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Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral (rib to cartilage) and sternocostal (cartilage to sternum) joints. 90% of patients are affected in multiple ribs on a single side, typically at the 2nd to 5th ribs. [1]
The costochondral joints are the joints between the ribs and costal cartilage in the front of the rib cage. They are hyaline cartilaginous joints (i.e. synchondrosis or primary cartilagenous joint). Each rib has a depression shaped like a cup that the costal cartilage articulates with. There is normally no movement at these joints.
There is one CVA on each side of the spine. [2] The lateral part of the CVA is formed by the lower border of the 12th rib, and the medial part of the CVA is formed by the transverse processes of the lumbar vertebrae. [1] The CVA is distinct from the costovertebral joints. [2] The lower poles of the kidneys are within the CVAs. [1]
Costochondritis is a common cause of chest pain, consisting of up to 30% of chest pain complaints in emergency departments. The pain is typically diffused with the upper costochondral or sternocostal junctions most frequently involved, unlike slipping rib syndrome, which involves the lower rib cage.
Tietze syndrome typically presents unilaterally at a single joint of the anterior chest wall, with 70% of patients having tenderness and swelling on only one side, usually at the 2nd or 3rd rib. [ 2 ] [ 3 ] Research has described the condition to be both sudden [ 4 ] and gradual, varying by the individual.
Pain across the costal margin is most commonly caused by costochondritis. [ 6 ] The costal paradox , also known as Hoover's sign and the costal margin paradox , is a sign where the costal angle decreases upon inspiration rather than increasing, indicating chronic obstructive pulmonary disease .
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The prominent knobs of bone at the costochondral joints of rickets patients are known as a rachitic rosary or beading of the ribs.The knobs create the appearance of large beads under the skin of the rib cage, hence the name by analogy with the beads of a Catholic Christian rosary.