​Kembara Xtra - Medicine - Costochondritis

​Kembara Xtra - Medicine - Costochondritis 
Pain in the front of the chest wall and discomfort in the costochondral and costosternal regions, most commonly affecting the second to the fifth costal cartilages. ● System(s) affected: musculoskeletal 
Costosternal syndrome; parasternal chondrodynia; anterior chest wall syndrome are all synonyms for this condition.

Epidemiology (Incidence and Prevalence): Predominant age: 20 to 40 years; Predominant gender: female Incidence: 30% of trips to emergency rooms for chest pain; 13% of visits to primary care for chest pain Prevalence: 20 to 40 years; Female Epidemiology: Predominant age: 20 to 40 years; 

Pathophysiology 
Inflammation can be generated by tugging from adjoining muscles in the costochondral or costosternal regions, even if the exact mechanism is not completely understood.

Risk Factors Recent upper respiratory infection (URI) with coughing Recent trauma (including motor vehicle accident, domestic abuse), or new-onset physical activity Risk Factors Unusual physical activity or misuse of the upper extremities Recent upper respiratory infection (URI) with coughing Risk Factors

The pain is typically stabbing, aching, or pressure-like, and it involves several (and mostly unilateral 2nd to 5th) costal cartilages. This is the diagnostic symptom.
Movements of the upper body and activities that require physical activity make the condition worse. Palpation of the damaged cartilage segments causes the condition to recur. 
A feeling of constriction in the chest is frequently connected with the pain.


The patient's medical history must be presented in full and in detail, including an assessment of any cardiac risk factors, in order to arrive at an accurate diagnosis.
Careful screening and examination for both substance misuse and instances of domestic violence in the patient's social history

The Patient's Clinical Examination 
A comprehensive cardiopulmonary exam to rule out any other conditions that could be causing the patient's chest pain. - Cardiac rhythm; murmurs; gallops, rubs
- Potentially ominous sounds emanating from the lungs, such as rales, rhonchi, wheezes, and rubs
Tenderness across the costochondral junctions is required to confirm the diagnosis, however this does not definitively rule out the possibility of chest pain being caused by other conditions.
When there is redness or swelling of the costal cartilage, the condition is frequently referred to as Tietze syndrome. Tietze syndrome is also an inflammatory condition that typically affects just one costal cartilage on rib 2.
It's possible that moving the upper extremity on the affected side will bring back the pain.

Considerations Relating to Children
Consider the possibility that the chest pain the youngster is experiencing is psychologically caused.
Consider the possibility that your child has slipping rib syndrome if they have persistent chest and abdominal pain.

Considerations Regarding the Aged

Consider herpes zoster in older people.

Differential Diagnosis Take into consideration the possibility of an alternative diagnosis in the event that additional signs and symptoms are present. These signs and symptoms include shortness of breath, dyspnea on exercise, cough, fever, tachycardia, and hypotension.
Cardiac: coronary artery disease (CAD); acute coronary syndrome (ACS): a cardiac contusion resulting from trauma
– Aortic aneurysm – Pericarditis – Myocarditis – Gastrointestinal – Gastroesophageal reflux – Peptic esophagitis – Esophageal spasm – Cholecystitis – Musculoskeletal – Fibromyalgia – Cholecystitis –
- Syndrome of the Slipping Rib - Arthritis of the Costovertebral Joint - Painful Xiphoid Syndrome - Rib Trauma
● Psychogenic – Panic attacks
Pneumonia, chronic cough, pulmonary embolism, pneumonitis, and pneumothorax are all respiratory conditions.
Other - including but not limited to domestic violence and abuse, herpes zoster, spinal tumors, metastatic cancer, and substance misuse (cocaine).

Findings in the Laboratory Primarily a clinical diagnosis; Laboratory testing and imaging to rule out alternative diseases; Elevated ESR levels regularly found in patients.
Initial Tests (laboratory, imaging) It is not recommended to perform imaging for the diagnosis of costochondritis.

Diagnostic Methods and Other Procedures
ECG should be considered for patients over the age of 35 and for those who have a history of coronary artery disease or are at risk for it. None of these tests are advised for the diagnosis of costochondritis.
X-rays of the chest should be considered in patients who exhibit the necessary cardiopulmonary symptoms.

a spiral CT for pulmonary embolism and D-dimer should be considered if there is a history of or risk factors for pulmonary embolism. CT imaging should be considered if there is a strong suspicion of aortic dissection, an infectious process, or a neoplastic process.
The Interpretation of Tests

 Symptoms of inflammation in the costochondral joint

Management 
Reassurance that the disease is not life-threatening and the possibility of a long, sluggish recovery from the discomfort

Preventative Steps and Precautions 
Stretching exercises Rest and heat (or ice) massage Minimize activities that provoke symptoms (for example, limit the frequency or intensity of exercise or work activity) Minimize symptom-provoking activities.

Medication Relieving pain using nonsteroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or diclofenac), acetaminophen, or other analgesics 
When dealing with muscle spasm, the use of muscle relaxants that target skeletal muscle can be of great use.


Additional concerns with the Referral 
It may be beneficial to refer the patient to physical therapy in order to alleviate discomfort and enhance function.

Rarely required local injections of mixed lidocaine and corticosteroid into costochondral regions are an option for treating costochondritis that does not respond to other treatments. If an alternative diagnosis that requires specialized input is suspected, a referral to a gastroenterologist or cardiologist should be considered.

Different Methods of Treatment 

Acupuncture, dry needling by appropriately qualified physicians, chiropractic manipulation, exercise prescription, acupuncture, and massage all have limited data but might potentially be tried safely by patients who are interested.

Admission

Only in the event that a cardiac cause or another major cause of chest pain is being considered.

Follow-Up Treatments and Other Complementary Therapies 
If the diagnosis is unclear or the symptoms do not improve with conservative treatment, a follow-up appointment should be scheduled within one week.
It is important to educate people about the self-limiting character of the condition, notwithstanding the possibility that it may repeat.

In order to prevent overuse syndromes, the patient should be instructed on the appropriate physical activity regimens.
Attempt to steer clear of sudden and major shifts in activity level.
The disease tends to be self-limiting, meaning that it can last anywhere from weeks to months and usually goes away within a year; nevertheless, it can be persistent, particularly in teens. It frequently comes again.

Complications 

Could be recurring or resistant to treatment.

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