Trip Answers

Question answered:26/05/06 Warning! this question is over two years old.

eMedicine has a chapter on costochondritis [1] in its emergency medicine section.  It gives the following information on history and physical:

"History:

The onset is often insidious. Chest wall pain with a history of repeated minor trauma or unaccustomed activity (eg, painting, moving furniture) is common. Pain may be described as follows:
 - Exacerbated by trunk movement, deep inspiration, and/or exertion
- Lessens with decreased movement, quiet breathing, or change of position
- Sharp, nagging, aching, or pressurelike
- Usually quite localized but may extend or radiate extensively
- May be severe
- May wax and wane

Physical:

Pain with palpation of affected costochondral joints is a constant finding in costochondritis.
 - The second through the fifth costochondral junctions typically are involved.  More than 1 junction is involved in more than 90% of patients.
 - Surprisingly, patients may not be aware of the chest wall tenderness until examination.

The diagnosis should be reconsidered in the absence of local tenderness to palpation.
 - Tietze syndrome is characterized by nonsuppurative edema.
 - Costochondritis has no palpable edema."

GP Notebook also has a chapter [2], which reports the following:

"Tietze's syndrome is an idiopathic costochondritis.

The patient complains of pain that is often localized to the costal cartilage.
 - the syndrome usually affects the second rib, followed by the third and fourth
 - the pain is made worse by motion, coughing, or sneezing
 - there is localized tenderness

Investigations:
 - chest xray and bone scan are not helpful for diagnosis
 - computed tomography findings are considered to be specific for osteochondritis of the rib

Treatment is with analgesia. In persistent cases local steroid injections may be indicated.

Notes:

 - Tietze's syndrome usually occurs in the second through fourth decades of life and rarely has been described in children
 - in the paediatric age group, the presence of a costochondral mass is often alarming and the possibility of a tumour (benign or malignant) or septic joint must be considered (2)"

References

1) eMedicine. Costochondritis. 2005 (http://www.emedicine.com/emerg/topic116.htm)
2) GP Notebook. Costochondritis(idiopathic). (http://www.gpnotebook.co.uk/simplepage.cfm?ID=-429195260&linkID=31191&cook=yes)

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