7 Key Symptoms of Costochondritis You Shouldn’t Ignore

Costochondritis is an inflammatory condition that affects the cartilage connecting your ribs to your breastbone (sternum). This condition can cause significant discomfort and anxiety, as the chest pain it produces can sometimes be mistaken for more serious cardiac issues. Understanding the symptoms of costochondritis is crucial for proper identification and seeking appropriate medical care. While it’s generally not a serious condition, recognizing its signs can help you differentiate it from other chest-related problems and provide peace of mind.

The condition typically affects the cartilage at the costosternal joint where your ribs attach to the sternum, though it can occur at any of these junctions. Women and people assigned female at birth tend to experience this condition more frequently than men, and it can affect people of all ages. In this comprehensive guide, we’ll explore the most common symptoms of costochondritis to help you better understand this condition.

1. Sharp Chest Pain or Sternum Pain

The hallmark symptom of costochondritis is sharp, aching pain in the chest area, particularly around the sternum or breastbone. This pain is the most recognizable feature of the condition and often the reason why people seek medical attention.

The pain characteristics include:

• Location: The discomfort typically occurs on the left side of the sternum but can affect either side or multiple areas of the chest wall
• Quality: Patients often describe it as a sharp, stabbing, or aching sensation that can range from mild to severe
• Intensity: The pain may start suddenly or develop gradually, and its severity can fluctuate throughout the day
• Duration: Episodes can last for minutes, hours, or even persist for several days or weeks

What makes this pain particularly concerning is that it can sometimes mimic the sensation of a heart attack, causing understandable anxiety. However, unlike cardiac pain, costochondritis pain is typically localized to specific points along the sternum and rib cage rather than radiating to the arm or jaw.

2. Tenderness When Pressing the Chest Wall

One of the most distinctive features of costochondritis is reproducible tenderness when pressure is applied to the affected area of the chest wall. This characteristic helps healthcare providers differentiate costochondritis from other causes of chest pain.

This symptom manifests as:

• Point tenderness: Specific spots along the sternum or rib joints that are particularly sensitive to touch
• Palpable pain: Pressing firmly on the affected costochondral junctions (where ribs meet the sternum) reproduces or worsens the pain
• Multiple tender points: Usually affects more than one rib junction, most commonly the second through fifth ribs
• Surface pain: The discomfort feels like it’s coming from the chest wall surface rather than deep within the chest cavity

This reproducible tenderness is actually a helpful diagnostic feature. If pressing on your chest wall causes the same pain you’ve been experiencing, it strongly suggests costochondritis rather than a cardiac or pulmonary problem. Healthcare providers often use this simple physical examination technique as a key part of their assessment.

3. Pain That Worsens With Movement or Deep Breathing

A defining characteristic of costochondritis is that the pain intensifies with certain physical activities and breathing patterns. This symptom can significantly impact daily life and help distinguish costochondritis from other chest conditions.

The pain typically worsens with:

• Deep breathing: Taking a full, deep breath often triggers sharp pain as the rib cage expands
• Coughing or sneezing: These sudden movements can cause acute stabbing sensations in the affected area
• Upper body movement: Twisting the torso, reaching overhead, or turning quickly can aggravate the pain
• Physical activity: Exercise, lifting objects, or carrying heavy bags may increase discomfort
• Lying in certain positions: Some sleeping positions, particularly lying on the affected side, can intensify symptoms

This movement-related pain occurs because these activities stress the inflamed cartilage at the costochondral junctions. The mechanical stress on already irritated tissue causes increased discomfort. Many people with costochondritis learn to modify their breathing patterns and movements to minimize pain, though this isn’t a long-term solution.

4. Pain Between Breasts in the Center of the Chest

For many people, especially women, costochondritis causes pain in the middle of the chest bone area, right between the breasts. This central chest pain is particularly common and can be quite alarming when it first occurs.

Characteristics of this centralized pain include:

• Midline location: The discomfort centers on the sternum itself, which runs down the middle of the chest between the breasts
• Variable radiation: While focused centrally, the pain may radiate slightly to either side along the rib attachments
• Pressure sensation: Some people describe it as feeling like pressure or tightness in the center of the chest
• Bra discomfort (in women): The band of a bra sitting across this area may cause increased pain or make existing pain more noticeable
• Position sensitivity: Leaning forward or backward may either relieve or worsen the central chest pain

This symptom is particularly significant for women experiencing costochondritis, as the pain between the breasts can cause concern about breast health or cardiac issues. It’s important to note that while the pain feels very real and can be quite uncomfortable, costochondritis affecting this area is generally benign and treatable.

5. Pain Under the Left Rib Cage

While costochondritis can affect any of the rib-sternum junctions, pain under the left rib cage is particularly common. This location of pain often causes the most anxiety because of its proximity to the heart.

