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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]
Chest pain is pain or discomfort in the chest, typically the front of the chest. [1] It may be described as sharp, dull, pressure, heaviness or squeezing. [ 3 ] Associated symptoms may include pain in the shoulder, arm, upper abdomen , or jaw, along with nausea , sweating, or shortness of breath .
The underlying cause is unclear. Some believe the pain may be from the chest wall or irritation of an intercostal nerve. [1] [2] Risk factors include psychological stress. [2] The pain is not due to the heart. Diagnosis is based on the symptoms. Other conditions that may produce similar symptoms include angina, pericarditis, pleurisy, and chest ...
The neurogenic type is the most common and presents with pain, weakness, paraesthesia, and occasionally loss of muscle at the base of the thumb. [1] [2] The venous type results in swelling, pain, and possibly a bluish coloration of the arm. [2] The arterial type results in pain, coldness, and pallor of the arm. [2]
Physical examination consists of gentle pressure to the chest wall with a single finger to identify the location of the discomfort. [2] Swelling and tenderness upon palpation at one or more of the costochondral, sternocostal, or sternoclavicular joints, is a distinctive trait of Tietze syndrome and is considered a positive diagnosis when found ...
Slipping rib syndrome is often confused with costochondritis and Tietze syndrome, as they also involve the cartilage of the thoracic wall. Costochondritis is a common cause of chest pain, consisting of up to 30% of chest pain complaints in emergency departments.
The third mechanism occurs when the chest is compressed from front to back, causing it to widen from side to side. [10] The lungs adhere to the chest wall because of the negative pressure between them and the pleural membranes lining the inside of the chest cavity; thus when the chest widens, they are pulled apart. [10]
The pleural space is maintained in a constant state of negative pressure (in comparison to atmospheric pressure). If the chest wall, and thus the pleural space, is punctured, blood, air or both can enter the pleural space. Air and/or blood rushes into the space in order to equalise the pressure with that of the atmosphere.