Costochondritis and Musculoskeletal Chest Pain

Presentation

Patients, typically younger than age 40, present with a day or more of steady aching with intermittent stabbing chest pain. The pain may follow an episode of minor trauma, a period of frequent coughing, or unusual physical activity or overuse. The symptoms may be localized to the left or right of the sternum and may worsen when the patient takes a deep breath, changes position, twists at the torso, pushes or pulls against resistance, or reaches overhead. There may be associated anxiety about the etiology of the pain, but there is no associated nausea, vomiting, diaphoresis, or dyspnea, and most patients do not have significant cardiac risk factors. The middle anterior costal cartilages (connecting the ribs to the sternum) may be diffusely tender to firm palpation, without swelling or erythema, and exactly matching the patient’s complaint. There may be sites other than the sternal borders, such as the anterior ribs, xiphoid process, or thoracic spine that are the source of the patient’s pain. The rest of the physical examination is normal, along with normal vital signs that include pulse oximetry.