There can be many medical reasons for chest, rib and upper back pain including heart and lung conditions, infections and trauma incidences like fractures.
However, once that has been ruled out a diagnosis to be considered is costochondritis.
What?
The condition is classified as inflammation of the costochondral junction of the ribs (where the bone and cartilage meet) or of the costosternal joints (where the ribs connect to the chest bone). The issue is normally unilateral (one sided) but can sometimes be bilateral.
Signs and symptoms:
- Chest pain that can radiate into the upper chest near the shoulder, down the rib into the area under the armpit and even into the back near your shoulder blade
- Pain can be sharp with certain movements and a dull ache at rest
- Sometimes there is visible swelling over rib joints
- Neck and shoulder range can be affected
- Pain with laughing, coughing, sneezing and deep breathing
Why?
The exact reason for an individual developing inflammation of that particular area is yet to be determined. However, there are a few mechanisms that have been anecdotally found to trigger costochondritis symptoms including:
- Trauma to the area (eg. Direct fall/pressure or injury to the pec muscle)
- Intense exercise of the area
- A bout of illness with lots of coughing
Diagnosis methods
The condition is primarily diagnosed with clinical tests including:
- Palpation of the costochondral and costosternal joints (usually ribs 2-5)
- Assessment of thoracic, cervical and glenohumeral joint range
- Cough/sneeze/laugh test
- Deep breathing test
Scans would only be beneficial if you needed to rule out any of the below alternate diagnoses. Potentially a blood test would be beneficial if a multi joint inflammatory condition is suspected.
Examples of differential diagnosis
- Coronary artery disease (or other heart conditions acute or chronic)
- Pulmonary embolism or pneumothorax
- Rib fractures or subluxations
- Costovertebral sprain
- Tietze syndrome
- Pectoralis muscle injury
- Infections (e.g., pneumonia)
- Xiphoidalgia
Treatment
- A review with a physiotherapist can be helpful to accurately diagnose
- Ice over the joints or heat over the muscles
- Speak to your pharmacist regarding pain relieving medication
- Modification of aggravating activities
- Gentle massage to the neck, shoulder and chest muscles can be helpful in some cases
- Gentle stretches and strengthening exercises once the pain has reduced
If you believe you are suffering from costochondritis then book an appointment to see one of our friendly physiotherapists today!