Costochondritis

1. What is Costochondritis? (Pathology)

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 mimics 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 (very common in Bangalore's tech population).

• Trauma: A blow to the chest or a car accident.

2. Symptoms: How to Identify It

Most patients describe the pain as:

• Sharp and Stabbing: Often located on the left side of the breastbone.

• Tender to Touch: This is the key differentiator. If you press on your ribs and the pain gets worse, it is likely costochondritis.

• Worsens with Movement: Deep breaths, coughing, or stretching the arms can trigger a spike in pain.​​​ 

3. Diagnosis: The "Finger Test"

We diagnose Costochondritis primarily through a physical examination. Imaging (X-ray, MRI) is usually done only to rule out other problems (like fractures or tumors), as inflammation often does not show up clearly on scans.

What we look for:

• Tenderness: We palpate the costosternal joints.

• Tietze Syndrome check: If there is visible swelling along with the pain, it is classified as Tietze Syndrome (a variant of costochondritis).

4. Why See a Pain Physician for Chest Pain?

"If you are reading this, you have likely already seen a cardiologist. You’ve had an ECG, an Echo, and maybe even a TMT—all normal. Yet, the pain is still there.

I am Dr. Nitish Mandal (MD, FIPM, TIPM Nashville), a specialist in Interventional Pain Management. Unlike general practitioners who look for organ failure, or cardiologists who look for heart disease, my specialty focuses on the nerves, joints, and musculoskeletal structures that cause physical pain.

Costochondritis is not a 'heart issue,' but it is a very real 'mechanical issue.' It requires a doctor who understands the biomechanics of the rib cage. At my clinics in Koramangala and J.P. Nagar, I specialize in differentiating true chest wall pain from other conditions and treating it with precise, ultrasound-guided interventions that go beyond simple painkillers."

5. Treatment Options at Koramangala and JP Nagar Pain Clinics

• While mild cases resolve with rest, chronic costochondritis requires specialized intervention.

• Conservative Management

• NSAIDs & Ice/Heat: To reduce acute inflammation.

• Posture Correction: Essential for preventing recurrence.

• Stretching: Gentle expansion of the pectoralis muscles.

Interventional Pain Management (When Pills Fail)​

• Ultrasound-Guided Micro-Injections: We inject a local anesthetic and steroid precisely at the inflamed joints to shut down the inflammation immediately.

6. Frequently Asked Questions (FAQ)

• "Does costochondritis show up on an ECG?"

No. Costochondritis is a musculoskeletal issue involving cartilage and bone. It does not affect the heart's electrical activity, so an ECG will always appear normal.

• "How long does costochondritis last?"

It can last anywhere from a few weeks to several months. Without proper treatment, it can become a chronic condition lasting over a year.

• "Is costochondritis dangerous?"

No, it is not life-threatening. However, the anxiety it causes (fear of heart attack) and the restriction in breathing (due to pain) can significantly impact quality of life.

7. Is it Heart, Gastric, or costochondritis?​

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