3 Similar Types of Chest Pain: Costochondritis, Tietze syndrome, and Intercostal Neuralgia


Costochondritis occurs when the cartilage in the rib cage (where the upper ribs attach to the sternum) becomes inflamed. This area is called the sternocostal joint, and the pain associated with costochondritis ranges from mild to severe. This particular type of pain is often described as feeling like a heart attack. The pain is more commonly felt in the left side of the chest between the fourth to sixth ribs and sometimes radiates to the back or abdomen. Pain usually increases with movement and/or deep breathing and decreases when idle. Costochondritis tends to be more prevalent in women than in men.

Genetics, injuries, surgery to the sternum area, arthritis, joint infections, tumors, and viruses are the most common causes of costochondritis, but infectious diseases can also cause the condition. Pressing on the affected area causes pain, and without this tenderness, a diagnosis of costochondritis is unlikely. Although it can last for several weeks, costochondritis is usually harmless and goes away on its own.

Health professionals usually deem it necessary to rule out other conditions before making a diagnosis of costochondritis. A physical exam (pressing on the breastbone, moving the rib cage and arms in an effort to re-create the pain, and ensuring that no swelling is present) is typically performed before making the diagnosis of costochondritis. No specific test exists that can confirm costochondritis is present.

Treatment for costochondritis includes taking anti-inflammatory medications such as ibuprofen or naproxen, alternating heat and ice to the affected area, stretching exercises, and avoiding activities that make the symptoms worse usually help ease the pain. If the pain is severe, a physician may prescribe anti-seizure medication, anti-depressants, or narcotics.

Costochondritis and Tietze syndrome pain are very similar; however, if swelling accompanies the pain, Tietze syndrome is typically diagnosed. Tietze syndrome is rare and comes on suddenly. The affected area is normally between the second and third ribs. Although swelling is the distinguishing symptom of Tietze syndrome, redness, tenderness, and warmth to the area may also be present. Tietze syndrome pain can last up to several months and may be confused with the pain of a heart attack (as with costochondritis). Determining a diagnosis involves a physical exam as performed for costochondritis; however, in order to make a specific diagnosis of Tietze syndrome, blood tests are usually ordered to determine if inflammation is present. Treatment of Tietze syndrome and costochondritis is the same.

Intercostal neuralgia is caused when the intercostal nerves (nerves that originate from the spinal cord and lie between the twelve ribs) become inflamed or damaged. Intercostal neuralgia pain presents in the upper trunk and chest wall and may radiate to the shoulder blade(s) and/or lower pelvis. A sharp, shooting, and/or burning pain around the ribs, in the upper chest, and/or upper back is the most common symptom. Tingling, numbness, or a squeezing sensation may also be present. Pain typically intensifies when deep breathing, stretching, laughing, sneezing, or coughing. In severe cases, muscle twitching, loss of appetite, muscle atrophy and/or shrinkage, and/or intensified pain develops.

Intercostal neuralgia is often caused by the shingles virus, trauma to the chest, nerve pressure, or injury from surgery to the affected area. A diagnosis of intercoastal neuralgia involves a healthcare professional performing a physical examination and ruling out other conditions. During the physical exam, the physician presses between the area of the ribs while the patient is taking a deep breath. If a pain is felt during this physical exam, and other possible diagnoses are eliminated, intercostal neuralgia may be diagnosed.

Although no cure exists for intercostal neuralgia, various treatment options are available to manage the pain. Lidocaine patches and capsaicin creams often offer temporary relief. Antidepressants and/or anticonvulsants are sometimes prescribed for long-term pain management. Opioids may be also be prescribed, but due to the many side effects, they are usually a last resort. In addition to topical and oral medications, nerve blocks can be done to help with the inflammation and pain. Another option includes a thoracic epidural injection of anti-inflammatory medication into the affected area. Also, pulsed radiofrequency, a minimally-invasive procedure, can be effective in managing the pain. Other treatments that may help include, but are not limited to, physical therapy, relaxation therapy, and cognitive therapy.

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