Costochondritis, also known as chest wall pain or Tietze syndrome, is an inflammation of the cartilage that connects the ribs to the breastbone (sternum). This inflammation causes intense chest pain that can radiate to the back, abdomen, or arms. Costochondritis flares are episodes of worsening pain and tenderness that can last for days or weeks before settling down again.
What are the main symptoms of a costochondritis flare?
The primary symptom of a costochondritis flare is a sudden worsening of chest pain on one or both sides. This pain is often described as sharp, aching, or pressure-like. It can range from mild discomfort to severe pain. Other common symptoms include:
- Chest tenderness – The chest wall is sore and tender to touch.
- Difficulty taking deep breaths – Breathing deeply exacerbates the pain.
- Radiating pain – Pain that radiates to the back, abdomen, shoulders, arms, or neck.
- Stabbing pain – Brief, sharp pains that feel like a knife stabbing the chest.
In addition to chest pain and tenderness, flares may also cause difficulty sleeping, anxiety, and reduced ability to carry out daily activities. The symptoms are often worse with movements like bending, twisting, stretching, or lifting objects.
What causes a flare up?
Doctors don’t know the exact cause of costochondritis, but flares are often triggered by:
- Injury – Any trauma or injury to the chest wall from an accident, sports, or physical exertion.
- Infection – Viral or bacterial respiratory infections.
- Stress and anxiety – Increased muscle tension from emotional stress.
- Arthritis – Inflammatory types like rheumatoid arthritis or ankylosing spondylitis.
- Overuse – Repetitive movements that strain the chest muscles.
- Weather changes – Cold weather or changes in barometric pressure.
Once you have costochondritis, these triggers can set off a flare at any time. Even mild physical activities may be enough to make your pain suddenly spike after a period of calm.
How long does a flare last?
For most people, a flare lasts between a few days and a couple of weeks. The duration and severity can vary widely between individuals. Some people only get mild flares that last a few days. For others, the intense pain and disability can persist for several weeks at a time before quieting down. Recurrent flares are common.
Acute flare
An acute flare often begins quite suddenly, even waking you from sleep. The pain builds rapidly over several hours and peaks on the first day. It remains severe for 2-5 days before starting to settle. An acute flare may be triggered by injury or over-exertion.
Slow-burn flare
A slow-burn flare develops gradually over several days or weeks. The pain starts mild but persists and slowly intensifies. It plateaus at moderate to severe pain for 1-2 weeks before easing. Slow-burn flares are more common and may arise from ongoing inflammation.
Chronic flare
A chronic flare occurs when acute episodes repeatedly reoccur. You get brief 1-2 week respites between flares. The chest never fully recovers between bouts. Chronic flares indicate an ongoing costochondritis problem that needs proper treatment.
What does the pain from costochondritis feel like?
People often describe the chest pain as:
- Sharp, stabbing, or knife-like.
- Dull, aching, or pressure-like.
- Shooting or burning.
- Like a heavy weight on the chest.
The severity of pain can range from mild to excruciating. It may be localized in a small area or spread across a larger section of your chest. The pain can switch between sharp and dull. It typically gets worse with deep breathing, coughing, movement, and touching the chest.
Does it feel like a heart attack?
Costochondritis pain can mimic the chest pain of a heart attack. The symptoms overlap because the heart and sternum share nerves. However, costochondritis pain usually worsens with palpation while cardiac pain generally remains the same. A heart attack also causes other symptoms like shortness of breath, sweating, nausea, and arm pain.
Where does the pain radiate?
Costochondritis affects the cartilage joints connecting the sternum (breastbone) to the ribs. As a result, the pain usually radiates to areas near the inflamed joints such as:
- Upper and mid back
- Abdomen
- Shoulders and shoulder blades
- Arms
- Neck
It rarely spreads below the solar plexus. Referred pain follows the distribution of nerves from the inflamed costal cartilage. It may feel like it’s coming from these other areas, but the true source is the ribs.
What does chest wall tenderness feel like?
Costochondritis also causes chest wall tenderness. Even light touch or pressure over the ribs and sternum elicits pain. Activities like hugging, lying on your side, or wearing tight clothes can become uncomfortable.
Pressing on the ribs feels sore and tender. Firm pressure suddenly intensifies the ache. Costochondritis tends to cause point tenderness – specific spots hurt more than the surrounding areas.
