Costochondritis: Chest Wall Pain Symptoms, Causes and Treatment

What is costochondritis?

Costochondritis is inflammation of the costochondral joints, where the ribs join the cartilage that connects them to the breastbone (sternum). It causes chest wall pain, usually on the left side, often across more than one rib. The NHS page on costochondritis describes it as a common cause of chest pain that usually gets better on its own.

Important: Chest pain can be a sign of a heart attack, blood clot in the lung or other emergencies. If you have new or severe chest pain, pain with breathlessness, sweating, nausea, or pain spreading to the arm, jaw or back, call emergency services. Do not assume it is costochondritis.

Symptoms

• Sharp, aching or pressure-like pain at the front of the chest
• Pain that worsens when you press on the rib joints next to the breastbone
• Pain with deep breaths, coughing, twisting or lifting
• Usually affects the 2nd to 5th ribs
• No visible swelling (swelling suggests Tietze syndrome)

Causes

In many people no clear cause is found. Known triggers include:

• Repetitive strain: heavy lifting, new upper-body exercise, carrying children
• Severe coughing, for example after a chest infection
• Chest injury from a fall or seatbelt
• Infections of the joint (rare, sometimes after surgery or in people who inject drugs)
• Inflammatory arthritis, such as ankylosing spondylitis, psoriatic arthritis or rheumatoid arthritis
• Fibromyalgia, where chest wall tenderness is common

How is costochondritis diagnosed?

Costochondritis is a diagnosis of exclusion. A doctor first makes sure the pain is not coming from the heart, lungs or other organs. Typical steps:

Test	Purpose
Physical examination	Reproduces tenderness at the rib joints
ECG and blood tests (e.g. troponin)	Rule out heart causes when chest pain is new or concerning
Chest X-ray	Rule out lung problems or rib fracture
Inflammatory markers	Check for inflammatory arthritis or infection
MRI, CT or ultrasound	Used for persistent, swollen or atypical cases

If you already have ECG results, blood tests or chest imaging and are still in pain, you can send your reports for a doctor review. This is not an emergency service; urgent chest pain must be assessed locally and immediately.

Standard treatment

Treatment is conservative and works for most people:

1. Relative rest. Avoid activities that clearly provoke the pain, such as heavy lifting or push-ups, until it settles.
2. Pain relief. Anti-inflammatory medicines such as ibuprofen (if safe for you) or paracetamol.
3. Heat or ice. Warm compresses or cold packs applied for short periods.
4. Stretching and posture work. Gentle chest and thoracic spine stretches, often guided by a physiotherapist.
5. Treat triggers. Manage a chronic cough, review workout technique.
6. Local injection. For persistent cases, a doctor may inject local anaesthetic, with or without a corticosteroid, into the painful joint.
7. Treat underlying disease. If inflammatory arthritis is found, rheumatology care is essential.

Surgery is very rarely considered, and only for specific problems such as infection.

Regenerative options: an honest view

There is no high-quality research on stem cells, exosomes or PRP for costochondritis. We mention them only because patients ask.

• PRP therapy has evidence in some tendon and joint conditions, and occasional case reports describe its use in chronic chest wall pain. That is not enough to call it effective.
• Stem cell therapy has no published trials for costochondritis.

A responsible doctor will not recommend a regenerative program for costochondritis unless pain has lasted many months, serious causes have been excluded, standard measures and local anaesthetic injections have failed, and you understand the treatment is experimental for this use. In many cases our medical team will advise you to stay with conservative care and local follow-up instead.

In the US, Australia and the UK, stem cell injections for chest wall pain are not approved, and the FDA warns about unapproved stem cell therapies.

Who may be a candidate, and who should not

May be considered for further assessment in Bangkok:

• Chest wall pain persisting for many months
• Heart and lung causes already excluded with tests
• Little improvement after physiotherapy, medicines and local injection

Should not travel for treatment; seek local care instead:

• New, worsening or unexplained chest pain
• Chest pain with breathlessness, fainting, palpitations or sweating
• Fever, redness or swelling over the joint (possible infection)
• Recent chest surgery
• Known or suspected heart disease without cardiology review

Risks of injections near the chest

Any injection near the rib cage carries specific risks:

• Pain flare after the injection
• Infection
• Bleeding or bruising
• Pneumothorax (air leaking around the lung) if the needle passes too deep, which is why ultrasound guidance is used
• Steroid side effects such as skin thinning

What a program in Bangkok looks like

For the small number of suitable patients:

1. Send your reports. ECG, blood tests, chest imaging and specialist letters.
2. Doctor review. A frank opinion, which may be “continue conservative care”.
3. Full assessment on arrival. Including cardiac screening if needed.
4. Ultrasound-guided treatment where appropriate.
5. Physiotherapy plan for posture and chest wall mobility.

See how it works for the full patient journey.

Aftercare

• Avoid heavy lifting and strenuous upper-body exercise for 1–2 weeks
• Use heat and gentle stretching as advised
• Watch for fever, increasing redness or shortness of breath and seek care immediately if they occur
• Return to exercise gradually, with good technique
• Keep your local doctor informed

Sources

• NHS: Costochondritis
• Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American Family Physician, 2009.
• U.S. FDA: Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes