Pain in my sternum when i take a deep breath

Overview

Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions.

Costochondritis is sometimes known as chest wall pain syndrome, costosternal syndrome or costosternal chondrodynia. Sometimes, swelling accompanies the pain (Tietze syndrome).

What causes costochondritis is unclear. Treatment focuses on easing the pain while waiting for the condition to improve on its own, which can take several weeks or more.

Symptoms

The pain associated with costochondritis usually:

• Occurs on the left side of your breastbone
• Is sharp, aching or pressure-like
• Affects more than one rib
• Can radiate to arms and shoulders
• Worsens when taking a deep breath, coughing, sneezing or with any chest wall movement

When to see a doctor

For chest pain, seek emergency medical attention to rule out life-threatening causes such as a heart attack.

Causes

Costochondritis usually has no clear cause. However, costochondritis might be associated with trauma, illness or physical strain, such as severe coughing.

Risk factors

Costochondritis occurs most often in women older than 40.

Tietze syndrome usually occurs in teenagers and young adults, and with equal frequency in men and women.

May 11, 2022

1. Ferri FF. Costochondritis. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed Jan. 20, 2022.
2. Phillips K, et al. Management of isolated musculoskeletal chest pain. https://www.uptodate.com/contents/search. Accessed Jan. 20, 2022.
3. Frontera WR, et al. Costosternal syndrome. In: Essentials of Physical Medicine and Rehabilitation. 4th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Jan. 24, 2022.
4. Wise CM. Major causes of musculoskeletal chest pain in adults. https://www.uptodate.com/contents/search. Accessed Jan. 20, 2022.

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Overview

What is costochondritis?

Costochondritis is a harmless swelling (inflammation) of cartilage in your chest. The cartilage connects your ribs to your breastbone (sternum), creating the costochondral joint. Costochondritis feels like a sharp or aching pain. The pain can start suddenly or develop slowly and spread across your chest.

Because the pain is in your chest, you might misinterpret costochondritis as a heart attack.

How common is costochondritis?

Costochondritis is a common diagnosis in people with chest pain. One study revealed that 30% of people who go to the emergency department with chest pain are diagnosed with costochondritis.

Who is at risk for costochondritis?

Adults (especially people assigned female at birth) older than 40 are at a higher risk for costochondritis.

In adolescents aged 12 to 14, costochondritis accounts for 10% to 30% of chest pain complaints.

Is costochondritis contagious?

No, costochondritis isn’t contagious. The condition can’t be spread from you to another person.

Is costochondritis life-threatening?

No, costochondritis isn’t life-threatening. It’s common for the chest pain to be misinterpreted as a heart attack. But costochondritis is not fatal. Treatments are available to help you heal from this condition.

Symptoms and Causes

What causes costochondritis?

It’s not completely clear what causes costochondritis, but experts note that this condition can be triggered if you:

• Cough too hard.
• Get a respiratory tract infection.
• Exercise too much.
• Exert yourself in a rare way, like moving furniture or reaching into a high cupboard.
• Injure your chest.
• Use your arms too much.
• Have a bacterial infection.
• Have a fungal infection.

Costochondritis is sometimes a sign of other conditions that affect your cartilage like:

• Osteoarthritis.
• Ankylosing spondylitis.
• Rheumatoid arthritis.

Rarely, there may be a tumor in your chest.

What are the symptoms of costochondritis?

If you have costochondritis, you’ll feel pain that may start on the left side of your chest and spread (radiate) out to the rest of your chest. Sometimes the pain spreads to your stomach and your back.

What makes costochondritis worse?

You may notice that your costochondritis pain worsens when:

• There’s something pressing against your chest, like a seatbelt or when you’re hugging someone.
• You’re breathing deep.
• You’re sneezing or coughing.
• You’re physically active.
• You’re lying down.

Diagnosis and Tests

How is costochondritis diagnosed?

