you were my patient, i’ll order a new endoscopy with biopsies and an esophageal manometry. Then i will think about the need of a laparoscopic Nissen fundoplication.

    2. In relation to the chest wall pain, i’ll refer to you to a RHEUMATOLOGIST. He must palpate your chest wall, perform clinical tests and order a HLA-B27 antigen test. In terms of treatment, it depends of what’s the diagnosis varying form NSAIDs, corticosteroids to costal nerve block.

    3. Your GERD problem limits the treatment with NSAIDs and corticosteroids. First i’ll treat the GERD and inmediately refer you to a rheumatologist.


    Dr. Jon Mikel Iñarritu

  52. seronegative arthropathy ? conective tissue disorder?
    what type of treatment is there and what type of doctor would i go to. And in regareds to the pain it is a waxing and waning dull pain 24/7.
    Also what is the outlook on this disorder and what is it exactly

  53. I have had an endoscopy i have LA grade c espogitits i currently take 40 mg nexium in the morningg followed by zegerid 40 mg at night it does a little to help my reflux i have been on all the ppi’s . We discussed him doing a Nissen fundoplication but his feelings are that if P.P.I’S fail to improve the reflux. The surgery would be pointless. I have a normal Ekg, neg chest X-ray’s . My pain is bi-lat sternum to nipple line across. From below my clavicle to the floating ribs following the costal cartilage. I know that these symptoms do not present as normal Tietze. Palpating the ribs do not seem to reproduce the pain but if my sternum is pressed with force i feel the pain radiate.Espogilty motility disorder is what the gi doctor figured it was and prescribed amytipiline for the dysphasia. It did not help my chest on a side note if did help any lower gi issues. Also this may seem interesting but 1mg of klonopin seems to ease the shortness of breath. When i rotate my upper body i feel the pain in my ribs exercise makes the pain worse. I am currently taking 40mg nexium 40mg zegerid 0.5 1.0 mg klonpin and 2400mg of ibuprofen daily. What tests should i be asking for i do not know. The (esr) and (crp) tests seemed to be a good start i have been fighting doctors on the fact that the problem is not somatic. Cleared by a psychotherapist and a psychiatrist i have mild hypomania and anxiety secondary to chronic pain. I hope this expands my problems a bit more. I feel that is some one sees this they might save a lot of pain and time. Sorry for spelling error’s med. lingo is hard

  54. Dear Clinton:

    When someone is found to have chronic musculoskeletal chest pain, it should be differentiated from other multiple causes of this kind of pain.

    It would be nice if you can exactly describe the localization and type of pain and besides blood-work studies, if your physician has ordered other tests.

    My attention is held on elevated CRP. That could rise the possibility of a rheumatologic disorder (seronegative arthropathy).

    The best treatment depends on the diagnosis and it could be more than one modality (passive-agressive).

    On the other hand, how do you know do you have severe GERD (“almost Barrett”)? What kind of treatment are you getting? Does your physician had offered you an antireflux surgery?


    Jon Mikel Iñarritu, M.D.

  55. I have read your comment concerning Titeze syndrome my question is have had this disease for almost 18 months with no response to any treatment. What would you recommend as the best aggressive treatment for this i have major gerd to to the point of almost barrets. I am 27 and besides the titeze and stomach issues i am otherwise normal. My (esr) is normal but my (crp) is 4.0 while being on 2400mg of ibuprofen.
    I have pain daily what type of doctor is best in treating this condition i am in constant pain and i get S.O.B. Alot i have a clear psyc. eval. so somatic is ruled out any help would be great thanks.

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