Enhanced Verifiable CPD from the
University of Birmingham

Dentaljuce Shorts: 500 words, 10 MCQs, on general medicine and surgery.


Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral (rib to cartilage) and sternocostal (cartilage to sternum) joints. This condition predominantly affects women over the age of 40 but is also common among adolescents presenting with chest pain. Costochondritis is a common cause of chest pain in emergency departments, accounting for approximately 30% of such cases.


Costochondritis typically presents unilaterally, usually on the left side, affecting the 2nd to 5th ribs at the sternocostal and costochondral joints. The primary symptom is chest pain, which is often exacerbated by movement and deep breathing. This pain can be sharp, aching, dull, or pressure-like and may radiate to the shoulder, arm, front neck, or scapula.

The condition usually develops gradually following repetitive coughing, strenuous physical activity, or trauma to the chest. Symptoms can last from weeks to months, with some refractory cases persisting for over a year. Unlike Tietze syndrome, costochondritis does not present with heat, erythema, or swelling of the affected area. Signs such as tachycardia, hypotension, shortness of breath, fever, nausea, or a productive cough are unrelated to costochondritis and warrant further investigation.

The costal cartilages
The costal cartilages


The exact cause of costochondritis is unknown. It is believed to result from repetitive minor trauma, with risk factors including strenuous coughing, exercise, and lifting. In rare cases, infection of the costosternal joint by organisms such as Actinomyces, Staphylococcus aureus, Candida albicans, Salmonella, or Escherichia coli can cause costochondritis.


Costochondritis is predominantly diagnosed clinically based on physical examination, medical history, and ruling out other conditions. A physical exam will assess for tenderness or pain upon palpation, with an absence of heat, erythema, or swelling. Movements of the upper body or breathing that worsen the pain help to confirm the diagnosis. The crowing rooster manoeuvre, the hooking manoeuvre, or the horizontal flexion manoeuvre can reproduce the pain for further confirmation.

Differential Diagnosis

  • Cardiopulmonary: Acute coronary syndrome, aortic dissection, pneumothorax, pulmonary embolism, myocardial infarction, angina, pericarditis.
  • Musculoskeletal: Tietze syndrome, slipping rib syndrome, painful xiphoid syndrome, muscle strain, myofascial pain syndrome, thoracic disc herniation, rib fracture.
  • Other: Fibromyalgia, SAPHO syndrome, ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis, neoplasms, myelomatous pleural effusion, pleuritis, precordial catch syndrome, pneumonia, anxiety disorders, panic disorders, hyperventilation syndrome, gastroesophageal reflux disease, esophagitis, herpes zoster, Bornholm disease, vitamin D deficiency, cocaine use.
Anatomy of the costal cartilage
Anatomy of the costal cartilage


Costochondritis is usually self-limited and will resolve on its own. Initial treatment often involves conservative methods such as rest, pain relief medications (e.g., acetaminophen, NSAIDs like ibuprofen or naproxen), and the use of heat or ice compresses. Creams and patches containing compounds like capsaicin, NSAIDs, or lidocaine may also be beneficial.

Manual therapy methods such as myofascial release, muscle energy techniques, balanced ligamentous tension (BLT), rib mobilisation techniques, and stretching exercises can aid in recovery. Educating patients about body mechanics, posture, and activity modification is also important.

In severe cases where symptoms persist for a year or longer, corticosteroids or local anaesthetic injections may be considered.

Muscles of the thoracic wall
Muscles of the thoracic wall


Costochondritis is a common condition responsible for 13–36% of acute chest pain-related concerns among adults, depending on the setting, and 14–39% among adolescents. It primarily affects individuals over the age of 40 and is more common in women than men.

Self-assessment MCQs (single best answer)

Which of the following joints are primarily affected in costochondritis?

Costochondritis predominantly affects which demographic?

What is the primary symptom of costochondritis?

Which of the following is NOT typically associated with costochondritis?

Which organisms can rarely cause infectious costochondritis?

Which of the following is a typical conservative treatment for costochondritis?

In severe cases of costochondritis that persist for over a year, what treatment might be considered?

Which of the following manoeuvres is used to reproduce pain for confirming the diagnosis of costochondritis?

Which condition is NOT a differential diagnosis for costochondritis?

What percentage of acute chest pain cases in emergency departments are attributed to costochondritis?


Dentaljuce provides Enhanced Continuing Professional Development (CPD) with GDC-approved Certificates for dental professionals worldwide.

Founded in 2009 by the award-winning Masters team from the School of Dentistry at the University of Birmingham, Dentaljuce has established itself as the leading platform for online CPD.

With over 100 high-quality online courses available for a single annual membership fee, Dentaljuce offers comprehensive e-learning designed for busy dental professionals.

The courses cover a complete range of topics, from clinical skills to patient communication, and are suitable for dentists, nurses, hygienists, therapists, students, and practice managers.

Dentaljuce features Dr. Aiden, a dentally trained AI-powered personal tutor available 24/7 to assist with queries and provide guidance through complex topics, enhancing the learning experience.

Check out our range of courses, or sign up now!

Membership Options

Dentaljuce offers a range of membership options…

Regular Membership

With enhanced CPD Certificates. Dentaljuce is brought to you by the award winning Masters team from the School of Dentistry, University of Birmingham, UK. All have won awards for web based learning and teaching and are recognised as leaders and innovators in this field, as well as being highly experienced clinical teachers. Full access to over 100 courses, no extras to pay.

Buy Now

£89.00 per year

Student Membership

No Certificates. With universities cutting down on traditional lectures, many students are currently having to rely more on online resources. If you don't need CPD Certificates, we are offering an amazing discount on your Dentaljuce personal membership fee. Special student price just £29 for 12 months individual membership.

Buy Now

£29.00 per year

I couldn't manage now without Dentaljuce.
(AH - BDS Student)

© Dentaljuce 2024 | Terms & Conditions | Privacy Policy

Recording CPD time: recorded.