This symptom presents as:

• Left-sided predominance: The left side of the chest is more frequently affected, though the right side can be involved as well
• Lower rib involvement: Pain often affects the fourth, fifth, or sixth ribs on the left side
• Frontal chest wall: The discomfort is typically felt in the front of the chest rather than radiating to the back, though some back discomfort may occur
• Discrete painful areas: You may be able to pinpoint exact spots under the rib cage that are most painful
• Breathing-related changes: The pain in this area often varies with respiratory movements

The location of this pain is significant because it can be confused with cardiac issues, particularly angina or heart attack symptoms. However, costochondritis pain under the left rib cage has distinct characteristics: it’s reproducible with palpation, worsens with chest wall movement, and doesn’t typically cause other cardiac symptoms like nausea, sweating, or shortness of breath unrelated to pain-limited breathing.

6. Pain That May Radiate to the Back or Abdomen

While costochondritis primarily affects the front of the chest, the pain can sometimes radiate to other areas, including the back and upper abdomen. This referred pain pattern can make diagnosis more challenging.

The radiation pattern includes:

• Back pain: Discomfort may extend from the chest around to the back along the rib line, though it remains primarily a chest wall issue
• Upper abdominal discomfort: Pain from the lower costochondral junctions can sometimes be felt in the upper abdomen, just below the rib cage
• Shoulder and arm awareness: While less common, some people report awareness or mild discomfort in the shoulder or arm area on the affected side
• Intercostal pain: Pain may follow the path of the ribs around the side of the body
• Variable patterns: The radiation pattern can change from day to day or with different movements

This radiating quality doesn’t mean the condition is spreading or worsening. Rather, it reflects the interconnected nature of the musculoskeletal system and how inflammation in one area can cause discomfort in adjacent or connected structures. The pain remains musculoskeletal in nature and doesn’t indicate involvement of internal organs.

7. Pain That Comes and Goes (Intermittent Pattern)

Costochondritis often follows an intermittent pattern, with symptoms flaring up and then subsiding. This characteristic waxing and waning of symptoms is typical of the condition and can sometimes make it frustrating to manage.

The intermittent pattern includes:

• Unpredictable flare-ups: Pain may suddenly worsen without obvious triggers, then improve spontaneously
• Good days and bad days: You might have periods of minimal discomfort followed by days of significant pain
• Trigger sensitivity: Certain activities or stresses may precipitate pain episodes, but not consistently
• Variable duration: Flare-ups can last hours, days, or occasionally weeks before subsiding
• Chronic recurring pattern: Some people experience complete resolution, while others have occasional recurrences over months or years
• Time of day variations: Pain may be worse at certain times, such as morning stiffness or evening fatigue

This intermittent nature is actually reassuring in that it indicates the condition is not progressively worsening. However, it can be challenging because the unpredictability makes it difficult to plan activities or know what to expect from day to day. Understanding that this pattern is normal for costochondritis can help reduce anxiety about the condition.

What Causes Costochondritis?

Understanding the underlying causes of costochondritis can help you identify potential risk factors and take steps to minimize recurrence. In many cases, however, the exact cause remains unknown, and the condition is classified as idiopathic costochondritis.

Physical trauma or injury: Direct impact to the chest from accidents, falls, or contact sports can injure the costochondral junctions, leading to inflammation. Even minor repeated trauma can contribute to the condition.

Repetitive strain or overuse: Activities that involve repeated upper body movements, heavy lifting, or strenuous exercise can strain the chest wall muscles and cartilage. This is particularly common in people who engage in intensive upper body workouts, rowing, or racquet sports.

Respiratory infections: Severe coughing from respiratory illnesses such as bronchitis, pneumonia, or even persistent colds can strain the costochondral junctions. The repeated forceful movement of coughing puts stress on these structures.

Arthritis conditions: Various forms of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis, can affect the costochondral joints and cause inflammation similar to costochondritis.

Fibromyalgia: People with fibromyalgia may be more susceptible to developing costochondritis as part of their widespread pain condition.

Poor posture: Prolonged poor posture, especially when sitting at a desk or computer for extended periods, can place abnormal stress on the chest wall structures, potentially contributing to inflammation.

Tumor (rare): In very rare cases, tumors in the chest area can cause symptoms similar to costochondritis, though this is uncommon.

Unknown factors: In many instances, costochondritis develops without any identifiable cause, making it an idiopathic condition.

Prevention Strategies

While it’s not always possible to prevent costochondritis, especially when the cause is unknown, there are several strategies that may help reduce your risk of developing this condition or experiencing recurrent episodes.

