Nursing Continue Education

Costochondritis -Reading and Sharing

Pathophysiology

Much of the chest wall consists of ribs and cartilage, which serve as an elastic bridge between the individual rib bones and also the sternum. Costochondritis is a condition of inflammation in the costochondral junctions of the ribs or chondrosternal joints, in the absence of swelling or induration, in the chest wall causing chest wall pain and tenderness (Proulx & Zryd, 2009).

Incidence and prevalence

Costochondritis can affect both children and adults and is a diagnosis that accounts for nearly thirty percent of adults who present to the hospital with chest pain (Proulx & Zryd, 2009). The condition occurs most often in women and adults over the age of forty (Mayo Clinic, 2011).

Physical assessment and examination

Upon physical examination of the patient, the pain will be reproducible with palpation of the chest wall near the affected cartilage and includes pain in more than one rib (Proulx & Zryd, 2009). If the patient is at high risk for cardiac issues, an EKG should be completed to rule out MI. If there are bony abnormalities in the chest wall, or rise and fall of the chest are not seen bilaterally, an x-ray should be ordered. Chest wall pain is often described as sharp, aching, or pressure and can increase intensity based on activity, palpation, or depth of inhalation (Proulx & Zryd, 2009). Assessment should include precipitating factors, such as a harsh cough, recent physical activity or lifting, or new upper body exercise (Proulx & Zryd, 2009). Palpation of the chest wall should be gentle and include the anterior, posterior, and lateral thoracic and lumbar area, as well as the cervical spine, clavicles, and shoulder (Proulx & Zryd, 2009). The clinician can also ask the patient to take a deep breath and hold it to see if the pain increased with inspiration, or ask the patient to move the arm or the affected side to see if the pain intensifies with upper body movement (Proulx & Zryd, 2009). Auscultation of the heart and lungs sound be completed to rule out adventitious sounds, as costochondritis itself will not be audible. The skin on the chest wall should also be examined to rule out skin rashes, irritation, or a painful skin irritation such as shingles (Proulx & Zryd, 2009). Routine lab testing is not necessary in most cases but can be ordered if there is an uncertain diagnosis or if an otherwise undiagnosed fever accompanies the chest wall pain.

Evidence-based treatment plan and patient education

Treatment of costochondritis focuses on comfort measures with analgesics and non-steroidal anti-inflammatory medications, based on each individual patient. This painful condition can last weeks to months and eventually resolves. Educate the patient on a trial of heat and cold therapy to see which of these provides more relief, and then proceed with that option three times per day as needed. Educate the patient to reduce physical activity in the upper body until the pain begins to diminish, particularly if upper body activity is an aggravating factor. For those patients who have a cough, anti-tussive cough medication can be purchased over the counter. For pain that persists past one month, referrals to PT with specific stretching exercises have been reported to produce perceived improvement in pain to some patients (Zaruba & Wilson, 2017).

Follow up and evaluation

Follow up should be done if the patient has ongoing chronic pain lasting longer than 1 month, or sooner with increasing pain, fever, or swelling (Mayo Clinic, 2011).

Reference:

Mayo Clinic. (2011). Costochondritis. Retrieved from www.HealthLetter.MayoClinic.com

Proulx, A.M. & Zryd, T.W. (2009). Costochondritis: Diagnosis and treatment. American Family Physician, 80(6), 617-620.

Zaruba, R.A. & Wilson, E. (2017). Impairment based examination and treatment of costochondritis: A case series. The International Journal of Sports Physical Therapy, 12(3), 458-467.

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