What Ails You: Cartilage inflammation can cause serious chest pain
A relatively common complaint is pain which seems to cut horizontally across one side of the chest running toward the arm pit. The pain may make it difficult to breathe, difficult to lay on your tummy, and difficult to lift things. If your doctor isn’t listening closely, he may think you are describing shoulder pain, but you’re not.
Costochondritis is inflammation in the cartilage where the ribs join to the bony breast bone. This condition is one of the more common causes of chest pain in children and among adults it affects women more often than men.
Although costochondritis is an inflammatory condition, it usually has no definite cause. It might be repeated minor trauma to the chest wall like a vibration from heavy equipment or prolonged driving. Sometimes it comes on after a respiratory infection because of the repeated strain of coughing and sneezing. Occasionally it is the result of a bacterial infection in folks who have had chest surgery. Training errors (poor exercise technique) can also cause this painful condition.
Because chest pain is a hallmark sign of heart disease, it is imperative that you see your doctor to have him rule out any more sinister cause of your symptoms. The costochondritis itself will not show on any particular test or scan. Your doctor will diagnose costochondritis by ruling out any other cause. Tietze syndrome causes pain similar to costochondritis, but comes on more abruptly and causes pain which radiates to the arms and shoulders.
The pain of costochondritis is sharp and located in the front of your chest, although it may seem to also go through your chest toward your back. It is a little more common on the left side and most often affects the attachment sites of the fourth, fifth and sixth ribs. By way of contrast, Tietze syndrome normally affects your second and third ribs.
When you are sitting comfortably, you may have no pain at all. But when you move or stretch, especially movements that open up your chest, the pain can be severe. You are probably uncomfortable when taking deep breaths and moving your trunk to reach or twist is painful.
The definitive sign of costochondritis is pain when pressing the cartilage junction where the rib attaches to the sternum. This pain is severe and you may react with very little pressure at all. Tietze syndrome causes swelling at these junctions while costochondritis does not. Normally the swelling is just water and is not caused by pus or abscess. If your pain is a symptom of post-surgical infection, however, you will notice the area is red, warm, swollen and there may be pus or other discharge.
While costochondritis and Tietze syndrome make it painful to breathe it is not hard to breathe. If your chest pain is accompanied by difficulty breathing, this is a medical emergency. Likewise, nausea, sweating and any pain that is generalized in the chest and arm rather than well localized in the sternum is more likely caused by the heart and should be considered an emergency. If you’re not sure which you are having, better safe than sorry: get to a doctor.
Costochondritis and Tietze syndrome can take weeks to resolve. You can help relieve the pain by taking anti-inflammatory medication (ibuprofen, naproxen sodium or aspirin) and acetaminophen (Tylenol and other aspirin-free pain relievers).
A warm compress can help reduce your pain. Moist heat is much better and more soothing. If you don’t have a moist heat pad, you can make a warm compress easily. Take a kitchen towel and wet it thoroughly. Wring out the excess water, fold the wet towel so it is about the size of the area you want to treat and then put it in the microwave. Heat it like you would a cup of coffee — about three minutes. You’ll need tongs to take the steaming hot towel out. Now wrap the steaming towel inside a dry bath towel and place it over the painful area. You may need another towel between the compress and your skin to prevent burning. If moist heat doesn’t do the trick, try an ice pack.
Avoid unnecessary activities which cause pain, but do be sure to breathe deeply often. Since this chest pain makes it uncomfortable to breathe deeply, you’ll be inclined to take shallow breaths. You need to breathe deeply to clear your lungs and avoid developing pneumonia.
It may be helpful to gently stretch the area. Stand in a doorway with your hands holding the edges of the doorway behind you. Step forward through the doorway holding the walls behind you. Step forward until you feel a gentle stretch. If the stretch doesn’t quite feel like it’s in the right place, bring your hands up the sides of the doorway, but not above shoulder height. Gently lean into this stretch so that you feel “stretch” not “pain.” Hold your body centered in the doorway rather than allowing your body to twist toward one side. Do not try to force this stretch! Stretch gently for about ten seconds, relax and then repeat the stretch two more times. Do this stretch gently several times each day.
Your physical therapist can help speed your recovery by using various modalities, steroid applications and joint mobilization to reduce your inflammation and improve the mobility of your ribs. If your pain is really persistent, the doctor may try steroidal medication or injection.
Costochondritis and Tietze cause pain that is a nuisance more than an indication of severe disease. Although the pain is troublesome, you’ll make a full recovery within several weeks.
ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com
