all information


(Tietze’s Syndrome)

Pronounced: COST-o-kon-DRY-tis

En Español (Spanish Version)


Costochondritis is a localized pain in the anterior (front) chest wall.

Occurring in patients of any age, costochondritis means pain at the junction of the bony and cartilaginous parts of a rib—usually the second, third, fourth, or fifth rib—that is highly localized. Sometimes, but not always, there is accompanying swelling and inflammation, a condition preferably referred to as Tietze’s syndrome. Neither costochondritis nor Tietze’s syndrome is a serious disease, but their symptoms mimic those of several dangerous conditions.

The Rib Cage


© 2008 Nucleus Medical Art, Inc.


There is no known specific cause, but several types of arthritis may affect the costochondral joints.

Risk Factors

The following factors increase your chance of developing costochondritis. If you have any of these risk factors, tell your doctor:


If you experience any of these symptoms, do not assume it is due to costochondritis. These symptoms may be caused by other, serious health conditions such as heart attack, digestive problems, and bone cancer . If you experience any one of them, see your physician.

  • Sharp, localized anterior chest pain, possibly radiating to the arm or shoulder and possibly aggravated by sneezing, coughing, deep breathing, or twisting motions of the chest
  • Tenderness or swelling over a costochondral joint (located on each rib, 1-2 inches on either side of the breast bone)


Your doctor will ask about your symptoms and medical history, and perform a physical exam. If the diagnosis is in doubt, tests to examine the ribs more closely and to rule out other conditions may include the following:

  • Chest x-ray—a test that uses radiation to take pictures of the chest
  • Blood tests
  • Electrocardiogram (ECG,EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle to evaluate the heart
  • Endoscopy or contrast x-rays of the esophagus and stomach—to look for digestive diseases. In endoscopy, a thin, lighted tube is inserted down the throat to examine the digestive system.
  • Bone scan—to look for cancer in the bones


Talk with your doctor about the best treatment plan for you. Once the diagnosis is confirmed and no serious condition is found, treatment is optional. Treatment choices include the following:

Hot or Cold Compresses

Often thermal treatments will provide satisfactory relief until the condition resolves itself.

Over-the-counter Analgesics

Your doctor may recommend aspirin, acetaminophen, ibuprofen, or naproxen.

Cortisone Injections

An injection of local anesthetic and cortisone directly into the sore joint often relieves the pain.

Intercostal Nerve Block

Very rarely the pain is sufficiently intense and prolonged to require numbing the area with a nerve block.


Costochondritis occurs spontaneously at any age, usually without warning or identified causes. There is no way to prevent it.


Fibromyalgia Symptoms

National Library of Medicine


Canadian Family Physician

Pain Health Info


Costochondritis. EBSCO Dynamed website. Available at: Accessed August 9, 2005.

Gilliland BC. Relapsing polychondritis and other arthritides. In: Isselbacher K, et al. Eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:1055-1064.

Last reviewed February 2008 by Ross Zeltser, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Your Health and Happiness