Etiology
Usually idiopathic.
Inflammatory:
Repetitive microtrauma, such as a history of recent coughing or unaccustomed repetitive upper-limb movement.[1]
Infectious:
Can occur due to direct extension of infection, such as pulmonary infection or sternotomy wound infection or hematogenous spread.[10][11][12]
Risk of hematogenous infectious spread is increased in intravenous drug users and people with diabetes mellitus.[12][13]
Reported infectious organisms includeCandida albicans,Pseudomonas aeruginosa,Staphylococcus aureus, Streptococcus species, and Escherichia coli.[11][12][13][14]
Nomenclature of disease can vary, depending on the presence or absence of swelling of a single costal cartilage.[9] Diagnosis of Tietze syndrome may be made when a patient presents with chest pain, tenderness, and swelling. In costochondritis, swelling is usually absent.
Pathophysiology
Costochondritis has no clear cause. Diagnosis of costochondritis may be associated with previous trauma, illness, or physical strain, such as severe coughing, which can be followed by inflammation of costochondral junctions of ribs or chondrosternal joints.[9]
Classification
Classification of painful musculoskeletal chest-wall syndromes[1][2]
A. Chest wall pain of local origin:
Arising from the ribs and their articulation
Costochondritis
Tietze syndrome - localized swelling of the affected costal cartilages
Seronegative spondyloarthropathies
Rib trauma
Slipping rib syndrome
Costovertebral arthritis.
Arising from sternum
Sternoclavicular arthritis
Manubriosternal arthritis
Painful xiphoid syndrome.
Arising from myofascial structures
Traumatic muscle pain
Precordial catch syndrome
Epidemic myalgia.
Arising from thoracic spine, spinal cord, and spinal nerves.
B. Chest wall pain of remote origin:
Fibromyalgia (fibrositis)
Psychogenic
Referred pain from cervical spine, shoulders, and thoracic outlet.
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