Costochondritis

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Costochondritis
Developed for OUCOM CORE By Sheri Hull, D.O.
Edited by Wayne Feister, D.O. and the CORE
Osteopathic Principles and Practices
Committee Series C Session 7
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Definition

• Inflammation of the junction of the upper ribs
  and the costal cartilage
• Localized chest pain aggravated by coughing,
  sneezing or deep breathing
• aka Anterior Chest Wall Syndrome

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Causes of Costochondritis

• Causes of costochondritis are not known and may
  involve several factors. Possible causes include
  heredity (genetic predisposition), viruses, and
  trauma (injury).
• Costochondritis can be an independent condition
  by itself or sometimes be a feature of a more
  widespread disorder.
• Examples of illnesses that can feature
  costochondritis include fibromyalgia, psoriatic
  arthritis, ankylosing spondylitis, reactive
  arthritis and inflammatory bowel disease, i.e.
  ulcerative colitis and Crohns disease.

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Anatomy
Netter, F. Atlas of Human Anatomy. 2nd Edition.
1997. East Hanover Novartis
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Anatomy
Netter, F. Atlas of Human Anatomy. 2nd Edition.
1997. East Hanover Novartis
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Symptoms

• Chest Pain
• Very common in children and adults
• Sharp chest pain with/without radiation to back
• 4th, 5th, 6th ribs most common
• Reproducible by palpating the costochondral joint

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Differential Diagnosis

• Cardiac Conditions
• Tietze Syndrome
• - An inflammation of the costochondral cartilages
  of the upper front of the chest. Blood testing
  (Sedimentation Rate or C-Reactive Protein Rate)
  can show signs of inflammation in patients with
  Tietze syndrome, whereas patients with
  costochondritis alone typically have normal tests
  for inflammation.

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Diagnosis - Costochondritis

• Motion may be restricted may be necessary to
  correct rib motion restrictions to make accurate
  diagnosis
• Based on painful palpitation of the
  costochondral junction
• Also dependent on exclusion of other causes
  (cardia, infections, etc.)

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Treatment

• Direct Rib Release
• Remember these people are in pain !
• Anti-inflammatory medication and moist heat may
  also offer relief

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Treatment Direct Rib Release
Speece, C., et. al. Ligamentous Articular
Strain Osteopathic Manipulative Techniques for
the Body. 2001. SeattleEastland Press.
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Treatment Direct Rib Release

• The physician presses upward with the bottom hand
  while releasing pressure from the top hand.
• The physician holds this position for several
  seconds, after which the bottom hand releases
  pressure and the top hand exerts downward
  pressure.

Nicholas Atlas of Osteopathic Techniques
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Treatment Muscle Energy

• During exhalation the physicians right hand
  exaggerates the exhalation motion of the
  dysfunctional rib.
• The patient inhales again (black arrow) as the
  physicians right hand resists (white arrow) the
  inhalation motion of the dysfunctional rib.

Nicholas Atlas of Osteopathic Techniques
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Treatment Muscle Energy
The patient exhales, and the physician
exaggerates the exhalation motion (white arrow)
of the dysfunctional rib.
Nicholas Atlas of Osteopathic Techniques
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Treatment HVLA

• The physician slightly rolls the patient toward
  the physician by gently pulling the left
  posterior shoulder girdle forward.
• The physician places the thenar eminence of the
  right hand posterior to the angle of the
  dysfunctional rib.
• The patient is rolled back over the physicians
  hand, and the surface created by the patients
  crossed arms rests against the physicians chest
  or abdomen.

Nicholas Atlas of Osteopathic Techniques
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Treatment HVLA

• Pressure is directed through the patients chest
  wall, localizing at the thenar eminence.
• The patient inhales and exhales, and at end
  exhalation a thrust impulse (white arrows) is
  delivered through the patients chest wall
  slightly cephalad to the thenar eminence.

Nicholas Atlas of Osteopathic Techniques
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References

• Downing, CH. Osteopathic Principles in Disease.
  1935. AAO.
• DiGiovanna, E. Schiowitz, S. An Osteopathic
  Approach to Diagnosis and Treatment. 1997.
  Philadelphia Lippincott, Williams, and Wilkins.
• Kimberly, PE. Outline of Osteopathic
  Manipulative Procedures The Kimberly Manual,
  Millennium Edition. 2000. Marceline AOA.
• Foundations for Osteopathic Medicine. 1997.
  Baltimore Williams and Wilkins.
• Nicholas, AS. Atlas of Osteopathic Techniques.
  2008 Lippincot

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References - continued

• Netter, F. Atlas of Human Anatomy. 2nd
  Edition. 1997. East Hanover Novartis.
• Owens, C. An Endocrine Interpretation of
  Chapmans Reflexes. 1937. AAO.
• Speece, C., et. al. Ligamentous Articular
  Strain Osteopathic Manipulative Techniques for
  the Body. 2001. Seattle Eastland Press.
• http//www.emedicinehealth.com/costochondritis/ar
  ticle_em.htm
• www.steadyhealth.com