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Health condition · Clinically reviewed

Costochondritis, reproducible chest wall pain - not your heart.

One of the most common causes of chest pain in young adults - benign, self-limiting and treatable. The trick is confirming what it is, and confidently ruling out what it isn\'t.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BMJ Best Practice and peer-reviewed musculoskeletal sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including image-guided injections for refractory chest wall pain.

Key facts

Costochondritis at a glance.

The essentials, in plain English - what it is, how it differs from Tietze syndrome, and how it is treated in the UK today.

  • What it is

    Inflammation of the costochondral or costosternal joints - the cartilage that joins the ribs to the sternum.

  • Who gets it

    Very common cause of chest wall pain, especially in young adults and children - accounts for a large slice of non-cardiac chest pain in primary care.

  • Tietze syndrome

    A related but distinct entity with the same joints affected plus visible swelling - costochondritis usually has no swelling.

  • Typical triggers

    Repetitive activity, coughing, upper respiratory infection, trauma or surgery, and sometimes inflammatory arthritis.

  • Course

    Usually self-limiting - resolves over weeks to months with simple analgesia and activity modification. Recurrences can happen.

  • Foundation therapy

    NSAIDs (oral or topical) plus reassurance and gentle rehabilitation once serious causes of chest pain are excluded.

Why this guide matters

Chest pain is scary. Costochondritis is common.

The instinct with any chest pain is to think of the heart - and rightly so. But once cardiac and pulmonary causes are excluded, most chest wall pain in young adults is musculoskeletal.

  • Cardiac first, always

    The first job in any chest pain is to be sure it isn't the heart or lungs. See our chest pain guide for the assessment pathway.

  • Reproducible pain is the giveaway

    When pressing on the costochondral junction reproduces the exact pain, costochondritis becomes the working diagnosis.

  • Simple treatment usually works

    NSAIDs, topical gel, activity modification and time - most people are back to normal within weeks.

How the diagnosis is made

From first pain to a confident plan.

The steps a UK GP or A&E clinician will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Timing, triggers, whether the pain is sharp and reproducible, and any cardiovascular risk factors - the history usually tells the story.

  2. 02

    Assessing

    Reproducing the pain

    Palpating the costochondral junction should reproduce the patient's pain - a positive finding is the hallmark of the diagnosis.

  3. 03

    Assessing

    Exclude serious causes first

    Cardiac and pulmonary causes are the priority - visceral pain, associated symptoms, or risk factors change the plan.

  4. 04

    Excluding

    ECG and troponin if in doubt

    If the picture is not classic or there are cardiac features, an ECG plus troponin comes before anything else.

  5. 05

    Excluding

    Chest X-ray for red flags

    Considered when the story raises the possibility of rib fracture, pneumothorax, malignancy or infection.

  6. 06

    Refining

    Bloods if inflammatory suspected

    FBC, CRP and a rheumatology screen if the pattern suggests inflammatory arthritis such as AS, RA, reactive or psoriatic.

  7. 07

    Refining

    MRI or bone scan - selective

    Reserved for atypical, persistent or refractory cases - not part of the routine work-up.

Typical timeline: a single visit to a confident diagnosis in most cases.

Symptoms

What costochondritis actually feels like.

Sharp, localised chest wall pain that gets worse when you press on it or breathe deeply - and the features that mean something else may be going on.

  • Sharp, localised chest wall pain

    Sharp or aching, often unilateral, and pinpointed to the costochondral junction rather than deep in the chest.

  • Tender on palpation

    Pressing over the affected joint reproduces the pain - the single most useful clinical sign.

  • Worse with breathing and coughing

    Deep breaths, coughing, sneezing or laughing all wind the pain up because the joints move.

  • Worse with movement

    Reaching, lifting, upper limb activity or lying on the affected side often flare things up.

  • Multiple contiguous ribs

    Commonly affects the 2nd to 5th costochondral joints, often several in a row on one side.

  • No swelling

    Distinguishing feature from Tietze syndrome, which shares the distribution but has a visible tender lump.

  • Self-limiting course

    Weeks to months is typical, with a good prognosis - though recurrence is not unusual.

  • Red flag - not reproducible

    Chest pain that cannot be reproduced by palpation, especially with cardiac risk factors, needs urgent assessment.

Treatment

How costochondritis is treated in the UK.

Reassurance and simple analgesia first, physiotherapy and topical treatments next - and image-guided injections when the pain refuses to settle.

  • Reassurance and explanation

    Once cardiac and other serious causes are excluded, understanding that this is benign and self-limiting is a large part of the treatment.

  • Oral NSAIDs

    Ibuprofen or naproxen at standard doses - first-line for pain and inflammation when there are no contraindications.

  • Topical NSAID gel

    Diclofenac gel over the tender joint - localised effect with fewer systemic side effects, useful alongside or instead of oral NSAIDs.

  • Paracetamol

    A helpful adjunct or alternative when NSAIDs are not suitable.

