Costochondritis: What It Is, Why It Hurts, and How Long It Lasts
Updated: 3 hours ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
Editorial note: This article is for education only. It is based on medically reviewed clinical guidance updated in 2025. It is not a substitute for professional medical care. Because chest pain can signal a heart attack, always get emergency evaluation for new or unexplained chest pain.
TL;DR
Costochondritis is a harmless but painful inflammation of the cartilage where the ribs meet the breastbone. It most often strikes the upper left ribs, hurts more with deep breaths and movement, and can last several weeks. There is no lab or imaging test that confirms it — diagnosis comes from ruling out heart and lung problems. Most cases heal on their own with simple pain relief, heat or ice, stretching, and rest.
Quick answer: Costochondritis is inflammation of the rib-to-breastbone cartilage. Pain is usually sharp or pressure-like, on the left side, and worse with deep breathing, coughing, or movement. It most often affects women over 40, lasts several weeks, and resolves on its own. There is no confirmatory test — doctors diagnose it by exam and by ruling out heart and lung causes. First-line treatment is over-the-counter pain relievers, heat or ice, topical creams, gentle stretching, and rest. Because its pain mimics a heart attack, new chest pain should always be evaluated in an emergency setting first.
What is costochondritis?
Costochondritis is inflammation of the cartilage that connects a rib to the breastbone, the sternum. The rib cage itself is built from twelve pairs of ribs. The first seven pairs — the "true ribs" — attach directly to the sternum through strips of costal cartilage made of hyaline cartilage, the tissue that becomes inflamed in this condition.
The pain may be sharp, aching, or pressure-like, and it can radiate to the arms and shoulders. Costochondritis most commonly affects the upper ribs on the left side of the body, where the pain is often worst at the point where the rib cartilage meets the sternum.
Because of that left-sided pain pattern, costochondritis is often mistaken for a heart attack. It is sometimes called chest wall pain syndrome, costosternal syndrome, or costosternal chondrodynia. When visible swelling accompanies the pain, the condition is called Tietze syndrome.
Key facts at a glance
Definition: inflammation of the cartilage connecting a rib to the sternum
Most common location: upper ribs, left side of the chest
Most common joints involved: the 2nd through 5th costochondral junctions
Most at-risk group: women over age 40
Typical duration: several weeks or longer, then self-resolves
Swelling present: only in Tietze syndrome, most common in teens and young adults
Confirmatory test: none — diagnosis is clinical and by exclusion
Costochondritis vs. Tietze syndrome
Costochondritis and Tietze syndrome share the same underlying cartilage inflammation, but they differ in one visible way. Tietze syndrome includes localized swelling at the costochondral junction and tends to occur in teenagers and young adults with equal frequency in men and women. Costochondritis without swelling is more common in women over 40.
Visible swelling — costochondritis: no; Tietze syndrome: yes, at the rib-sternum junction
Typical age — costochondritis: over 40; Tietze syndrome: teens and young adults
Sex distribution — costochondritis: more common in women; Tietze syndrome: equal in men and women
Number of joints — costochondritis: often several ribs on one side; Tietze syndrome: usually one or two joints
Course — both are self-limited and resolve in weeks
How common is costochondritis?
Exact rates are hard to pin down because no single test confirms the diagnosis, so published estimates vary widely. Researchers estimate costochondritis appears in somewhere between 4% and 50% of patients who present with chest pain, depending on the setting and population studied.
Chest pain itself is a frequent reason people seek care — it accounts for roughly 1% to 3% of ambulatory primary care visits and 9% to 10% of emergency department visits. Among ambulatory patients with chest pain, chest wall causes account for 20% to 50% of cases, and costochondritis in particular accounts for 6% to 13%.
The condition is most common in adults aged 40 to 50, with a slight predominance in women. In one pediatric series, costochondritis accounted for 13% of chest pain in adolescents, where the overall musculoskeletal cause rate was 31%. These figures come from observational cohorts and expert reviews rather than randomized trials, so estimates should be treated as best-available ranges.
What does costochondritis pain feel like?
