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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]
Conservative measures are often the first forms of treatment offered to patients with slipping rib syndrome, especially those in which symptoms are minor. [16] Often the patients will be reassured and recommended to limit activity, use ice, and take pain medication such as nonsteroidal anti-inflammatory drugs (NSAIDs). [ 4 ]
Costochondritis is most commonly confused with Tietze syndrome, as they have similar symptoms and can both affect the costochondral and sternocostal joints. Costochondritis is considered a more common condition and is not associated with any swelling to the affected joints, which is the defining distinction between the two.
In costochondritis and Tietze syndrome, inflammation of the costal cartilage occurs. [4] This is a common cause of chest pain. [5] Severe trauma may lead to fracture of the costal cartilage. [6] Such injuries often go unnoticed during x-ray scans, but can be diagnosed with CT scans. [6]
The McKenzie method is a technique primarily used in physical therapy.It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. [1] [2] [3] In 1981 he launched the concept which he called "Mechanical Diagnosis and Therapy (MDT)" – a system encompassing assessment, diagnosis and treatment for the spine and extremities.
The CVA is an anatomic concept of the relationship of the 12th rib to the transverse processes of the lumbar vertebrae. [1] 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]
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 .
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.