Practice good posture: Maintain proper posture while sitting, standing, and working. Ensure your workspace is ergonomically set up to support good positioning of your shoulders, back, and chest. Take regular breaks to stretch and change positions if you work at a desk.

Warm up before exercise: Always warm up properly before engaging in physical activity, particularly exercises involving the upper body. Gradually increase intensity rather than starting with strenuous movements that could strain the chest wall.

Use proper lifting techniques: When lifting heavy objects, use your legs rather than your upper body, keep the load close to your body, and avoid twisting motions. Don’t lift objects that are too heavy for you to handle safely.

Avoid overexertion: Listen to your body and avoid pushing through chest pain during exercise. Build up your activity levels gradually and allow adequate rest and recovery between intensive workouts.

Protect your chest: Wear appropriate protective equipment during contact sports or activities where chest trauma is possible. This includes proper padding and safety gear.

Manage respiratory infections promptly: Seek appropriate care for persistent coughs and respiratory infections. Managing coughing effectively can reduce strain on the chest wall.

Address underlying conditions: If you have arthritis or other inflammatory conditions, work with your healthcare provider to manage these conditions effectively, as good control may reduce the risk of costochondritis.

Strengthen supporting muscles: Gentle strengthening exercises for the chest, back, and shoulder muscles can provide better support for the costochondral structures. Consult with a physical therapist for appropriate exercises.

Maintain a healthy weight: Excess weight can place additional stress on the musculoskeletal system. Maintaining a healthy weight through balanced nutrition and appropriate physical activity can reduce this stress.

Frequently Asked Questions

How long does costochondritis last?

Costochondritis typically improves within a few weeks to several months. Some cases resolve in a few weeks, while others may persist for several months. In some individuals, symptoms may recur intermittently. The duration varies significantly from person to person.

Is costochondritis serious or dangerous?

Costochondritis is generally not a serious or life-threatening condition. While the chest pain can be alarming and uncomfortable, it doesn’t indicate heart problems or cause permanent damage to the chest structure. However, it’s important to have chest pain evaluated by a healthcare provider to rule out more serious conditions.

How can I tell if my chest pain is costochondritis or a heart attack?

Costochondritis pain is typically reproducible by pressing on the chest wall, worsens with movement or deep breathing, and is localized to specific points. Heart attack pain usually comes with additional symptoms like shortness of breath, nausea, sweating, and pain radiating to the arm or jaw. However, any new or severe chest pain should be evaluated immediately by medical professionals to rule out cardiac causes.

Can stress or anxiety cause costochondritis?

While stress and anxiety don’t directly cause costochondritis, they can make you more aware of chest sensations and may increase muscle tension in the chest wall, potentially aggravating symptoms. Anxiety can also cause chest tightness that may coexist with or be confused with costochondritis.

Why is costochondritis more common on the left side?

The exact reason why costochondritis tends to affect the left side more frequently isn’t fully understood. It may be related to the fact that people are more likely to notice and report left-sided chest pain due to concerns about the heart, or it could reflect biomechanical factors in how we use our bodies.

Can I exercise with costochondritis?

Gentle exercise is generally acceptable, but you should avoid activities that worsen your pain. High-impact activities, heavy lifting, and exercises that stress the chest wall should be limited until symptoms improve. Low-impact activities like walking may be better tolerated. Consult with your healthcare provider about appropriate activity levels for your specific situation.

Does costochondritis show up on X-rays or other imaging?

Costochondritis typically doesn’t show up on standard X-rays, CT scans, or MRI because it involves inflammation of cartilage and soft tissue rather than bone abnormalities. Diagnosis is usually made based on clinical symptoms and physical examination. Imaging may be used to rule out other conditions rather than to diagnose costochondritis itself.

Can costochondritis affect my breathing?

Costochondritis can make deep breathing painful, which may cause you to take shallow breaths to avoid discomfort. However, it doesn’t directly impair lung function or oxygen exchange. If you’re experiencing significant difficulty breathing or shortness of breath beyond pain-limited breathing, seek medical attention to rule out other conditions.

Is costochondritis contagious?

No, costochondritis is not contagious. It’s an inflammatory condition of the cartilage, not an infection that can spread from person to person.

When should I see a doctor for chest pain?

You should seek immediate medical attention if you experience severe chest pain, chest pain accompanied by shortness of breath, sweating, nausea, or pain radiating to your arm or jaw. Any new or unexplained chest pain should be evaluated by a healthcare provider. Even if you suspect costochondritis, proper medical evaluation is important to rule out more serious conditions and confirm the diagnosis.

References:

• Mayo Clinic – Costochondritis
• NHS – Costochondritis
• Cleveland Clinic – Costochondritis
• Johns Hopkins Medicine – Costochondritis
• MedlinePlus – Costochondritis