The pain pattern is the hallmark of this condition. According to clinical guidance, costochondritis pain typically has these characteristics:
Pain quality: sharp, aching, or pressure-like
Radiation: can spread to the arms and shoulders
Movement triggers: worse with deep breathing, coughing, sneezing, or chest wall movement
Location: most often the left side of the breastbone
Extent: frequently involves more than one rib
Palpation: pain is reproducible when the rib-sternum junction is pressed
On examination, pressing gently on the upper costochondral junctions reproduces the pain — often at the point where one or two ribs meet the sternum. Doctors may also use provocation tests such as the "crowing rooster" maneuver (extending the neck while the examiner pulls the upper arms backward and upward) or horizontal arm flexion to reproduce symptoms. Vital signs are typically normal; abnormal heart rate or blood pressure should raise suspicion of a different cause.
It is worth stressing an important caveat from family medicine research: even when chest pain is reproducible by pressing on the chest wall, a notable portion of such patients may still have an acute heart attack. Reproducible pain reduces suspicion but does not eliminate it.
When should you get emergency care?
Chest pain always deserves emergency evaluation until a heart attack and other life-threatening causes are ruled out. Costochondritis is a diagnosis of exclusion, and the stakes of guessing wrong are high.
Emergency rule: For chest pain, seek emergency medical attention to rule out life-threatening causes, such as a heart attack. The guidance applies to costochondritis just as it does to every other chest pain condition.
Call emergency services or go to the nearest emergency department right away if chest pain:
Comes on suddenly or feels like pressure, squeezing, or heaviness
Radiates to the jaw, neck, or left arm
Is accompanied by shortness of breath, sweating, dizziness, or nausea
Occurs with a rapid heartbeat or low blood pressure
Happens during exertion or does not improve with rest
Conditions that costochondritis can mimic include acute coronary syndrome, pericarditis, pulmonary embolism, pneumonia, aortic dissection, and gastrointestinal problems — which is why the workup happens first and the costochondritis label comes later.
What causes costochondritis?
In most cases, no clear cause is ever found. The inflammation appears spontaneously, and the pathophysiology remains poorly understood. Known associations include physical strain on the chest wall.
Physical strain: repetitive or strenuous upper-body activity
Severe coughing: repeated stress on the costochondral junctions from a respiratory illness
Trauma: direct impact or injury to the chest wall
Illness: viral or respiratory infections causing coughing fits
Underlying conditions: fibromyalgia and inflammatory joint disorders occur more often alongside it
Costochondritis is also more likely to appear in people with fibromyalgia, who often have tender points at the same second costochondral junctions.
What makes costochondritis more likely?
The strongest risk factor is age and sex. The condition happens most often in women over age 40. Research on patients aged 40 to 50 shows a slight predominance in women, who accounted for 69% of cases in one series compared with 56% in men in another.
Female sex: women over 40 are the highest-risk group
Age 40–50: peak age range for presentation
Recent respiratory illness: coughing strains the rib cartilage
Strenuous upper-body activity: repetitive strain on costochondral junctions
Fibromyalgia: co-occurs frequently
How is costochondritis diagnosed?
There is no laboratory or imaging test that can confirm costochondritis. The diagnosis is made clinically — through the physical exam and by ruling out everything more dangerous.
During the visit, a healthcare professional feels along the breastbone for tenderness or swelling and may move the rib cage or arms in specific ways to trigger the symptoms. Because the pain can imitate heart disease, lung disease, gastrointestinal problems, and osteoarthritis, tests such as an electrocardiogram (ECG) and chest X-ray are commonly ordered to exclude those conditions. In costochondritis, both the ECG and the chest X-ray come back normal.
Medical history: onset, triggers, character of pain, cardiac risk factors
Chest wall palpation: reproduces pain at costochondral junctions — the key finding
Provocation maneuvers: crowing rooster and horizontal arm flexion tests
ECG: rules out heart rhythm and ischemic causes; normal in costochondritis
Chest X-ray: rules out pneumonia, pneumothorax, and lung masses; normal in costochondritis
Blood tests: only if another condition is suspected — no marker confirms costochondritis
A notable portion of patients with chest wall tenderness may also have an acute myocardial infarction, so clinicians keep the cardiac workup broad even when the exam points toward the chest wall. Costochondritis should not be considered confirmed until serious causes are genuinely excluded.
What treatments work for costochondritis pain?
Because the condition usually resolves on its own over several weeks or longer, treatment focuses on pain relief while waiting for the inflammation to settle.
Over-the-counter and prescription medicines
First-line therapy is simple pain relief. Nonsteroidal anti-inflammatory drugs such as aspirin, naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB), and acetaminophen (Tylenol) are available without a prescription; stronger versions require a prescription. These medicines can damage the stomach lining and kidneys with prolonged use.
