Overview

Costochondritis is inflammation of the costal cartilage — the firm cartilage that connects the upper ribs to the breastbone (sternum). It is one of the most common causes of chest wall pain, and it is benign: it does not damage the heart, lungs or ribs, but it can feel alarming because it sits where people expect cardiac pain.

The most important step is being sure the pain is chest wall pain rather than something else. In adults with chest pain, clinicians commonly consider an electrocardiogram and sometimes a chest X-ray before settling on costochondritis.

Typical Pattern

Aching or sharp pain near the breastbone, often on both sides
Pain that is worse with deep breaths, coughing, stretching or pressing directly on the spot
Tenderness over the rib-cartilage junctions
Pain that does not travel to the arm or jaw, and is not accompanied by shortness of breath, sweating or nausea
Often worse after activity, awkward sleeping or prolonged postures

Why It Develops

The cartilage joints where the ribs meet the sternum can become irritated by loading, coughing, chest compression exercises, contact sport, or prolonged positions that stress the chest wall. In many cases there is no single clear cause.

It is most commonly seen in adults in their 40s and 50s, with a slight predominance in women, but it can occur at any age.

How It Is Diagnosed

Costochondritis is diagnosed from the pattern: reproducible tenderness over the rib-cartilage junctions, worse with deep breaths and stretching, without features that suggest the heart, lungs or other structures are involved.

Because chest pain has important causes beyond the chest wall, a clinician will usually ask about cardiac symptoms and may arrange an ECG or chest X-ray — especially in adults — before attributing the pain to the cartilage.

Treatment

Costochondritis is self-limiting for most people, and treatment is supportive:

Reassurance that the pain, while uncomfortable, is not damaging
Heat or cold packs over the area for comfort
Simple pain relief or topical anti-inflammatory gel, guided by a pharmacist or clinician
Activity pacing: reduce aggravating loads (heavy pressing, coughing fits, awkward positions) without full rest
Gentle chest expansion and breathing exercises once the sharp pain settles

One large study found that 91% of people with new-onset costochondritis had resolution of pain after three weeks of treatment with rest and nonsteroidal anti-inflammatory medication. If pain persists beyond several weeks or worsens, an assessment is worthwhile.

When to Get Assessed

Arrange an assessment if chest pain is persistent, worsening, or keeps returning, so the diagnosis is confirmed rather than assumed.

Seek urgent care if chest pain is heavy, tight or squeezing, spreads to the arm, neck or jaw, comes with shortness of breath, sweating, nausea or dizziness — or if pain follows major chest trauma. Those patterns need emergency attention regardless of how the pain feels when pressed.

References

StatPearls. "Costochondritis." https://www.statpearls.com/ArticleLibrary/viewarticle/20071
Mott T, Jones G, Roman K. "Costochondritis: Rapid Evidence Review." American Family Physician. 2021;104(1):73-78. https://www.aafp.org/pubs/afp/issues/2021/0700/p73.pdf

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.

Costochondritis