Pediatric Costochondritis

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is a common reason seek medical attention for their children. Annually, physicians evaluate >600,000 cases of in patients aged 10-21 years, a number that may reflect overwhelming concern about chest pain as a manifestation of cardiac disease as noted in older patients. [1, 2]

Costochondritis is a common cause of chest pain in children and adolescents. The condition is characterized as an inflammatory process of one or more of the costochondral cartilages that causes localized tenderness and pain of the anterior chest wall. [3] Most cases of costochondritis are idiopathic. The remaining cases may result from costochondral irritation due to direct trauma to the area, aggressive exercise resulting in a strain of the costochondral cartilage, or a prior upper respiratory tract infection with cough which can cause repeated stretching and strain at the costochondral junction resulting in local irritation and pain.

Costochondritis is a relatively benign and usually self-limited condition though symptom resolution can persist for up to three months. [4] Patients are often evaluated initially in the emergency department (ED) or in their primary care physician’s office.

The term Tietze syndrome implies swelling; costochondritis refers to pain alone.

The exact pathophysiology of cartilage and capsular involvement is unknown because costochondritis does not warrant surgical intervention or tissue biopsy. Theoretically, the cartilage involved in costochondritis is either inflamed or fractured. Either condition presumably leads to inflammation with subsequent stimulation of pain receptors.

United States

Several studies of chest pain in pediatric patients report costochondritis prevalences of 14-32% [4, 1, 5, 6] ; a single study reported rates as high as 79% [7] however this higher prevalence may be due to a less stringent diagnostic criteria for costochondritis. The overall incidence is approximately 4% in children and adolescents.

No reports have associated mortality with costochondritis, and no mortality is expected.

A study indicates Hispanics may have an increased prevalence of costochondritis, but most studies do not mention race as a factor. [8]

Studies of chest pain in children demonstrate that males and females are affected equally. There are no recent studies evaluating the effect of gender in costochondritis.

No data support an association between age and costochondritis; the condition is well described in children of all ages, including infants. [9]

Pantell RH, Goodman BW Jr. Adolescent chest pain: a prospective study. Pediatrics. 1983 Jun. 71(6):881-7. [Medline].

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Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15. 80(6):617-20. [Medline].

Driscoll DJ, Glicklich LB, Gallen WJ. Chest pain in children: a prospective study. Pediatrics. 1976 May. 57(5):648-51. [Medline].

Selbst SM, Ruddy RM, Clark BJ. Pediatric chest pain: a prospective study. Pediatrics. 1988 Sep. 82(3):319-23. [Medline].

Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiology in the Young. 2013. 23:361-367.

Brown RT. Costochondritis in adolescents. J Adolesc Health Care. 1981 Mar. 1(3):198-201. [Medline].

Disla E, Rhim HR, Reddy A, et al. Costochondritis: a prospective analysis in an emergency department setting. Arch Int Med. 1994. 154 (21):2466-2469.

Mukamel M, Kornreich L, Horev G, Zeharia A, Mimouni M. Tietze’s syndrome in children and infants. J Pediatr. 1997 Nov. 131(5):774-5. [Medline].

[Guideline] Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct.

Son MBF, Sundel RP. Musculoskeletal Causes of Pediatric Chest Pain. Pediatr Clin N Am. 2010. 57:1385-1995.

Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Med. 2005. 35(6):537-55. [Medline].

Drossner DM, Hirsh DA, Sturm JJ, et al. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med. 2011. 29:632-638.

Saleeb SF, Wing YV, Li BA, Shira Z, Warren BA, Lock JE. of Screening for Life-Threatening Chest Pain in Children. Pediatrics. 2011. 128:e1062-e1068.

Lipsitz JD, Hsu DT, Apfel HD, et al. Psychiatric Disorders in Youth with Medically Unexplained Chest Pain versus Innocent Heart Murmur. J of Pediatr. 2012. 160:320-324.

Lee JL, Gilleland J, Campbell RM, et al. Internalizing Symptoms and Functional Disability in Children with Noncardiac Chest Pain and Innocent Heart Murmurs. J Pediatr Psychol. 2013. 38(3):255-264.

Loiselle KA, Lee JL, Gilleland J, et al. Factors Associated with Healthcare among Children with Noncardiac Chest Pain and Innocent Heart Murmurs. J Pediatr Psychol. 2012. 37(7):817-825.

Malghem J, Vande Berg B, Lecouvert F, et al. Costal cartilage fractures as revealed on CT and sonography. Am J Roentgenol. 2001. 176:429-432.

Mendelson G, Mendelson H, Horowitz SF et al. Can (99m)-technitium methylene diphosphonate scan objectively document costochondritis?. Chest. 1997. 111(6):1600-1602.

Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007 May. 30(4):321-5. [Medline].

Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. 2009 Apr-Jun. 31(2):169-71. [Medline].

Zaruba RA, Wilson E. IMPAIRMENT BASED EXAMINATION AND TREATMENT OF COSTOCHONDRITIS: A CASE SERIES. Int J Sports Phys Ther. 2017 Jun. 12 (3):458-467. [Medline].

Selbst SM. Approach to the child with chest pain. Pediatr Clin N Am. 2010. 57:1221-1234.

Gregory PL, Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Med. 2002. 32(4):235-50. [Medline].

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

Barry L Myones, MD Co-Chair, Task Force on Pediatric Antiphospholipid Syndrome

Barry L Myones, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American College of Rheumatology, American Heart Association, American Society for Microbiology, Clinical Immunology Society, Texas Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David D Sherry, MD Chief, Rheumatology Section, Director, Amplified Musculoskeletal Pain Program, The Children’s Hospital of Philadelphia; Professor of Pediatrics, University of Pennsylvania School of Medicine

David D Sherry, MD is a member of the following medical societies: American College of Rheumatology, American Pain Society

Disclosure: Nothing to disclose.

Lawrence K Jung, MD Chief, Division of Pediatric Rheumatology, Children’s National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

James M Oleske, MD, MPH François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary, Allergy, Immunology and Infectious , Department of Pediatrics, Rutgers New Jersey Medical School; Professor, Department of Quantitative Methods, Rutgers New Jersey Medical School

James M Oleske, MD, MPH is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Allergy Asthma and Immunology, American Academy of Hospice and Palliative Medicine, American Association of Public Health Physicians, American College of Preventive Medicine, American Pain Society, Infectious Diseases Society of America, Infectious Diseases Society of New Jersey, Medical Society of New Jersey, Pediatric Infectious Diseases Society, Arab Board of Family Medicine, American Academy of Pain Management, National Association of Pediatric Nurse Practitioners, Association of Clinical Researchers and Educators, American Academy of HIV Medicine, American Thoracic Society, American Academy of Pediatrics, American Public Health Association, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Pediatric Costochondritis

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