Sternum Inflammation: Understanding Costochondritis, Tietze's Syndrome, Causes, and Treatment

What is inflammation of the sternum called?

Inflammation of the sternum, or breastbone, is most commonly referred to as costochondritis, which involves inflammation of the cartilage connecting the ribs to the sternum. A less common but related condition, Tietze's syndrome, also involves this inflammation but is characterized by visible swelling.

Understanding the Anatomy: The Sternum and Rib Cage

To fully grasp sternum inflammation, it's crucial to understand the anatomy of the thoracic cage. The sternum is a flat, dagger-shaped bone located in the center of the chest. It connects the ribs via cartilage and forms the front of the rib cage, protecting the heart and lungs.

The ribs are connected to the sternum by costal cartilage – strong, flexible connective tissue that allows the rib cage to expand and contract during breathing. The joints where the ribs meet the cartilage are called costochondral joints, and where the cartilage meets the sternum are the sternocostal joints. Inflammation in these cartilaginous joints is the root cause of the conditions discussed.

The Primary Conditions: Costochondritis and Tietze's Syndrome

When individuals experience pain and inflammation around the sternum, two primary conditions are typically considered:

• Costochondritis: This is the most frequent cause of chest wall pain, affecting the cartilage that connects your ribs to your sternum.

  • Key Characteristic: The defining feature of costochondritis is pain without swelling. The pain can be sharp, aching, or pressure-like, often localized to one or more ribs near the sternum. It is benign, meaning it is not dangerous or life-threatening, and often resolves on its own.
  • Prevalence: It is a common condition that can affect people of all ages, though it is more prevalent in adults and adolescents.

• Tietze's Syndrome: While similar to costochondritis in terms of location and pain, Tietze's syndrome is a distinct, less common condition.

  • Key Characteristic: Unlike costochondritis, Tietze's syndrome is characterized by pain accompanied by visible swelling and tenderness of the affected costal cartilage. The swelling can be firm and warm to the touch. It most commonly affects a single rib, usually the second or third, and can persist for longer periods than typical costochondritis.
  • Prevalence: Tietze's syndrome is rare, typically affecting young adults and adolescents.

Causes and Risk Factors

The exact cause of costochondritis and Tietze's syndrome is often unknown (idiopathic). However, several factors can contribute to their development:

• Trauma: Direct impact to the chest, such as from a fall, car accident, or sports injury.
• Repetitive Strain or Overuse: Activities that put stress on the chest wall, including:
  • Vigorous or unaccustomed exercise, such as heavy bench pressing, push-ups, rowing, or overhead movements.
  • Repetitive arm movements.
  • Prolonged or severe coughing or sneezing, often due to respiratory infections.
• Infection:
  • Viral Infections: Upper respiratory infections (e.g., flu, common cold) can lead to inflammation.
  • Bacterial Infections: Less common but more serious, these can occur after surgery or in individuals with IV drug use, leading to septic costochondritis.
• Arthritis: Certain types of arthritis can cause inflammation of the costal cartilage, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and reactive arthritis.
• Fibromyalgia: This chronic pain syndrome can manifest as widespread musculoskeletal pain, including chest wall tenderness.
• Biomechanical Imbalances: Poor posture, muscle imbalances (e.g., overly tight pectorals and weak upper back muscles), or restricted thoracic spine mobility can place undue stress on the sternocostal joints.

Common Symptoms

The symptoms of costochondritis and Tietze's syndrome are primarily related to chest pain:

• Chest Pain: The hallmark symptom is sharp, aching, or pressure-like pain, usually localized to the front of the chest. It often affects one side but can be bilateral.
• Localized Tenderness: The pain is reproducible by pressing on the affected costal cartilage.
• Exacerbated by Movement and Breathing: Pain typically worsens with deep breaths, coughing, sneezing, twisting the torso, or certain arm movements.
• Radiation: The pain may radiate to the back, shoulders, or arms, mimicking more serious conditions like a heart attack, which often causes anxiety.
• Swelling (Tietze's Syndrome Only): A key differentiator for Tietze's syndrome is a visible, sometimes warm, swelling over the affected cartilage.

Diagnosis

Diagnosing costochondritis or Tietze's syndrome primarily involves a process of exclusion, as chest pain can indicate more serious underlying conditions.

• Clinical Examination: A healthcare professional will perform a physical exam, palpating (pressing) the chest wall to identify areas of tenderness. If the pain is reproduced by pressing on the costochondral joints, it strongly suggests costochondritis or Tietze's syndrome.
• Exclusion of Serious Conditions: Due to the location of the pain, doctors will first rule out cardiac issues (heart attack, angina), lung conditions (pneumonia, pleurisy), and gastrointestinal problems. This may involve:
  • Electrocardiogram (ECG/EKG): To assess heart activity.
  • Blood Tests: To check for cardiac enzymes, inflammatory markers, or signs of infection.
  • Chest X-ray: To rule out lung conditions or bone abnormalities.
  • Other Imaging (MRI, CT Scan): Rarely needed for diagnosis of costochondritis itself, but may be used to rule out other causes of chest pain if initial tests are inconclusive.
• Differentiation: The presence of visible swelling helps differentiate Tietze's syndrome from costochondritis.

