Amongst the sources of chest pain that we see in the pain clinic, a very common cause is a condition called costochondritis.
The ribs are not bone all the way round to the breastbone (sternum), and rather like what you see on a "spare rib", where there is a section of gristle on the end of the bony rib, we are similarly built. Our ribs are bone round to a line that runs down roughly in line with or just inside the nipple (in a man) and that then curves a little outwards over the lower ribs. Between these points and the sternum in the front the rib is more gristly (costal cartilage). The medical prefix for cartilage is chondr-. Sometimes, often for no obvious reason although sometimes because of trauma to the rib, the rib-cartilage junction (costochondral junction) can become sore or inflamed, sometimes with some swelling. This is called costochondritis. A variant of this is called Tietze's Syndrome.
Sometimes, in addition, the junction between the costal cartilage and the sternum (often at the lower end) can also become tender. This is sometimes called sternochondritis.
Very frequently, associated with costochondritis, people will develop trigger points in the muscles in the back, either between the shoulder blades or in the muscles just to the sides of the backbone, often just below where the bra strap in a woman sits (or the equivalent position in a man!).
In some cases, particularly when only a small number of costochondral junctions are painful, this may respond to local injection around the junctions of a small amount of local anaesthetic and locally acting steroid, using a very fine needle.
Costochondritis is further discussed very well in a page on the patient.co.uk site, which you can access here.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 15/02/2016