Diagnosing costochondritis starts with a process of elimination. When you go to your healthcare provider with chest pain, they’ll immediately test for:

• Heart and vascular problems, like a heart attack.
• Lung problems, like pneumonia.
• Digestive issues, like chronic acid reflux (also called gastroesophageal reflux disease or GERD).
• Musculoskeletal issues, like a broken rib.

Your healthcare provider may also talk to you about your mental/emotional health because stress, anxiety and panic attacks can cause chest pain.

Your healthcare provider will make a diagnosis of costochondritis based on your symptoms and their physical findings. Normally, there is no need for further testing.

Management and Treatment

How is costochondritis treated?

Remember that you should always see a healthcare provider if you’re experiencing chest pain. It’s vital to get the right diagnosis so you can receive the best treatment.

Your healthcare provider might first recommend over-the-counter medications that can help reduce the swelling and pain in your chest. Medications include:

• Ibuprofen (Advil®, Motrin®).
• Naproxen (Aleve®).
• Acetaminophen (Tylenol®).

Take one dose two to three times per day, or as your healthcare provider recommends.

If those don’t help with your pain and swelling, your healthcare provider may prescribe:

• Corticosteroids, an anti-inflammatory injection.
• Transcutaneous electrical nerve stimulation (TENS). TENS is a small device that uses electric currents to treat pain.

Do I need to see a specialist about costochondritis?

If needed, your primary healthcare provider may refer you to a rheumatologist (a physician who specializes in diseases of the muscles, bones and joints) or a surgeon.

Do I need surgery for costochondritis?

Surgery for costochondritis is rare. Sometimes, if other treatments aren’t successful, your surgeon may remove cartilage. A surgery that removes cartilage is called a chondrectomy.

What are the at-home treatments for costochondritis?

There are ways you can help reduce symptoms of your costochondritis at home. Suggestions include:

• Take over-the-counter medications.
• Get plenty of rest.
• Hold an ice pack against your chest.
• Place a heating pad or warm washcloth on your chest.

Does diet play a role in recovering from costochondritis?

Although you might be willing to try anything to reduce the pain or speed your recovery from costochondritis — even make changes to your diet — there’s really nothing you eat or drink that affects how you heal from costochondritis.

What happens if I don’t get treatment for costochondritis?

In most instances, costochondritis heals with or without treatment. Your healthcare provider may recommend medications and treatments that help with your pain and swelling.

Remember that you shouldn’t automatically assume that your chest pain is costochondritis. If you have severe chest pain, you should go to the emergency department for treatment. Don’t wait to see if it just goes away.

How long does costochondritis last?

Costochondritis isn’t permanent, but it can last for several months. Sometimes it can return again after it heals.

Prevention

Can costochondritis be prevented?

There isn’t any one cause of costochondritis. Some of the causes might be preventable, while others might not be. For example, you can do your best to avoid exercising too much or coughing too hard. But, you may not be able to avoid costochondritis caused by an injury to your chest during a car crash.

What medications may reduce my risk of costochondritis?

Injury and infection, the common causes of costochondritis, can’t be prevented with medications.

Can my diet help prevent costochondritis?

Diet doesn’t prevent costochondritis. There’s nothing you can eat or drink that can reduce your risk.

Outlook / Prognosis

What’s the outlook for people with costochondritis?

You may have costochondritis for several months. It’s not permanent or harmful pain. Treatments can help relieve your symptoms.

Can costochondritis go away on its own?

Yes, costochondritis generally goes away on its own. But it can take several months. Take good care of yourself and get enough rest until your symptoms go away.

When can I get back to my normal daily activities?

Costochondritis shouldn’t prevent you from doing your normal activities, although the sharp or heavy pain may make you uncomfortable.

Can costochondritis come back after it’s been treated?

Yes, costochondritis can come back after it heals. This is called a relapse.

Living With

When should I contact my healthcare provider?

See your healthcare provider immediately if you’re experiencing chest pain.

If you’ve been diagnosed with costochondritis, contact your healthcare provider if your pain gets worse or doesn’t get any better with treatment.

When should I go to the emergency department for costochondritis?

Always go to the emergency department if you have severe chest pain.

