Nursing Guide to Costochondritis: Nursing Diagnosis, Interventions, & Care Plans

Costochondritis Etiology and Epidemiology

Costochondritis (also called costosternal syndrome) can be described as benign pain in the chest wall due to costal cartilage inflammation (Wise, 2021). Costal cartilage is the connective tissue that connects the ribs to the sternum at the sternal articulations (costosternal joints) (Schumann et al., 2021). Costochondritis most often affects the upper costal cartilages at the 2nd to 5th ribs, and typically more than one joint is affected.

Pain or tenderness at the area often raises suspicion of MI or angina, as there is no external swelling, heat, or erythema (Wise, 2021).

The cause of costochondritis is often unknown unless there has been prior trauma (e.g., a fall with associated rib fracture) in the area. Other suspected causes may be:

• Repetitive joint strain injuries (e.g., associated with persistent coughing or repetitive movements)
• Heavy lifting
• Strenuous exercise
• Viral respiratory infections.

Prevalence is not well known. However, 1994 study suggests it is more common in the Hispanic population (Disla et al., 1994).

Costochondritis Diagnosis

The diagnosis of costochondritis begins with ruling out more serious diagnoses associated with chest pain. A thorough pulmonary and cardiac assessment should be performed. Differential diagnoses that should be excluded include (Schumann et al., 2021):

• Acute coronary syndrome or myocardial infarction
• Esophageal injury
• Pulmonary embolism
• Aortic dissection
• Pneumothorax
• Pneumonia
• Rib fracture

Tietze syndrome should also be excluded as a diagnosis as this is often confused with costochondritis. This condition is rare but is characterized by swelling of one specific costal cartilage, usually at the 2nd rib (Proulx & Zyrd, 2009).

After other conditions are ruled out, diagnosis can be made by reproducing pain at the costosternal junctions with palpation. Pain associated with costochondritis typically has the following characteristics (Schumann et al., 2021; Wise, 2021):

• Worsens with movement
• Worsens in certain positions
• Worsens with deep breathing or coughing
• May be sharp, dull, or pressure-like
• May be localized or radiate
• May last for 6 to 12 months

There are no laboratory tests associated with diagnosis, but evaluation should include an EKG and chest X-ray to rule out other diagnoses. However, a chest X-ray will appear normal in patients with costochondritis.

Management

Management includes pain control with nonsteroidal anti-inflammatory drugs (NSAIDs) (Schumann et al., 2021). Some providers may also prescribe muscle relaxants such as cyclobenzaprine (Flexeril®). Topical creams or patches may also be useful, in addition to gentle stretching, physical therapy, minimizing physical activity involving the chest, and intermittent heat therapy.

In general, costochondritis is a self-limiting, benign condition that requires minimal medical management.

Costochondritis Nursing Care Plan

Costochondritis Assessment

Assess for:

• Pain with movement
• Pain with deep breathing
• Any external signs of trauma
• History of repetitive movements or recent respiratory illness
• Rule out signs and symptoms of differential diagnoses such as:
  • Shortness of breath
  • Vital sign abnormalities
  • Nausea/vomiting

Nursing Diagnosis/Risk For

• Acute pain
• Alteration in comfort
• Alteration in breathing pattern (related to pain)

Interventions

• Apply warmth to the area with a heating pad or warm compress.
• Provide ongoing assessment of symptoms and vital signs.
• Administer prescribed medications for pain and inflammation.

Expected Outcomes

• The patient will understand the condition and what causes it.
• Pain will be decreased with prescribed medications and therapeutic interventions.

Patient/Caregiver Education

Educate the patient on:

• The condition, emphasizing that this is a NON-life-threatening form of chest pain
• Medication regimens and precautions with NSAIDs
• Heat application and gentle stretching of surrounding muscles
• Preventive measures such as proper body mechanics with exercise and work activities
• Avoidance of strenuous exercise and activity until resolution of symptoms

Content Release Date

4/1/2022

Content Expiration

12/31/2027

Course Contributors

The content for this course was created by Laura Bell, BSN, RN, CCRN.

Laura is a SME writer for Relias with over 13 years of acute care experience in nursing. She began working in adult critical care at Wake Med Cary Hospital in 2011, obtained her CCRN certification in 2016, and served in the role of Rapid Response/Code Blue/Rounding RN for over 2 years. She continues to work as a staff nurse in the intensive care unit. Laura has a passion for education and excellence in nursing care. She has been involved in numerous special projects and educational activities to improve staff development, evidence-based clinical practice, and patient satisfaction. She continues to strive for excellence in education and clinical development as an acute care course writer.

References

• Disla, E., Rhim, H. R., Reddy, A., Karten, I., & Taranta, A. Costochondritis. (1994). A prospective analysis in an emergency department setting. Archives of Internal Medicine, 154(21), 2466-2469. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/619617
• Proulx, A. M., & Zryd, T. W. (2009). Costochondritis: Diagnosis and treatment. American Family Physician, 80(6), 617-620. https://www.aafp.org/pubs/afp/issues/2009/0915/p617.html
• Schumann, J. A., Sood, T., & Parente, J. J. (2021). Costochondritis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK532931/
• Wise, C. M. (2021). Major causes of musculoskeletal chest pain in adults. UpToDate. https://www.uptodate.com/contents/major-causes-of-musculoskeletal-chest-pain-in-adults?search=costochondritis&sectionRank=1&usage_type=default&anchor=H7&source=machineLearning&selectedTitle=1~82&display_rank=1#H7