Costochondritis: diagnosis and treatment.

Costochondritis, an inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, is a common condition seen in patients presenting to the physician's office and emergency department. Palpation of the affected chondrosternal joints of the chest wall elicits tenderness. Although costochondritis is usually self-limited and benign, it should be distinguished from other, more serious causes of chest pain. Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation. History and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults. Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph. Consider further testing to rule out cardiac causes if clinically indicated by age or cardiac risk status. Clinical trials of treatment are lacking. Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance.

Síndrome de tietze en la infancia. Revisión clínicoepidemiológica en el Área de Salud del Bierzo / Tieze's Syndrome in childhood. Clinico-epidemiological review in the Health Care Area of Bierzo

El síndrome de Tietze es una inflamación benigna localizada en la unión esternocostal o condrocostal de causa desconocida y raro en niños. Se realizó un estudio para la detección de esta entidad en nuestro medio, retrospectivamente durante un año en el Servicio de Urgencias hospitalario y durante el mismo período, uno prospectivo en una consulta de pediatría en Atención Primaria. Como criterios de inclusión se han utilizado la presencia de dolor costal o costocondral localizado y tumoración en la zona. Sólo se encontró el síndrome de Tietze en mayores de 10 años, siendo más frecuente en cartílagos costales bajos. Las pruebas complementarias fueron normales. El tratamiento consiste en analgésicos y/o AINEs, con resolución favorable aunque un caso requirió esteroides y terapia no farmacológica: estimulación nerviosa eléctrica transcutánea (TENS).Este síndrome debe de ser tenido en cuenta para evitar estudios y pruebas diagnósticas sofisticadas e invasivas, siendo la clínica el elemento más útil cuando se sospecha (AU)

Unexpected frequency of idiopathic costochondral pain.

A study of the records of patients seen in a two-year period in a private gynecologic practice and a one-year period in the emergency department of a general hospital was prompted by the incidence of chest wall pain diagnosed as costochondral pain. The study revealed 76 women in the former practice and 156 men and women in the latter with this condition. Physicians need to understand this symptom complex and be aware of the frequency of its occurrence in patients presenting with chest pain and fearing breast cancer or cardiac disease. Costly, intensive investigation can be avoided when careful, deep palpation of the costochondral junction discloses pain traversing the rib under the breast, leading to a diagnosis of idiopathic costochondral pain.