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Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral (rib to cartilage) and sternocostal (cartilage to sternum) joints. 90% of patients are affected in multiple ribs on a single side, typically at the 2nd to 5th ribs. [1]
Costochondritis is a common cause of chest pain, consisting of up to 30% of chest pain complaints in emergency departments. The pain is typically diffused with the upper costochondral or sternocostal junctions most frequently involved, unlike slipping rib syndrome, which involves the lower rib cage.
Psychogenic causes of chest pain can include panic attacks; however, this is a diagnosis of exclusion. [12] In children, the most common causes for chest pain are musculoskeletal (76–89%), exercise-induced asthma (4–12%), gastrointestinal illness (8%), and psychogenic causes (4%). [13] Chest pain in children can also have congenital causes.
The underlying cause is unclear. Some believe the pain may be from the chest wall or irritation of an intercostal nerve. [1] [2] Risk factors include psychological stress. [2] The pain is not due to the heart. Diagnosis is based on the symptoms. Other conditions that may produce similar symptoms include angina, pericarditis, pleurisy, and chest ...
Unlike both costochondritis and Tietze syndrome, which affect some of the true ribs (1st to 7th), SRS affects the false ribs (8th to 10th). SRS is characterized by the partial dislocation, or subluxation, of the joints between the costal cartilages. [26] This causes inflammation, irritated intercostal nerves, and straining of the intercostal ...
Stress and potential cardiac damage from exercise during the test is a problem in patients with ECG abnormalities at rest or in patients with severe motor disability. Pharmacological stimulation from vasodilators such as dipyridamole or adenosine, or positive chronotropic agents such as dobutamine can be used.
CVA tenderness is also present in patients who have retrocecal appendicitis and retroperitoneal abscesses. [4] In patients with sickle cell disease, blockage of blood flow to the kidney may cause CVA tenderness. [4] A lack of CVA tenderness in patients with low back pain supports a diagnosis other than kidney pathology. [7]
The Bruce protocol is a standardized diagnostic test used in the evaluation of cardiac function and physical fitness, developed by American cardiologist Robert A. Bruce. [1] According to the original Bruce protocol the patient walks on an uphill treadmill in a graded exercise test with electrodes on the chest to monitor.