  • Heat, cold and physiotherapy

    Warm packs, ice, gentle stretching and posture work help many patients recover more comfortably.

  • Activity modification

    Avoiding heavy lifting and modifying exercise for a few weeks lets the inflammation settle without deconditioning.

  • Image-guided local injection

    A steroid and local anaesthetic injection into the costochondral joint under ultrasound guidance - reserved for refractory cases.

  • Neuropathic agents for chronic pain

    Amitriptyline or gabapentin can help refractory or chronic chest wall pain where nerve involvement is suspected.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Any new or unexplained chest pain deserves proper clinical assessment. If in doubt, get seen the same day.

  • NICE Clinical Knowledge Summaries. Chest pain assessment and non-cardiac chest pain.

  • BMJ Best Practice. Costochondritis - assessment and management.

  • British Society for Rheumatology. Guidance on musculoskeletal chest wall syndromes.

  • Royal College of Radiologists. Image-guided musculoskeletal injections.

Red flags

When chest pain isn\'t costochondritis.

The mimics matter more than the diagnosis itself. These are the situations that need urgent assessment or a different plan.

  • Cardiac chest pain

    Central, crushing or radiating pain, especially with breathlessness, sweating or cardiovascular risk factors - needs immediate assessment. See our chest pain guide.

  • Pulmonary embolism

    Sudden pleuritic pain with breathlessness, tachycardia or leg swelling - a medical emergency, not costochondritis.

  • Pneumothorax

    Sudden one-sided chest pain with breathlessness and reduced air entry - needs urgent imaging.

  • Rib fracture

    Preceded by trauma or severe cough, focally tender bone rather than joint - X-ray if clinically suspected.

  • Herpes zoster (shingles)

    Burning dermatomal pain that precedes a vesicular rash - a common mimic of chest wall pain in older adults.

  • Malignancy

    Unexplained persistent bony chest pain, night pain, weight loss or a known cancer history - warrants imaging.

  • Systemic infection

    Fever, sweats or a suggestive history - consider sternoclavicular or costochondral joint infection, especially in immunosuppressed patients.

  • Inflammatory arthritis

    Morning stiffness, other joint involvement, back pain or a family history - consider AS, RA, reactive or psoriatic arthritis.

  • Slipping rib syndrome

    Sharp lower chest or upper abdominal pain with a click - a distinct entity (Cyriax) that needs a different approach.

Living with it

A benign condition, a clear plan.

Four things that make the biggest difference day to day - understanding the diagnosis, simple analgesia, sensible activity modification, and knowing when to come back.

A quiet reminder

Prognosis is excellent - most people fully recover.

The vast majority of costochondritis settles with time and simple treatment. Recurrences can happen but respond to the same approach.

  1. 01 Reassure

    Know what it is (and isn't)

    Once serious causes are ruled out, remember this is benign, common and expected to settle. Anxiety keeps the pain going.

  2. 02 Simple

    Analgesia and topicals

    A short course of NSAIDs, or topical diclofenac gel over the tender spot, does the heavy lifting for most people.

  3. 03 Move

    Modify, don't stop

    Avoid the triggers - heavy lifting, deep upper-body work - but keep moving. Gentle stretching and posture matter.

  4. 04 Escalate

    When to come back

    If pain is not settling after a few weeks, keeps recurring, or new features appear, ask for review - a targeted injection or further work-up may help.

Frequently asked

Everything we get asked about costochondritis.

Quick answers on how to tell it apart from cardiac pain, Tietze syndrome, injections and prognosis.

  • What is costochondritis?

    Costochondritis is inflammation of the cartilage that joins your ribs to your breastbone (the costochondral or costosternal joints). It is a very common cause of chest wall pain, particularly in young adults and children, and is usually self-limiting.

  • How is it different from Tietze syndrome?

    The pain and the joints affected are similar, but Tietze syndrome comes with visible tender swelling over the joint. Costochondritis typically has tenderness without swelling. Tietze syndrome is much less common.

  • How do I know it isn't my heart?

    Costochondritis pain is usually sharp, localised, and can be reproduced by pressing on the joint. Cardiac pain is more often deep, pressure-like, not reproducible on palpation, and comes with symptoms like breathlessness, sweating or nausea. If you are not sure, treat it as cardiac and get seen - your clinician can arrange an ECG and blood tests to be certain.

  • What causes it?

    Often the cause is unclear. Known triggers include repetitive activity, heavy coughing, a recent upper respiratory infection, chest trauma, thoracic surgery and inflammatory arthritis such as ankylosing spondylitis, rheumatoid arthritis, reactive or psoriatic arthritis.

  • How long does it last?

    Most cases settle over a few weeks to a few months with simple treatment. Some people have recurrent episodes, and a small number develop more chronic pain that benefits from targeted treatment such as an image-guided steroid injection.

  • When do I need an injection?

    A steroid and local anaesthetic injection into the costochondral joint, done under ultrasound guidance by a musculoskeletal or pain specialist, is a reasonable option when the diagnosis is clear and standard treatment has not worked after several weeks.

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