Costochondritis: Chest Wall Pain with Arthritis and Fibromyalgia

Oh, Costochondritis! This is easily one of the worst and most painful symptoms of life with Spondylitis and Fibromyalgia. Before I knew what it was, I honestly thought I was having a heart attack!

Thankfully, my FB group for Fibromyalgia and Ankylosing Spondylitis in Women was there to assist and reassure me when it first happened. I’m endlessly thankful for support groups and patient groups that pool resources so we can learn from each other.

The first time I had a costochrondritis attack was August 2014, but it wasn’t until December 2015 that it got bad enough to not only leave me bedbound and in agony, but it also felt life-threatening as the chest pain I was experiencing was a sharp pain and the pressure was intense. I really thought I was having a cardiac incident.

Today’s post answers the basics about living with costochondritis. It happened several times before I knew the signs of costochondritis, and that is why I’m sharing this with you today.

What is Costochondritis?

Costochondritis is caused by inflammation of your sternum and ribs. Your costosternal joints, which are rubbery pieces of cartilage that attach the ribs to the breastbone, become inflamed. When costo attacks, it feels like my chest is being pulled down and inward, sort of like my chest is collapsing. Pressure builds in your chest until you feel the need to ‘pop’ your sternum. I work on opening my chest to relieve the pressure by doing gentle stretches and chest opening exercises.

Veteran patients who experience costochondritis regularly will all tell you that it can take a long time to pop and get some relief.

Studies suggest that as much as 50% of all chest pain is caused by musculoskelatal disorders.

Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking.

Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial

Worse of all, the pain of costchondritis mimics cardiac problems, such as a heart attack. So you never really know what you’re dealing with when it starts. Over time, I’ve learned the signs of a costochrondritis attack, which is what I’m sharing with you today.

One great tip to learning if you’re having a costo attack is that if your chest is painful to touch, you can be almost certain it’s not a heart attack. That said, let your doctor do the investigating if this is your first time experiencing chest wall pain.

What Causes Costochrondritis?

Sometimes costochondritis is a result of some sort of mechanical stress, such as physically straining yourself or perhaps coughing too hard.

Costochondritis is also known to affect patients who suffer from fibromyalgia, axial spondyloarthritis, rheumatoid arthritis, psoriatic arthritis, and other rheumatic conditions. Inflammation from inflammatory arthritis can also cause damage to rib cartilage.

Costochondritis can also be triggered by viral and bacterial infections. It can also develop after surgery and even with pregnancy since a woman’s ribcage is stretched during the third trimester.

Costochondritis SymptomsSharp Pain and Pressure

The hallmark symptom of costochondritis is intense chest wall pain that can be described as sharp, aching and full of pressure. Most certainly, I’ve experienced that the pain gets worse with breathing deeply or moving my upper body. This is because costochondritis attacks the joints that flex when you inhale. It can also feel like someone has stuck a knife in you. It really does take your breath away.

I remember once incident in 2015 that left me writhing in agony in my rheumatologist’s clinic in Taiwan and he never once suggested a link between Axial Spondyloarthritis and fibromyalgia. He didn’t even know what to call it, but he tried corticosteroid injections to try and get the inflammation to come down. Since I had visible inflammation present in all my major joints that summer, that was our only treatment option at the time. That particular costochondritis attack lasted for three months. I’m not kidding you. I was bedbound that whole summer and moving was terrible. I spent my time breathing shallowly, trying not to move, and reading or listening to classical music.

The symptoms are intense, especially if you’ve never experienced it before. Costochondritis is not life-threatening, but as I’ve mentioned, if you’ve never experienced it before, make sure you head to ER to rule out other life threatening problems.

With costochondritis, typically the second to fifth costochondral joints of the ribs are affected, especially your third and fourth ribs, but it can impact any of the seven rib junctions. Pain can happen in several places, but it’s almost always on one side of the body. For me, it presents on the left side every time it hits.

I’ve learned I need to wait it out. Sometimes it can last weeks to months, as I stated above with my summer from hell in 2015. Some patients have lived with it as long as a year. Thus it’s important for patients to understand what costochrondritis is and know that it will eventually go away.

Diagnosing Costochondritis and Treatment Protocol

X-rays don’t show soft tissue well and there’s no blood test for it, so costochondritis is typically diagnosed by a doctor through a physical exam. Older adults experiencing these symptoms may need to get an EKG to rule out the possibility of cardiac problems.

As I mentioned earlier, I’m always certain it’s costochondritis when I push on my chest gently and it’s extremely painful.

If you’re heading to ER, you can count on a physical exam being conducted by the doctor to see if tenderness to palpation of the costochrondal joints reproduces more pain. Any time this has happened with me, the pain intensifies and starts hitting several sites on the same side of my chest and torso.

Your doctor might suggest pain relievers such as:

  • Tylenol (acetaminophen)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Local anesthetic injections or steroid injections
  • Ice or heating pads can help
  • Epsom salt baths and magnesium rich baths help to reduce symptoms
  • Your doctor might give you a cough suppressant to reduce discomfort
  • Try some GENTLE stretching
  • Minimize your activity

Honestly, though, the best treatment is rest!

There’s also no real way of knowing how long the pain will last, though the American Family Physician report says that it can last from weeks to months, though for some it may last for a year. “Patients with costochondritis should be educated and reassured that this is a benign condition that will eventually resolve itself,” the journal states, sometimes without any treatment at all.

American Family Physician

Resource List:

  • Mayo Clinic: Costochrondritis
  • American Family Physician: Costochondritis: Diagnosis and Treatment
  • NHS: Costochondritis


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