The first thing we need is a basic understanding of Costochondritis.  I hope to give you an explanation as well as a personal glimpse into what it is like to have it.  As I said on the index page I will not be giving credit here as that would be impossible.  I have collected this information over time from various sources, source types, and from personal experience as well. DEFINITION Costochondritis is an insidious inflammation of the cartilage that attaches the ribs to the breastbone generally affecting the third or fourth ribs.  It produces anterior chest wall pain associated with tenderness of the sternum and rib regions.  Any of the seven costochondral junctions may be affected and more often than not, more than one site is affected. ETIOLOGY Costochondritis may be caused by trauma, as a result of a viral infection, or as part of an inflammatory disease process.  Though, insidious in nature, repetitive minor trauma has been suggestive as the cause.  But, generally the cause is unknown.  Though I was 44 when I was diagnosed, it is usually diagnosed between the age of twenty and forty.  It affects both sexes equally, but it is more prevalent in females. SYMPTOMS Costochondritis causes mild to severe pain in the lower rib area or upper breastbone, which can be mistaken as a heart attack, usually between the breast and upper abdomen.  It produces profuse tenderness, without swelling, to at least one joint of the rib cage.  It tends to be the most noticeable when sitting or leaning back.  The most painful stage tends to be in the beginning and can decrease in time.  So, it may change to a dull constant ache, or the feeling of sore ribs.  However, when it is a chronic condition, it just tends to keep recurring.  Pain on palpation is fairly consistent but after about a year, only about a half of those with Costochondritis continue with any discomfort, while only about a third report tenderness on palpation.  Stress is known to aggravate this condition. Qualities of the pain Sharp chest wall pain especially with pressure Pain may occur in more than one location Severe pain at times Tightness in chest Sensitivity to touch Worsens with trunk movement Worsens on exertion Improves with decreased movement Improves by breathing position Improves by changing position May be sharp, nagging, or aching in nature May cause a feeling of pressure May continue to come and go TREATMENT Costochondritis may trigger for years or a lifetime when associated with other autoimmune diseases.  It usually responds well to a course of painkillers and anti-inflammatories. Indocin is frequently prescribed.  Narcotic pain medications and occasional Cortisone shots are necessary for some to obtain relief from the pain and reduction of the inflammation but these measures should only be used as temporary measures and not long term. Rest until movement becomes comfortable.  Apply heat or ice to the affected areas.  Avoid all movements and activities that increase the pain and only return to exercise gradually to avoid re-injury.  These simple measures are all useful practices, however, if the condition does not respond to these simple treatment measures, more tests should be considered to because when Costochondritis is associated with liver disease, it is more difficult to treat. MY POINT of VIEW Living with Costochondritis hasn't really affected me that much.  For one thing it is a new diagnosis that I've only had for a few weeks and it tends to be more of a nuisance than anything else.  I take Indocin 75mg every 12 hours and that seems to do the trick.  I, also, take Skelaxin 800mg every eight hours.  My pain is fairly mild most of the time but it can and does flare from time to time.  My pain is generally located at the bottom of my rib cage near the sternum. There could be a couple reasons why my pain is not as intense as described.  For one thing, I already take steroids.  And for another, I have Osteoporosis.  Now this is pure conjecture and I have nothing to back it up with so don't quote me, but, here goes.  I have 2+ Osteoporosis [means I have the bones of the typical 88 year old person], and my bones are quite porous and rubbery.  As such, my bones have the ability to "give" and maybe this helps keep the pain to a minimum.  I would love to hear your views on this. Anyway, for me what I notice the most, is a feeling of my ribs being in my way.  The girth of my ribcage feels as if it has increased by several inches making them feel like they are protruding.  I know that sounds strange but it is the best way I know how to describe it.  I find I do not bend well during an acute phase.  Coming up from a reclining position is almost impossible without help but this may be an automatic response to protect an injured area.  All in all, I feel rather fortunate because it could be a lot worse. 2000 UPDATE My pain medicine continues to be adjusted.  I had to stop taking the Indocin and Skelaxin due to gastric disturbances and was put on Celebrex and Flexeril.  It seemed to be working out good until I was diagnosed with Meniere's Disease. Now I can't take the Celebrex because it makes my Meniere's Disease worse.  LOL...  So, now I take Flexeril, Ultram, and Vioxx. Unimportant observational note... what is with the letter X and pain meds?!?  lol...  I just noticed while typing this that I have never seen that letter used all that much.  Now, we have Celebrex, Flexeril, Vioxx. 2001 UPDATE My pain medicine continues to be changed as they find the most effective combination of muscle relaxers, anti-imflammatories and pain meds.  Currently I am on a regimen of Flexeril, Ultram, and Vioxx. I still have the feeling that was ribs "are in the way" with occasional pain as well. 2002 UPDATE The Ultram started causing nausea and vomiting so I had to stop taking it.  I have not replaced it with anything. I still have the feeling that was ribs "are in the way" at times with occasional pain as well. MY THOUGHTS As you may know, I am now [September 2002] renovating my site and as such, I am proofreading all my pages... thank goodness as I have found many strange MS type errors [typing one word while thinking another... happens in speech too] making reading quite cryptic.  LOL... Anyway, while reading the above I was hit with a memory from the past... possibly the appearance of Costochondritis.  In 1994, I went to the ER in Grand Junction, Colorado with chest pain.  My EKG and blood work did not show any cardiac problems but due to my family history and the significant amount of pain I was in, the doctor decided to keep me. I was there for two or three days and was treated for chest pain.  Whatever it was, worked.  I was not in pain.  After two or three days, they decided I could go home. While waiting for my ride, I had another attack and rang for some pain medicine.  The nurse informed that the doctor had not ordered any.  I was shocked!  What was I supposed to do.  They had done nothing and was leaving me the way I came in. They called my doctor and his PA [and wife] came in.  I explained I was still in pain and nothing had changed.  She questioned me about the pain and then decided to take a look at my chest.  This is when she palpated my chest.  Normally with heart problems there is no actual tactile examination.  While feeling around and pushing here and there, she pushed on a rib that sent me through the roof.  She decided then that my problem had not been cardiac at all. After asking about possible injuries, she decided I had a displaced rib.  [I had been out country swing dancing a few nights before and one of my partners had such a whip that he had jerked enough that I felt it in my wrist.] I think this was my initial appearance of Costo.  I can recall over the next few years of having to wrap my ribs due to pain too.  So, it is quite possible that the actual diagnosis of Costochrondritis was several years after it's appearance and may then explain why my pain is not near as bad as those that have just been diagnosed.... when I was first diagnosed.

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