Management and Treatment Strategies

Management of sternum inflammation focuses on pain relief, reducing inflammation, and addressing any underlying causes.

• Rest and Activity Modification: Limiting activities that aggravate the pain is crucial. This may mean temporarily avoiding exercises that involve chest expansion, heavy lifting, or repetitive arm movements.
• Pain Management:
  • Over-the-Counter (OTC) NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) or naproxen (Aleve) can reduce pain and inflammation.
  • Heat or Cold Therapy: Applying a warm compress or ice pack to the affected area can provide temporary relief.
  • Topical Pain Relievers: Gels or creams containing NSAIDs or counterirritants can be applied directly to the skin.
• Physical Therapy and Rehabilitation: For persistent cases or to prevent recurrence, a physical therapist can be invaluable. They may recommend:
  • Stretching: Exercises to improve flexibility in the chest (pectorals), shoulders, and back, especially the thoracic spine.
  • Strengthening: Exercises to strengthen upper back muscles (rhomboids, trapezius) to improve posture and reduce strain on the front of the chest.
  • Posture Correction: Guidance on maintaining proper posture to minimize stress on the rib cage.
  • Breathing Exercises: Diaphragmatic breathing to reduce reliance on accessory breathing muscles that can exacerbate pain.
• Corticosteroid Injections: In cases of severe, localized, and persistent pain, a doctor may inject a corticosteroid directly into the inflamed cartilage to reduce inflammation.
• Addressing Underlying Causes: If the inflammation is due to an infection, appropriate antibiotics will be prescribed. If it's linked to an arthritic condition, managing that condition is key.

Exercise Considerations and Prevention

For fitness enthusiasts and trainers, understanding how to manage and prevent sternum inflammation is vital for continued safe training.

• Listen to Your Body: The most important rule. If an exercise causes or exacerbates pain in the sternum area, stop immediately.
• Modify Exercises:
  • Reduce Load: Lower the weight or resistance for exercises like bench press, push-ups, or rows.
  • Alter Range of Motion: Perform movements through a reduced range that doesn't provoke pain.
  • Substitute Exercises: Temporarily replace exercises that involve significant chest wall stress. For example, switch from barbell bench press to dumbbell press (allows more natural wrist/shoulder position), incline push-ups, or machine presses.
  • Focus on Form: Ensure impeccable technique to minimize undue stress on joints.
• Prioritize Thoracic Mobility: Incorporate exercises that improve mobility in the upper back.
  • Foam Rolling: Gently roll the thoracic spine to release tension and improve extension.
  • Thoracic Rotations: Cat-cow stretches, thread-the-needle, or seated rotations.
  • Pectoral Stretches: Doorway stretches to release tight chest muscles that can pull on the sternum.
• Strengthen Postural Muscles: Emphasize exercises for the upper back (e.g., rows, pull-aparts, face pulls) to counterbalance strong chest muscles and improve shoulder blade stability.
• Proper Warm-up and Cool-down: Always begin workouts with a dynamic warm-up that includes gentle movements of the torso and shoulders, and end with static stretches.
• Gradual Progression: Avoid sudden increases in training volume, intensity, or new exercises. Progress slowly to allow your body to adapt.
• Breathing Mechanics: Practice diaphragmatic breathing (belly breathing) to reduce reliance on accessory breathing muscles in the neck and chest, which can contribute to muscle tension.

When to Seek Medical Attention

While costochondritis is generally benign, it's crucial to consult a healthcare professional if you experience chest pain, especially to rule out more serious conditions. Seek immediate medical attention if your chest pain is:

• Accompanied by shortness of breath, dizziness, sweating, or pain radiating to your jaw, left arm, or back. These can be signs of a heart attack.
• Severe or worsening despite rest and over-the-counter pain relievers.
• Associated with fever, chills, night sweats, or other signs of infection.
• Accompanied by visible swelling in the chest wall (suggesting Tietze's syndrome).
• Persistent for several weeks or months.

Conclusion

Inflammation of the sternum is most commonly known as costochondritis, characterized by localized chest pain without swelling, or the less common Tietze's syndrome, which includes visible swelling. While often benign and self-limiting, understanding the causes, symptoms, and appropriate management strategies is crucial for effective recovery and safe return to activity. For fitness enthusiasts, a proactive approach involving activity modification, targeted mobility, and strengthening exercises, coupled with listening to your body, can significantly aid in prevention and recovery, ensuring your continued journey toward optimal health and performance.