Costochondritis and chest and rib pain

This post has been copied and some following posts moved

I don’t know how common it is, but chostochondritis is regularly reported in social media.

With me it varies with my ME, and when I was at my worst the pain was one of my most disabling symptoms. Currently it is only there when I am in PEM. Having said that it only began over fifteen years plus into my ME.

It is frustrating that we still lack a comprehensive ‘natural history’ of our condition.

 

Yes but costochondritis is a mythical diagnosis.
There has been some quite nice work on costochondral pain and it seems likely that it is mostly due to one leg being slightly shorter than the other!!

 

I was intending it as a description rather than a diagnosis. Certainly I have no evidence that inflammation of the cartilage is involved. I suspect for me my legs are irrelevant as it was at its worst when I only got out of bed to go to the loo.

I can not rule out it being posture related, as when it got to the point that I was fainting from the pain all I could do was lie flat on my back as still as possible in a darkened room and wait for it to go away, but then that also applies to migraines. With me it definitely varies with my ME and now only occurs when in PEM and is much milder than it was previously. Subjectively it feels like an ME symptom like migraines when in PEM, rather than an indirect consequence such as my shoulder pain and restricted arm movement that happens when I spend too long lying on my side. Subjectively it is more like the other idiopathic pains I can experience when in PEM rather than something arising from a structural issue.

(Note, when I first started experiencing it my GP sought to rule out heart issues.)

My point in raising it was that unexplained chest pains are observed in ME but like so many other symptoms/features we don’t have good data on frequency.

 

Yes but it is almost certainly a mechanical strain of rib attachments rather than a 'chondritis' which is almost a contradiction in terms since hyaline cartilage has no blood vessels.

 

I agree, but some things are so common that an association is hardly worth looking for. I had the same terrible costal pain as a student, forcing me to lie down. My daughter had it. It is one of those things we reckon almost anyone can get at times. (My legs turn out to be about 3/4 inch different!)

 

Copied post

Just wanted to say I agree with what you say about the chest pain / chostochondritis. I get it too as you describe. Thank you for mentioning it. It's definitely not just one leg longer than the other which is just a silly statement. I liked @Hutan's suggestion that their may be a postural component from lying down in an awkward postion.

I agree that this thread feels like piling it on over a trivial first paper for a phd student.

 

There is actually at least one reasonably good quality published paper on this. People with this symptom were found to be much more likely to have a significant leg difference.

That does not mean that you will only get pain on standing. A leg length difference leads to a twisting effect on the whole ribcage as you grow over a period of years. I know that because as a student I made a plaster cast of my trunk and we could see it (I did not now at the time about my legs).

If you have a twisted thorax it seems likely that you will get pains in all sorts of positions. The usual story with this type of pain is that it comes on instantaneously and unpredictably, very severe. Inflammation doesn't do that.

So yes, like Hutan said.

 

Chest aching and pressure was my first major symptom and lasted for first year of illness. I think it is often part of post-viral onset of symptoms as I saw it then described by many long Covid patients again at the start of illness. It was diagnosed as costochondritis for me even though it didn’t fit the symptom properly, as not a sharp pain or in ribs. More a heavy pressure ache in chest.

 

In the months following ME/CFS onset, I developed a pain at the junction between the sternum and rib, not a constant ache but pain when pressed specifically at the junctions, and with a deep breath if I recall correctly (10 years ago). The practitioner at the time described it as Costochondritis. It lasted a few months.

Now, I was 52 years old at ME/CFS onset. I’d never experienced Costochondritis symptoms in the prior 50-odd years of life, so I can assure you it wasn’t a postural thing. Along with a transverse myelitis episode, I experienced this Costochondritis symptom in the few months following ME/CFS onset.

While I accept cartilage is avascular, it is made of connective tissue, and indicative of my immune profile tests at that time was that I may have a connective tissue disease. If you consider Tietze syndrome, affecting the same spot, symptoms can include swelling and redness, so inflammation must be possible. The cause of Tietze is suspected caused by a physical injury, but also like Costochondritis may be associated with rheumatic, autoimmune and connective tissue disorders.

 

Yes, occasionally I can find the spot and when I press on it I feel the pain.

 

Or hips being out of alignment ?

 

Hips are never out of alignment unless you have congenital dislocation. (A ball and socket only has one way of fitting.) That used to be a reasonably common condition but the last time I saw someone with it was forty years ago and they were over seventy years old. Dislocation of the hip in later life only occurs with major trauma and tends to be associated with fracture and need surgery. Perthes disease and slipped epiphysis lead to hip disintegration but that is something different.

 

Maybe more accurate to say pelvis? Mine's at a funny angle because there's a big enough difference in leg length to make me limp. The blokes in the orthopaedic dept. told me to expect back problems, but luckily I'm so tall I seem to have enough midsection to compensate.

Had to abandon any hope women's trousers would stay up by age of 12 (the 'nipped in' bit most women call their waist is the whole distance between pelvic crest and lowest rib), but I'd rather have to wear men's jeans than put up with constant pain.

 

Sure, the pelvis is out of alignment if legs are unequal.

What most people call 'hips' are of course greater trochanters, not hips - the widest bit the tailor measures.

 

Same here in terms of timing (51) and never before experienced. However I do have a leg length discrepancy. The anterior chest wall pain was on the right, my shorter tibia is on the left. This pain seemed to develop some months after improvement from bedbound phase when I was more able to sit and mobilise a bit more around the house. (I recall the "what fresh hell is this now?" comment!).

If the mechanical asymmetry affects loading stresses at the junction, maybe a bit more remodelling is required when there are long-term changes in posture or perhaps regional mast cells are otherwise more activated, resulting in local pain?

 

A rarely mentioned cause of chest pain which isn't a heart attack is severely low iron and hypovolemia.

When it happened to me, the differential diagnosis after heart attack was ruled out was "anxiety". (Obviously I'm a woman, so I must be anxious. *rolls eyes*) I started treating my own low iron because doctors didn't seem to consider it important. Eventually I noticed that my episodes of severe chest pain were diminishing. Nowadays I don't get it at all.