Dr. Nitish Mandal
Costochondritis
Your ECG, echo, or TMT came back normal. The chest still hurts when you press the breastbone, take a deep breath, or move your arms. That can be costochondritis: chest-wall cartilage, not the heart.
What is costochondritis?
Costochondritis is the inflammation of the cartilage that connects a rib to the breastbone (sternum). This junction is known as the costosternal joint.
When this cartilage becomes inflamed due to strain, injury, or viral infections, it causes sharp chest pain that can mimic a heart attack.
Why does it happen?
- Physical strain: heavy lifting, strenuous exercise, or severe coughing.
- Posture: hunching over a computer or phone for long periods.
- Trauma: a blow to the chest or a car accident.
How it feels
- Sharp and stabbing pain, often on the left side of the breastbone.
- Tender to touch. If pressing on the ribs makes the pain worse, it is likely costochondritis.
- Pain that worsens with movement, deep breaths, coughing, or stretching the arms.
Diagnosis: the finger test
Diagnosis is primarily a physical examination. Imaging such as X-ray or MRI is usually done only to rule out other problems, because inflammation often does not show clearly on scans.
The clinician palpates the costosternal joints for tenderness.
If there is visible swelling along with the pain, it is classified as Tietze syndrome, a variant of costochondritis.
Why see a pain physician
This is for people who have already seen a cardiologist and had an ECG, echo, or TMT, all reported as normal, yet the pain remains.
Dr. Nitish Mandal (MD, FIPM, TIPM Nashville) focuses on the nerves, joints, and musculoskeletal structures that cause physical pain.
Costochondritis is a mechanical issue, not a heart issue. The clinics in Koramangala and J.P. Nagar use ultrasound-guided interventions when simple painkillers are not enough.
Treatment options
What you may already have tried
- NSAIDs, ice, or heat to reduce acute inflammation.
- Posture correction, which helps prevent the pain from coming back.
- Stretching, including gentle expansion of the pectoralis muscles.
When pills fail
- Ultrasound-guided micro-injections of local anaesthetic and steroid at the inflamed joints.
- Ultrasound-guided parasternal blocks and intercostal nerve injections.
Frequently asked questions
- Does costochondritis show up on an ECG?
- No. Costochondritis is a musculoskeletal issue of cartilage and bone. It does not affect the heart's electrical activity, so an ECG will appear normal.
- How long does costochondritis last?
- It can last from a few weeks to several months. Without treatment, it can become chronic and last over a year.
- Is costochondritis dangerous?
- It is not life-threatening. The anxiety it causes, and restricted breathing due to pain, can still affect quality of life.
Heart, gastric, or costochondritis?
| Feature | Heart attack | Acid reflux | Costochondritis |
|---|---|---|---|
| Type of pain | Squeezing, heavy pressure, crushing | Burning sensation rising up the throat | Sharp, stabbing, aching |
| Location | Centre or left chest, may radiate to jaw or arm | Below the breastbone (epigastric) | Localised to the rib joints near the breastbone |
| Triggers | Physical exertion, stress | Spicy food, lying down after eating | Touching the area, moving arms, coughing |
| Effect of pressure | Pressing the chest does not change the pain | Pressing usually feels uncomfortable but not sharp | Pressing the spot reproduces the exact pain |
| ECG result | Abnormal changes | Normal | Normal |
Not everyone needs an injection. The first visit is to confirm that the pain is coming from the chest wall, then choose care that fits.
Page chat
Ask about costochondritis
The questions on this page, with answers taken from the same details shown above.
Chat
Pain clinic
Typically replies on WhatsApp
My ECG is normal but my chest still hurts.
That can be costochondritis: inflammation of the cartilage that connects a rib to the breastbone. Pressing the tender spot typically reproduces the exact pain.
How is it treated if pills fail?
Ultrasound-guided injections, parasternal blocks, and intercostal nerve injections at Koramangala and J.P. Nagar.