For severe pain, a narcotic such as tramadol may be needed, though narcotics are habit-forming. For chronic pain, especially when it interferes with sleep, tricyclic antidepressants such as amitriptyline are often used. The epilepsy medication gabapentin (Gralise, Neurontin) has also proved successful in managing chronic pain of this kind.
Self-care measures
Nonprescription pain relievers: aspirin, naproxen, ibuprofen, or acetaminophen
Topical pain relievers: creams, gels, patches, and sprays, sometimes containing NSAIDs, numbing medication, or capsaicin (the compound that makes hot peppers spicy)
Heat or ice: a warm compress or heating pad on the painful area several times a day on a low setting; ice may also help
Rest: avoiding or modifying activities that worsen the pain
Physical therapy and procedures
Gentle chest stretching exercises may help, and small studies suggest a structured stretching program benefits patients whose pain does not respond to other methods. Transcutaneous electrical nerve stimulation (TENS) — a device sending a weak electrical current through adhesive skin patches — may interrupt pain signals before they reach the brain.
If conservative measures fail, a healthcare professional can inject numbing medicine together with a corticosteroid directly into the painful joint. The evidence behind these injections is limited, so they are reserved for cases that do not respond to simpler care.
How long does costochondritis last?
The condition often goes away on its own, although it might last for several weeks or longer. Most patients achieve complete resolution of symptoms within a few weeks with conservative therapy. There is no set timeline, and a minority of cases become chronic enough to warrant antidepressants, gabapentin, or injections.
How can you prepare for your appointment?
You may be referred to a rheumatologist, a specialist in joint disorders. Arriving prepared makes the visit more productive.
Bring a list of symptoms and when they began, your key medical conditions and any chest injuries, major life changes or stressors, all medications and supplements with doses, and written questions. Expect the clinician to ask whether symptoms have worsened over time, where the pain sits, whether exercise makes it worse, whether breathing is difficult, whether you recently had a respiratory infection or chest injury, and whether heart problems run in your family.
The bottom line
Costochondritis is a common, benign cause of chest wall pain that mimics a heart attack but behaves very differently: it worsens with movement and touch, typically sits on the upper left chest, and resolves within weeks with basic pain relief. The single most important message is also the safest — never assume chest pain is costochondritis on your own. Get emergency evaluation first, let clinicians rule out the dangerous causes, and then treat the inflammation calmly at home.
Frequently asked questions
Can costochondritis come and go?
Yes. The pain often fluctuates with activity, posture, and breathing. It can flare up with coughing or exercise and settle during rest, with most people recovering fully within a few weeks though flares can recur in some.
How do you know it's costochondritis and not a heart attack?
You cannot tell on your own. Costochondritis pain worsens with touch, deep breathing, and movement, and an exam and ECG can rule out cardiac causes. Because a notable share of patients with reproducible chest wall pain still have a heart attack, new chest pain always needs emergency evaluation first.
Can costochondritis last for months?
It can, but that is not the typical course. Most cases resolve in several weeks. Pain persisting for months deserves re-evaluation to confirm the diagnosis and to consider chronic pain treatments such as amitriptyline, gabapentin, or targeted injections.
Does costochondritis cause shortness of breath?
Not directly. However, taking a deep breath is painful, so people often take shallow breaths and feel short of breath. True shortness of breath — especially with exertion, dizziness, or sweating — is a red flag that needs emergency assessment.
Is exercise bad for costochondritis?
Exercising that strains the chest wall makes the pain worse, so upper-body strenuous activity should be avoided or modified during a flare. Gentle chest stretching exercises may help, and most people return to normal activity once the pain settles.
Can costochondritis show up on an X-ray or blood test?
No. There is no laboratory or imaging test that confirms costochondritis. X-rays and ECGs are used to rule out other conditions; in costochondritis they come back normal.
Why does my costochondritis hurt more at night?
Lying in certain positions can press on the inflamed joints, and nighttime breathing patterns change. Sleeping propped up slightly or on the unaffected side often helps; persistent nighttime pain should be discussed with a clinician.
What is the difference between costochondritis and a pulled chest muscle?
Both cause chest wall pain that worsens with movement. Costochondritis pain is specifically tender at the joints where ribs meet the sternum and often involves several ribs on the left side, while muscle pain follows a muscle strain and may follow a specific exertion or injury.
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