How does costochondritis affect breathing?
Breathing, particularly deep inhalation, tends to aggravate costochondritis pain. Taking a deep breath causes a sharp stab or spike in the level of pain. As a result, people subconsciously limit their breathing during flares. This can leave you feeling short of breath.
The pain may cause some muscles between the ribs to tighten up and spasm. This also restricts breathing. Shallow “chest” breathing is less painful than “belly” breathing during an episode. Exhaling is usually more comfortable than inhaling.
Can the pain interfere with sleep?
Severe flares often disrupt sleep. Chest pain can prevent you from getting comfortable enough to fall asleep. It may wake you from sleep when rolling onto the affected side or during a coughing/sneezing fit.
Pain-induced anxiety and inability to take deep breaths also impair sleep quality. Exhaustion from inadequate rest worsens mood, concentration, and fatigue the next day. Those with chronic flares may develop insomnia.
When should I seek emergency care?
Seek immediate medical care if you experience:
- Sudden, crushing chest pain
- Pain spreading to the arms, back, neck, or jaw
- Shortness of breath
- Lightheadedness, dizziness, or passing out
- Nausea, sweating, or a cold sweat
While unlikely, it’s important to rule out a heart attack or pulmonary embolism when chest pain strikes. Better safe than sorry. Call an ambulance or have someone drive you to the ER.
What tests help diagnose costochondritis?
As there are no definitive tests for costochondritis, doctors mainly use other testing to rule out other causes of chest pain like:
- Blood tests – To check for inflammation or cardiac enzymes that would indicate a heart attack.
- Electrocardiogram (ECG) – To look for heart rhythm abnormalities or cardiac ischemia.
- Chest X-ray – To check for rib fractures, lung disease, or tumors.
- CT scan – To visualize the chest structures in detail.
- Cardiac stress testing – To check if pain worsens with exertion due to heart problems.
If these tests are normal, then costochondritis becomes the most likely diagnosis.
What are the treatment options for flares?
Treatment aims to relieve pain and inflammation during flares. Options may include:
- NSAIDs – Non-steroidal anti-inflammatory drugs like ibuprofen or naproxen.
- Heat and cold therapy – Warm compresses or cold packs applied to the chest.
- Rest – Avoiding strenuous physical activities and movements that trigger pain.
- Posture correction – Improving posture decreases strain on the chest.
- Physical therapy – Stretching and strengthening exercises to increase mobility.
During severe flares, prescription muscle relaxants or stronger painkillers may be needed temporarily. Injecting the numbing medication lidocaine into the sore costochondral joints can sometimes provide rapid relief.
How can I prevent future flares?
You may be able to reduce the frequency and intensity of flares by:
- Avoiding triggers like overexertion, respiratory infections, and stress.
- Using proper body mechanics and modifying activities.
- Doing regular low-impact exercise to build strength.
- Taking over-the-counter anti-inflammatories.
- Trying supplements like glucosamine, turmeric, or magnesium.
- Using hot and cold therapy preventatively.
- Practicing stress-reduction techniques.
- Getting enough rest between bouts of activity.
While some flare-ups are inevitable, these self-care measures can help reduce their impact. Let your doctor know if they become frequent or severe despite preventive efforts.
What is the long-term outlook with costochondritis?
With proper treatment, most people see a significant improvement in pain and flares within 6 to 12 weeks. However, costochondritis often follows a pattern of flaring and remission. Recurrences are common even after the initial bout resolves.
A minority of patients end up with chronic costochondritis leading to persistent chest pain. This causes ongoing impairment and disability. Aggressive anti-inflammatory treatment and physical therapy are key to avoid complications.
While annoying, costochondritis itself is not dangerous or life-threatening. However, severe flares can greatly impact quality of life. Seeking prompt treatment allows you to manage the episodes better and get back to normal function.
Conclusion
Costochondritis flares involve variable periods of worsening chest pain, tenderness, and breathing difficulty. The stabbing, aching pain may mimic a heart attack but is not life-threatening. While often triggered by overexertion, infections, or stress, flares can arise spontaneously. Rest, pain relief, and avoiding exacerbating factors comprise the main treatment during acute episodes. With a thoughtful, multi-pronged approach, many patients achieve adequate control of their costochondritis symptoms.