Chest pain on breathing – Costosternal Syndrome

Chest pain can be a scary symptom, with many jumping towards the conclusion of heart disease. Whilst heart disease is a condition definitely not to be ignored, costosternal syndrome is a very common condition that can cause pain similar to that experienced during a heart attack.

Costosternal syndrome is the inflammation of one or more of the costochondral junctions of the ribs or chondrosternal joints, usually at multiple levels, which causes tenderness and pain on the anterior chest wall. It does not have swellings nor induration. It is also known by other names such as parasternal chondrodynia, costochondritis or anterior chest wall syndrome.¹

Tietze syndrome is a similar disorder that is frequently confused with costosternal syndrome. However, it is rarer than costosternal syndrome and involves the swelling of a single costal cartilage, usually of the second rib.¹

Costosternal syndrome is one of the most common causes of chest wall pain and is more prevalent in females compared to males. It occurs in both adults and children, but has a higher prevalence in people 40 years and older.² It is a poorly understood syndrome as it usually has no clear cause. Theoretically, the cartilage is irritated or torn therefore leads to inflammation and pain. Direct trauma, such as motor vehicle accidents, heavy lifting or aggressive exercise can strain the joint.³ Coughing from being ill or respiratory infections can also cause strain in this joint.²

Pain in the chest wall is the main symptom of costosternal syndrome. It is sharp, aching, or pressure-like, and differs in intensity. it can appear in more than one location, but is usually located on only one side of the body at a time.¹ It is worse when coughing, sneezing, lying prone, deep inspirations and movements affecting the ribcage, such as moving the arm.^2,4

Using heating pads or heat with compresses is recommended, particularly so in cases involving the overuse of muscle.¹ This condition usually resolves in weeks to months. It is highly recommended to avoid aggravating activities that may provoke the symptoms.¹ Certain muscle stretching exercises have also been shown to be effective in improving the condition.⁵

A chiropractor may help to relieve some pain through the careful adjustment of certain joints in the chest. There has been an increasing amount of research linking chiropractic adjustments with an improved reduction of chest pain, including improvements in non-musculoskeletal symptoms such as vision and circulation.^6,7 It is important to distinguish costosternal syndrome from heart disease and other causes . For more information, you can contact allied health professional.

1. Proulx AM, Zryd TW. Costochondritis: Diagnosis and treatment. Am Fam Physician [serial on the Internet]. 2009 [2016 Jul 28];80(6):617-20. Available from: http://www.aafp.org/afp/2009/0915/p617.html
2. Melssen MC. Encyclopedia of sports medicine [e-book]. Middletown (US): American Library Association dba CHOICE; 2011 [2016 Jul 28];48(10):1881. Available from: ProQuest
3. Mayo Clinic Staff. Costochondritis [article on the Internet]. Mayo Clinic; 2015 [2016 Jul 28]. Available from: http://www.mayoclinic.org/diseases-conditions/costochondritis/basics/definition/con-20024454
4. Winzenberg T, Jones G, Callisaya M. Musculoskeletal chest wall pain. Aust Fam Physician [serial on the Internet]. 2015 [2016 Jul 28];44(8):540-4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1346531/?page=4
5. Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon [serial on the Internet]. 2009 [2016 Jul 28];31(2):169-71. Available from: https://www.researchgate.net/publication/38009768_Stretching_exercises_for_costochondritis_pain
6. Leboeuf-Yde C, Axén I, Ahlefeldt G, Lidefelt P, Rosenbaum A, Thurnherr T. The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. J Manipulative Physiol Ther. 1999;22(9):559. doi:10.1016/S0161-4754(99)70014-X
7. Polkinghorn BS, Colloca CJ. Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures. J Manipulative Physiol Ther. 2003;26(2):108-15. doi:10.1067/mmt.2003.8

Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should contact your own physician or other qualified health can provider with any questions you may have regarding your condition. Do not disregard professional medical advice or delay seeking it based on information from this content. Relying on information provided by this content is done at your own risk. Although the authors have made every effort to provide the most up-to-date evidence-based health information, this content should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations.