Examination of Costochondral Pain

Physical Examination Approach

The American College of Cardiology recommends performing a focused cardiovascular examination initially to rule out serious causes of chest pain such as acute coronary syndrome, aortic dissection, pulmonary embolism, or esophageal rupture 1
Palpate the costochondral joints systematically to identify areas of tenderness, which is the hallmark finding in costochondritis, as suggested by the American College of Radiology 2
Assess for pain exacerbation with deep breathing, coughing, or movement, which is characteristic of pleuritic chest pain, according to Praxis Medical Insights 3
Check for friction rub, which may indicate pleural or pericardial involvement rather than costochondral pain, as noted by Praxis Medical Insights 3

For patients older than 35 years or with cardiac risk factors, the American College of Cardiology recommends obtaining an ECG to rule out cardiac causes 1
Chest radiography may be useful as an initial imaging test to evaluate for specific etiologies or conditions that may simulate chest wall pain, as suggested by the American College of Radiology 2, 4
Ultrasound can be helpful in detecting costochondral abnormalities not visible on radiographs, with higher sensitivity than CT for detecting costochondral involvement, according to the American College of Radiology 5
Consider rib series radiographs for focal chest wall pain to assess for rib fracture or other rib lesions, as recommended by the American College of Radiology 6, 7

Anginal pain from coronary artery disease is usually described as pressure or heaviness rather than sharp or stabbing, as noted by Praxis Medical Insights 3
Pleuritic pain worsens with respiration and may be accompanied by a pleural friction rub, according to Praxis Medical Insights 3
Pain that is reproducible with chest wall palpation suggests musculoskeletal origin but does not completely rule out serious conditions, as reported by Praxis Medical Insights 3

Most nontraumatic musculoskeletal chest wall pain has been attributed to costochondritis, according to the American College of Radiology 2
Anterior chest wall pain affects a significant percentage of those with axial spondyloarthritis and may be the first manifestation of disease in some patients, as noted by the American College of Radiology 4