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Costochondritis
Developed for OUCOM CORE
By: Sheri Hull, D.O.
Edited by Katrina Rakowsky, D.O. and the
CORE Osteopathic Principles and Practices Committee
Series C – Session #7
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Costochondritis
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
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
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 Crohn’s disease.
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Anatomy
CORE OMM Curriculum
for Students, Interns, & Residents
Netter, F. Atlas of Human Anatomy.
2nd Edition. 1997. East Hanover:
Novartis
©2006
Anatomy
CORE OMM Curriculum
for Students, Interns, & Residents
Netter, F. Atlas of Human Anatomy.
2nd Edition. 1997. East Hanover:
Novartis
©2006
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
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Differential Diagnosis
• Cardiac Conditions
• Pulmonary Conditions
• GI 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.
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Costochondritis Diagnosis
• Motion may be restricted – may be necessary
to correct rib motion restrictions to make
accurate diagnosis
• Based on painful palpation of the
costochondral joint(s)
• Also dependent on exclusion of other causes
(cardiac, infectious, etc.)
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Treatment -Costochondritis
Remember these people are in pain!
- Anti-inflammatory medication and moist heat may
also offer relief
LAR Rib Release:
For pain medial to the upper shoulder blade or
costochondritis of the upper ribs:
• Contact rib around its circumference with thumbs
in the axilla and bring to a balance
• After release, rib should return to a normal
physiologic position and start moving with respiration.
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Ligamentous Articular Release
– Costochondritis 2nd and 3rd Ribs
Lateral Recumbent
CORE OMM Curriculum
for Students, Interns, & Residents
Speece, C., et. al. Ligamentous Articular Strain: Osteopathic
Manipulative Techniques for the Body. 2001. Seattle:Eastland Press.
©2006
Treatment: Alternating 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.
CORE OMM Curriculum
for Students, Interns, & Residents
Nicholas: Atlas of Osteopathic Techniques
©2006
Treatment Muscle Energy –
Inhalation Rib Dysfunction
During exhalation the
physician’s right hand
exaggerates the exhalation
motion of the dysfunctional rib.
The patient inhales again
(black arrow) as the
physician’s right hand resists
(white arrow) the inhalation
motion of the dysfunctional rib.
CORE OMM Curriculum
for Students, Interns, & Residents
Nicholas: Atlas of Osteopathic Techniques
©2006
Treatment Muscle Energy –
Inhalation Rib Dysfunction
The patient exhales,
and the physician
exaggerates the
exhalation motion
(white arrow) of the
dysfunctional rib.
Nicholas: Atlas of Osteopathic Techniques
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Treatment HVLA Left 7th
Rib Posterior
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
physician’s hand, and the surface
created by the patient’s crossed arms
rests against the physician’s chest or
abdomen.
Nicholas: Atlas of Osteopathic Techniques
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
Treatment HVLA
Pressure is directed
through the patient’s 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 patient’s chest
wall slightly cephalad to the
thenar eminence.
Nicholas: Atlas of Osteopathic Techniques
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
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
CORE OMM Curriculum
for Students, Interns, & Residents
©2006
References - continued
• Netter, F. Atlas of Human Anatomy. 2nd Edition. 1997. East
Hanover: Novartis.
• Owens, C. An Endocrine Interpretation of Chapman’s Reflexes.
1937. AAO.
• Speece, C., et. al. Ligamentous Articular Strain: Osteopathic
Manipulative Techniques for the Body. 2001. Seattle: Eastland
Press. P.98
• http://www.emedicinehealth.com/costochondritis/article_em.htm
• www.steadyhealth.com
CORE OMM Curriculum
for Students, Interns, & Residents
©2006