Also, call emergency services or go to the emergency department right away if you experience any of the following problems:

• Trouble breathing/shortness of breath, or if you stopped breathing for any reason.
• Any pain in your body that’s so severe that you can’t stand it.
• Injury to your head, neck or spine.
• Loss of consciousness (if you pass out/faint).
• Sudden weakness, especially if you can’t speak or move.
• Dizziness that doesn’t stop.
• A seizure that lasts longer than three to five minutes.
• Poisoning or an overdose.
• Severe allergic reaction.
• Coughing or throwing up blood.
• Heavy bleeding.
• High fever that doesn’t get better with medicine.
• Severe burn, electric shock or lightning strike.
• Stroke symptoms like slurred speech, numbness, weakness, loss of balance and/or vision problems.

What questions should I ask my healthcare provider about costochondritis?

• Do I need to see a rheumatologist?
• What pain medications should I take?
• Should I do TENS?
• Do I need surgery?

Frequently Asked Questions

Is costochondritis a type of cancer?

Chest pain can be frightening because it can be related to serious conditions. Some cancers, like lung cancer, can cause chest pain. Like costochondritis, the pain people experience when they have lung cancer gets worse when they cough. But, costochondritis isn’t a type of cancer.

Don’t hesitate to go to the emergency department if you have severe chest pain, though. You’ll want to know the cause of the pain so that you can get the best treatment.

What’s the difference between costochondritis and Tietze’s syndrome?

Costochondritis and Tietze’s syndrome are sometimes confused because they have similar symptoms. Two differences between them are:

• Tietze’s syndrome commonly affects adults under age 40. Costochondritis most commonly affects adults over age 40.
• Tietze’s syndrome causes visible chest swelling that continues after the pain is over. You can’t see the swelling caused by costochondritis.

Is costochondritis a symptom of COVID-19?

Both costochondritis and COVID-19 cause chest pain. If your chest pain is severe, you should go to the emergency department. Your healthcare provider will figure out whether the cause of your chest pain is costochondritis or something else.

Is costochondritis a symptom of fibromyalgia?

No, costochondritis and fibromyalgia are different conditions. People with fibromyalgia have long-lasting (chronic) muscle and joint pain all over their bodies. Costochondritis only causes pain in your chest, which sometimes travels to your back and stomach.

Are GERD and costochondritis related?

Gastroesophageal reflux disease (GERD) or chronic acid reflux is where your stomach acid flows up your esophagus and into your mouth. It causes heartburn, chest pain and acid indigestion. While costochondritis causes an aching, heavy or sharp pain, GERD is a burning pain.

Can you have costochondritis for years?

Costochondritis shouldn’t last long. Tell your healthcare provider if your chest pain lasts longer than a few weeks.

How should I sleep with costochondritis?

There’s no special way to sleep that helps with the pain from costochondritis. You may have to experiment with sleeping in different positions to see if lying one way or another is less painful.

Can costochondritis cause back pain?

Yes, the pain of costochondritis can sometimes spread (radiate) to your back. It may feel sharp or aching.

Can costochondritis cause nausea?

Nausea is not a symptom of costochondritis. Intense, aching or sharp chest pain are symptoms of costochondritis. The pain may get worse because of:

• Deep breathing.
• Physical activity.
• Sneezing.
• Coughing.
• Pressure against your chest from a hug, seatbelt, etc.

Remember that you should go to the emergency department if you have severe chest pain.

Can costochondritis cause trouble breathing?

Difficulty breathing is not a symptom of costochondritis, but it’s understandable if it feels difficult because of the chest pain, especially when that pain gets worse because of a deep breath or a cough. Go to the hospital immediately if you’re having trouble breathing. This is an emergency.

A note from Cleveland Clinic

Chest pain may be a very scary symptom. If your chest pain is severe, you should go to the emergency department to find out what’s causing it. It might be costochondritis or it might be a heart attack or some other serious condition. If it’s costochondritis, there’s no reason to worry. Costochondritis is a short-term swelling of the cartilage. Treatments are available to help reduce the pain associated with costochondritis while you heal.

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