What causes costochondritis? Many frustrated sufferers of this relatively common disorder would like to know the answer to this question. Costochondritis is a condition that causes chest pain that can be severe enough to mimic a heart attack – but the pain doesn’t stem from the heart but from inflammation involving the cartilage that connects the ribs in the chest to the sternum.
The inflammation of this cartilage causes chest pain that can often be reproduced by pressing firmly on the inflamed cartilage in the chest or by taking a deep breath. This stretches the inflamed cartilage causing pain. Costochondritis usually goes away on its own, which is fortunate since there’s no really good treatment for this condition except for heat and analgesia to relieve the discomfort. Unfortunately, when it goes away, it can reappear again at a later time.
The exact cause of costochondritis is unknown, but there may not be a single cause – but multiple ones. The underlying problem is inflammation in the cartilage, which may be associated with more than one trigger. Repetitive trauma and overuse is one probable cause of this frustrating condition. People who do a lot of lifting or athletes who work out with weights may repetitively injure the cartilage in their chest, which over time leads to inflammation. Even a one-time lifting injury could trigger inflammation in an unconditioned person.
Some medical conditions such as fibromyalgia, inflammatory bowel disease and some forms of arthritis have been linked to costochondritis. People with these disorders have inflammation in other areas that also affects the cartilage in their chest. Some people seem genetically predisposed to developing the symptoms of costochondritis. At one time, costochondritis was believed to be caused by a virus that triggered an inflammatory response, especially viruses involving the lungs, but this theory has fallen out of favor.
The reality is that no one really knows what causes costochondritis – and there may very well be multiple causes. The most important issue diagnostically is to distinguish it from chest pain that arises from heart disease or a heart attack since one is serious and the other benign. Doctors often press on the ribs and sternum when diagnosing a patient with costochondritis to see if it reproduces the pain, and they’ll do a thorough heart exam including an EKG to make sure the pain doesn’t come from the heart.
The Bottom Line
Exactly what causes costochondritis remains a mystery, but most experts think there are multiple ways the cartilage in the chest can become painful and inflamed with overuse and trauma being the biggest contender. Sometimes costochondritis disappears as quickly as it appeared, but other times it will linger – and no one knows exactly why. Fortunately, most people eventually get some relief from the pain and discomfort of costochondritis.
Merck Manual. Eighteenth edition. 2006.
MD Guidelines. (mdguidelines.com). “Costochondritis”
Am Fam Physician_._ 2009 Sep 15;80(6):617-620.