February 8, 2017

Costochondritis, also called Tietze’s Syndrome is an inflammation of the cartilage that attaches the inner end of the upper ribs to the flat bone in the middle of the chest (known as the sternum). Cartilage is a type of tissue that helps form many important body structures. For example, the ears are mostly made of cartilage.

Cartilages attach the ribs to the breastbone (sternum) and the sternum to the collarbones (clavicles). The joints between the ribs and the cartilages are called the costochondral joints. Those between the cartilages and the breastbone are called costosternal joints. Those between the sternum and the clavicles are called the sternoclavicular joints. The prefix ‘costo’ simply means related to the ribs. ‘Chondr-‘ means related to the cartilage and ‘-itis’ is the medical ending (suffix) that means inflammation. In costochondritis, there is inflammation in either the costochondral, costosternal or sternoclavicular joints (or a combination). This causes pain and tenderness, that tends to be worse with movement and pressure.

Most patients with costochondritis experience pain over the front of the chest (the area of the sternum). Costochondritis should only be diagnosed after excluding other more serious problems such as heart disease. Costochondritis pain is usually worsened by activity or exercise. Often the pain is worsened when taking a deep breath due to stretches of the inflamed cartilage. Pressing on the area can be extremely painful for the patient. Because of the many nerves that branch away from the chest, pain may be experienced in the shoulder or arms as well.

When called Tietze’s Syndrome, the pain from costochondritis is accompanied by redness and or swelling in the areas most tender.


The cause of costochondritis may be unknown, or it may be caused by any of the following –

Chest injury – An injury to your chest may cause costochondritis.

Strain – Activities that strain your chest wall muscles can lead to costochondritis. This includes hard coughing. Strain can also occur while you are playing sports with repeated arm movements, such as rowing, weightlifting, and volleyball.

Infection – Lung or chest infections can increase your risk of costochondritis.

Inflammatory diseases – Diseases that cause swelling around your joints, such as rheumatoid arthritis, increase your risk of costochondritis.

Risk Factors

There is no particular person more at risk of costochondritis than another. It does tend to affect younger people, especially teenagers and young adults. It can affect children. People performing repetitive movements that strain the chest wall, particularly if they are not used to it, might be considered more at risk of getting this condition. People with fibromyalgia tend to develop costochondritis more often than others. Fibromyalgia is a long-term (chronic) condition that causes widespread body pains and fatigue. (See separate leaflet called Fibromyalgia for more information.)

  • Race – A study indicates Hispanics may have an increased prevalence of costochondritis, but most studies do not mention race as a factor.
  • Sex – Studies of chest pain in children demonstrate that males and females are affected equally. There are no recent studies evaluating the effect of gender in costochondritis.
  • Age – No data support an association between age and costochondritis; the condition is well described in children of all ages, including infants.
  • Injury – A blow to the chest
  • Physical strain – Heavy lifting and/or strenuous exercise
  • Arthritis – In some people, costochondritis has been linked to specific problems, such as osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.
  • Joint infection – The rib joint itself can become infected by viruses, bacteria or fungi. Examples include tuberculosis, syphilis and aspergillosis.
  • Tumours – Non-cancerous and cancerous tumours also can cause costochondritis. Cancer may travel to the joint from another part of the body, such as the breast, thyroid or lung.


The main symptoms of costochondritis are pain and tenderness at the junction of the ribs and the breastbone. The pain increases with movement and deep breathing, and decreases with rest and quiet breathing. Pressure placed directly on the affected area will also cause significant pain.

The pain can vary in intensity but is often severe. It is often described as sharp, aching or pressure-like in nature. It is usually located on the front of the chest, but can radiate to the back, abdomen, arm or shoulder.

The pain usually occurs on only one side of the chest, most commonly the left, but can affect both sides of the chest at the same time.  Symptoms of costochondritis usually last for between one and three weeks.

Costochondritis is similar to a condition called Tietze syndrome, which affects the same area. However, with Tietze syndrome there is swelling as well as the pain and tenderness. Swelling is not a symptom of costochondritis.



  • Acetaminophen – This medicine decreases pain. Acetaminophen is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Acetaminophen can cause liver damage if not taken correctly.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.

Other Treatment

Rest – Affected person may need to rest and avoid painful movements and activities. Do not carry objects, such as a purse or backpack, if this causes pain. Avoid activities such as weightlifting until your pain decreases or goes away.

Heat – Heat helps decrease pain in some patients.

Ice – Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on the painful area for 15 to 20 minutes every hour or as directed.

Stretching exercises – Gentle stretching may help your symptoms.

Alternative Treatment

Acupuncture is a well known Chinese technique used to alleviate pain, especially bone and joint pains. Acupuncture is very useful in repeated episodes of costochondritis.

Glucosamine is naturally found in the cartilage of joints. Glucosamine sulfate is also found in the synovial fluid that surrounds all joints. Glucosamine supplements have shown the most promise in the treatment of osteoarthritis of the knee, but some feel it may have some benefit in the treatment of costochondritis.

Omega 3s – It is vitally important for a strong immune system and fighting inflammation.

An anti-inflammatory diet is recommended comprising of healthy and wholesome foods.  Salmon, sardines, herring, anchovies, flaxseed, hempseed and walnuts are a great source of anti-inflammatory Omega 3s. In addition, other anti-inflammatory fats include extra-virgin olive oil, avocado oil, flaxseed oil, hempseed oil and walnut oil.

Turmeric – A great natural pain reliever as well as being anti-inflammatory. Turmeric contains Curcumin and Curcuminoids which act in the same way as prescribed NSAIDs (non-steroidal anti-inflammatory drugs). Turmeric needs to be supplemented to reap the full benefits but can also be used topically and added to food.

Burdock Root – Burdock contains anti-inflammatory fatty oils and is great as a natural pain reliever.

Aloe Vera – Aloe Vera boosts the immune system and energy levels, providing the body with the right agents to restore and repair itself.

Refined carbohydrates are pro-inflammatory.

Vitamin D is integral for bone health, and severe deficiency can cause rickets in children and osteomalacia in adults. Although osteomalacia can cause severe generalized bone pain, there are only a few case reports of chest pain associated with vitamin D deficiency.

Noni fruit acts as an anti-inflammatory and is an excellent natural remedy for Costochondritis.  We have had reports from customers who have experienced rapid relief from Costochondritis in just a few days.  Two traditional names for Noni have been ‘painkiller tree’ and ‘headache’ tree. Research has show that noni is completely safe, and does not exhibit any toxic effects.

Serrapeptase also has anti-inflammatory properties and has had wide clinical use, spanning over twenty-five years throughout Europe and Asia.  It is a viable, natural alternative to salicylates, ibuprofen and the more potent NSAIDs. Unlike these drugs, Serrapeptase is a naturally occurring, physiologic agent with no inhibitory effects on prostaglandins and is devoid of gastrointestinal side effects.  Serrapeptase would also then be indicated as a natural remedy for Costochondritis.


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