What Causes Costochondritis to Flare Up?

What is costochondritis?

In many cases, the cause of costochondritis is unknown but viral, bacterial, or fungal infections may cause inflammation around your sternum.
In many cases, the cause of costochondritis is unknown but viral, bacterial, or fungal infections may cause inflammation around your sternum.

Costochondritis, sometimes called chest wall pain or costosternal syndrome, is a painful inflammation of the cartilage surrounding your sternum. The sternum, along with the ribs and cartilage, makes up your chest wall. Your chest wall is vital because it wraps around and protects your heart, lungs, liver, and other organs, but it can be susceptible to inflammation and infection like other parts of the body. 

In costochondritis, the costal cartilage that connects your ribs to your sternum becomes inflamed and creates moderate, localized chest pain. Sometimes, costochondritis causes pain to become sharp and severe and even radiate to your shoulder or upper back. This benign condition is more common in adults older than 40, but it can occur in children and teens as well. For adults, it's more common in women than men and can be so severe that some people believe it's a heart attack.

Recognizing the signs and symptoms of costochondritis can help you ease the pain and discomfort of this condition so you can get the relief you need.

Signs and symptoms of costochondritis

Sometimes costochondritis builds slowly, but it can also appear suddenly and make its presence known with chest pain on the left side. Since the pain occurs near the location of your heart, you might worry that you're experiencing a heart attack. It's important to check in at a clinic to help you rule out this possibility if you're experiencing other severe symptoms. 

Costochondritis presents a couple of warning signs and symptoms that you'll want to recognize:

Chest pain

The most noticeable symptom, chest pain, can be moderate to severe and may develop into a sharp, stabbing sensation. You feel this pain to the left of your sternum, and you might also feel a lot of pressure. In some cases, the pain may spread toward your shoulder and upper back.

Your chest pain may worsen when you cough, sneeze, or take deep breaths. It might also feel worse when you lay down to sleep or if you're doing anything strenuous like heavy lifting or intense exercise.

Chest tenderness

The other main symptom of costochondritis is tenderness when pushing down on your sternum and rib joints. This tenderness or soreness is due to the inflammation affecting your costal cartilage, and it becomes more intense the more pressure you apply to the area.

These two symptoms, chest pain and tenderness, can also apply to a rare but similar condition called Tietze syndrome. The main difference between these conditions is that Tietze causes swelling at the site of inflammation, along with occasional redness. There is no swelling associated with the pain and tenderness of costochondritis.

In addition, Tietze is more common in children and young adults, and it affects the area between the second and third rib. Costochondritis, on the other hand, affects multiple cartilage sites from the second through fifth rib joints.


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Causes of costochondritis

In many cases, the cause of costochondritis is unknown, and it can remain unknown even after undergoing tests and ruling out other conditions. Sometimes costochondritis does have a cause such as:


Viral, bacterial, or fungal infections may cause inflammation around your sternum that affects the rib joints. Respiratory tract infections and wound infections are a couple of the conditions that may lead to costochondritis.


If you have arthritis, you may have an increased chance of developing costochondritis. Some types of inflammatory arthritis, such as osteoarthritis, ankylosing spondylitis, and rheumatoid arthritis, are more likely to cause this condition. 

Chest injury

You might also develop costochondritis if you experience a traumatic chest injury, such as through a sports injury or vehicle accident.

Sudden physical strain

Severe coughing, heavy lifting, or intense exercise can lead to irritation of the ribs, which can turn into costochondritis.

When to see the doctor for costochondritis

While costochondritis by itself is considered non-serious, it's important to see your doctor for a check-up. Sometimes the symptoms of costochondritis can resemble those of more serious conditions. 

Head to a clinic or emergency room immediately if you experience chest pain and tenderness along with any of these symptoms:

Diagnosis for costochondritis

Your doctor will begin with a physical exam and ask you about other symptoms. They'll feel along your sternum and check for any pain, tenderness, or swelling. Then, they'll check your rib cage to see if movement triggers the symptoms. 

They might also order blood tests, a chest x-ray, or an electrocardiogram (ECG) to rule out other conditions. If your blood test shows possible infection, you may receive antibiotics or antiviral medication.

Treatments for costochondritis

In most cases, costochondritis heals on its own in about one to three weeks. Your costochondritis treatment plan will usually focus on pain relief, such as taking acetaminophen or non-steroidal anti-inflammatory medication, and applying hot and cold compresses. 

Your doctor might recommend gentle stretching exercises or transcutaneous electrical nerve stimulation (TENS) to help the surrounding nerves and muscles relax.  

American Family Physician: "Costochondritis: Diagnosis and Treatment."

American Family Physician: "Musculoskeletal chest wall pain."

Mayo Clinic: "Costochondritis."

Mount Sinai: "Costochondritis."

National Health Service: "Costochondritis."

National Organization for Rare Disorders: "Tietze Syndrome."

Schumann, J; Sood, T; Parente, J. StatPearls, StatPearls Publishing, 2020. "Costochondritis."

University of Florida Health: "Costochondritis."