There are a number of different conditions that cause chest pain that may present their symptoms in different ways. The chest or rib pain may be felt in a different location or there may be other symptoms corroborating a diagnosis other than costochondritis. In medical terms, this is called the “differential diagnosis” for chest pain. You can read more about differentiating costochondritis from other conditions here.
Your doctor will want to rule out serious, life-threatening conditions that can cause chest pain first, such as:
Ischemic heart disease is a condition that causes heart problems due to narrowed arteries that limit blood flow. Symptoms can include chest pain and heart attacks. Heart disease is the #1 cause of death in the United States. Risk factors include a sedentary lifestyle, obesity, and family history of heart conditions. Your physician will test blood sugar, blood pressure, and cholesterol levels to assess your risk for heart disease.
A pulmonary embolism is caused when a blood clot is stuck within an artery in the lungs, blocking blood flow. Symptoms include shortness of breath, coughing, and sharp stabbing chest pain. These blood clots are usually caused by deep vein thrombosis or blood clots from the legs. This condition is also be known as venous thromboembolism.
These other conditions also cause chest pain and may be easily confused for costochondritis:
Gastroesphogal reflux disease is a very common digestive condition that occurs when stomach acid flows into the esophagus, and symptoms include burning pain the chest. This condition is also called heartburn or indigestion sometimes.
Tietze syndrome is a similar condition to costochondritis, but is much more rare and has the additional symptom of swelling in the cartilage area. There is no swelling with costochondritis. Tietze also more commonly affects the 2nd or 3rd rib joint.
Fibromyalgia causes muscle and skeletal pain throughout the body, as well as fatigue, memory, and sleep problems. Fibromyalgia is different from costochondritis in that it often causes fatigue as well as pain throughout the body especially in the neck, back, and hips. Chest pain caused by fibromyalgia is typically on both sides of the chest.
There are several types of arthritis that may cause chest pain:
- Psoriatic arthritis – affects some people who also have psoriasis, a condition that causes scaly red patches of skin. This type of arthritis can cause joint pain, swelling, and stiffness.
- Ankylosing spondylitis – a type of inflammatory arthritis that affects the spine and causes reduced flexibility, while also causing pain in the back and joints.
- Rheumatoid arthritis – a chronic inflammatory disease that causes the body’s immure system to attack its own tissue. This condition causes painful swelling and often causes pain in joints around the body, rather than only in the chest like costochondritis.
Chest pain can be caused by destruction of the costochondral cartilage by a fungal or bacterial infection. These infections often follow from surgery or IV drug usage and can be detected by a CT scan.
Slipped rib syndrome
Slipped ribs are more rare and may also be called painful rib syndrome, clicking rib, rib tip syndrome, or a displaced rib. This is caused when the cartilage on lower ribs moves and causes pain in the upper body. Slipped ribs may be diagnosed by moving or manipulating the lower rib to trigger the pain; a clicking sound may also be present.
Painful xiphoid syndrome
Painful xiphoid syndrome is also called Xiphodynia and is a more rare cause of chest pain. This condition is indicated by pain in a small extension of the bone below the sternum called the “xiphoid process”. Xiphodynia is often caused by trauma or intense exercise, and is indicated by pain at the sternoxiphoid joint. Pain can be replicated by pressing on the xiphoid process.
Sternalis syndrome is another rare condition typically associated with pain directly over the sternum or the sternalis muscle. The pain may radiate into the arm and can be replicated by pressing on trigger points in the chest wall muscles. In a Swiss study, it was diagnosed in 14.4% of 672 cases of chest pain from patients.
Stress fractures in the sternum (or sternal fractures) are relatively rare, but can occur after repetitive, intense upper body exercise or in car accidents (e.g. blunt trauma). These type of fractures can occur in golfers, weight lifters, and other athletes. A fracture in the sternum usually presents with bruising and intense local pain, coughing, or difficulty breathing.
Be sure to book an appointment for a proper diagnosis and see a doctor if you are experiencing chest pain. Talk to your doctor before beginning any treatments.