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Musculoskeletal - Costrochondritis
In this episode, we review costochondritis, a common cause of noncardiac chest pain resulting from inflammation of the costochondral junctions of the anterior chest wall. We discuss the underlying pathophysiology, common risk factors such as repetitive upper-body activity and chest wall strain, and the typical presentation of localized chest pain that worsens with movement or deep breathing. The episode highlights the importance of a careful history and physical exam—particularly the reproduction of pain with palpation—and when additional testing like an EKG or chest imaging is needed to rule out cardiac causes. We also cover evidence-based management with conservative therapies such as NSAIDs, heat, and activity modification, along with key clinical pearls to help clinicians distinguish costochondritis from more serious causes of chest pain.
References
- Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
- Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. Am Fam Physician. 2021 Jul 1;104(1):73-78. PMID: 34264599.
- Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20. PMID: 19817327.
- Expert Panel on Thoracic Imaging, Stowell, J. T., Walker, C. M., Chung, J. H., Bang, T. J., Carter, B. W., Christensen, J. D., Donnelly, E. F., Hanna, T. N., Hobbs, S. B., Johnson, B. D., Kandathil, A., Lo, B. M., Madan, R., Majercik, S., Moore, W. H., & Kanne, J. P. (2021). ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 18(11S), S394–S405. https://doi.org/10.1016/j.jacr.2021.08.004
- Gulati, M, Levy, P. et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2021 Nov, 78 (22) e187–e285. https://doi.org/10.1016/j.jacc.2021.07.053
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By Kristopher Maday, PA-C, DFAAPAIn this episode, we review costochondritis, a common cause of noncardiac chest pain resulting from inflammation of the costochondral junctions of the anterior chest wall. We discuss the underlying pathophysiology, common risk factors such as repetitive upper-body activity and chest wall strain, and the typical presentation of localized chest pain that worsens with movement or deep breathing. The episode highlights the importance of a careful history and physical exam—particularly the reproduction of pain with palpation—and when additional testing like an EKG or chest imaging is needed to rule out cardiac causes. We also cover evidence-based management with conservative therapies such as NSAIDs, heat, and activity modification, along with key clinical pearls to help clinicians distinguish costochondritis from more serious causes of chest pain.
References
- Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
- Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. Am Fam Physician. 2021 Jul 1;104(1):73-78. PMID: 34264599.
- Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20. PMID: 19817327.
- Expert Panel on Thoracic Imaging, Stowell, J. T., Walker, C. M., Chung, J. H., Bang, T. J., Carter, B. W., Christensen, J. D., Donnelly, E. F., Hanna, T. N., Hobbs, S. B., Johnson, B. D., Kandathil, A., Lo, B. M., Madan, R., Majercik, S., Moore, W. H., & Kanne, J. P. (2021). ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 18(11S), S394–S405. https://doi.org/10.1016/j.jacr.2021.08.004
- Gulati, M, Levy, P. et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2021 Nov, 78 (22) e187–e285. https://doi.org/10.1016/j.jacc.2021.07.053