Costosternal chest pain

Costosternal chest pain research declares that Tietze's syndrome is the cause of roughly one third of people presenting at the emergency room with a suspected heart attack; breastbone pain.

Costosternal chest pain - in the joint between the rib and the breastbone - is the most common cause of "non-heart" chest pain. Chiropractic treatment of this breastbone pain is built around a thorough understanding of the anatomy.

Is this a heart attack or costosternal chest pain?

This page was last updated by Dr Barrie Lewis on 6 February, 2019.

This morning I fell down the stairs. It happened so suddenly that I do not remember any of it; but as soon as I realized what was happening I felt a sharp pain by the breastbone. All day everything I have done has hurt.

It is painful to breathe, I have a really hard time buttoning up my pants, and bending over to pick anything up is rather difficult. But as far as I know when I fell the only things that touched the ground were my arms, back, legs, and buttocks.

One of two things has probably happened; you have either cracked a rib which is quite likely since taking in a deep breath is painful, or injured the costosternal joint.

The cracked rib, assuming it is an undisplaced fracture, will heal in about a month, with no treatment. Grin and bear it. Use ice, and do not do the things that cause pain. Do not breathe deeply.

It is likely to be quite painful for a couple weeks.

An injured costosternal joint is more difficult, and also often has a corresponding pain in the midback. It can lead to a distressing condition called Tietze's syndrome.

You need to use your common sense. If your gut feeling is that you have had a serious injury then it is probably best to get an x-ray. If not, use alternating ice and heat and be careful for a couple days and see what happens.

If the pain continues, do not leave it. Tietze's syndrome can be murder.

Let us know how you get on.

Dr Barrie Lewis DC

The costo-chondral cartilage (see pic below) is the cause of one third of patients complaining of chest pain in one hospital's heart clinic - it's THE MOST COMMON CAUSE of non-heart chest pain.

Costosternal chest pain

Costosternal chest pain research declares that Tietze's syndrome is the cause of roughly one third of people presenting at the emergency room with a suspected heart attack.

One of the simplest treatments is cold hot therapy.


Chest pain is very common and obviously can be serious. However, it usually isn't. The proportion of patients with joint related chest pain is called the PREVALENCE. Recent research about chest pain reveals:

  • In the emergency department, approximately 10 to 15 percent of adults and 23% of children presenting with chest pain have a musculoskeletal breastbone condition, like Costosternal Chest Pain.
  • In one large study 11 percent of adults presenting with chest pain were felt to have a costo sternal cause. The incidence rose to 26 percent in those patients considered at low suspicion for myocardial infarction, making this THE MOST COMMON category of non-cardiac chest pain in this setting.
  • In an emergency department study of 122 consecutive patients, 30% were felt to have chest wall tenderness due to a costo-sternal syndrome. In 17, the tenderness reproduced their pain. (NB. Two of these patients had acute myocardial infarction, indicating that chest wall tenderness does not exclude the presence of serious coronary disease.)
  • In a study of 250 patients hospitalized for chest pain, 23% of the non-cardiac patients were felt to have a Costo-sternal (musculoskeletal) cause.
  • In a review of 399 episodes of chest pain evaluated in primary care practice settings, 36 percent were categorized as costo sternal (musculoskeletal) in origin, making this the most common diagnostic category.
  • Could it be a HEART ATTACK ...?

Chiropractic help

Chiropractic help receives many queries about breastbone discomfort, also known as costosternal chest pain.

Mr Slechtriem is a barge captain ferrying goods along the Rhine to Switzerland from Rotterdam. He consulted me for headaches that plagued him since a childhood fall from a swing.

On further questioning about conditions, he spoke of the frequent debilitating pain in the chest, pointing directly over the costo-sternal joints.

He was clearly a non-heart patient. Young, strong, non-smoker with low blood pressure. In any case he had been medically assessed.

Whilst the condition has not completely abated, he reported that within a month of starting treatment that the pain was at least 80% better. It does rear its ugly head occasionally, but abates now of its own accord.

He comes for management of his chest pain and headaches about once in 6 weeks, which keeps it under control. We are not going to cure him, alas, but he is well pleased.

In an average primary care clinic, at least one third of patients complaining of chest pain, have this costo-sternal condition. It may progress to Tietze's syndrome.

For more information on heart-related CHEST PAIN read this page.

Tietze's syndrome

Tietze's syndrome is characterised by tenderness and sometimes swelling of the breastbone rib joint, and sometimes that between the clavicle and the sternum.

In anatomical terms it's called costosternal chest pain.

I call it a stage 4 of costosternal chest pain; it can be a very distressing condition that has no acknowledged and scientifically proven treatment, but it responds reasonably well to chiropractic.

Note well that a heavy manipulation in the mid back will aggravate Tietze's syndrome, and in fact the lower grades of costosternal chest pain. The chiropractic adjustment of choice is the anterior thoracic technique.

It occurs not uncommonly after breast surgery and mastectomy causing great distress in the patient who assumes there has been a metastasis to the ribs or lungs. A thorough, careful examination of the whole area is vital to make a speedy diagnosis, because Tietze's syndrome is very treatable with chiropractic, but you are unlikely to be cured, like many medical conditions.

As an aside we should not be too disturbed that our conditions cannot be completely cured; it is just as true of most medical problems.

It is a good reason not to allow conditions to become chronic; for example, research indicates that no matter what treatment you have, after six months of neck pain you have it for life.

That is most likely also true of all our aches and pains. See your local chiropractor for your costosternal chest pain, and make sure that you do it as soon as you realise it is not going to resolve on its own. Certainly do not wait six months, or you may have it for ever.

Our best solution then is an occasional, but regular chiropractic adjustment for your chronic conditions; rather like the diabetic must continue with medical care.

Having said that, with type 2 diabetes the most important treatment is done at home; strictly limiting refined carbohydrate and taking regular short walks after meals to stop spikes in blood glucose. Likewise using ice and gentle massage between the ribs is something you can and must do at home, daily if necessary.


Costosternal chest pain research declares that breastbone pain is the cause of roughly one third of people presenting at the emergency room with a suspected heart attack.

The costosternal cartilage is a big source of chest pain.
Tietze's syndrome affects the SC joint too.

Medical and chiropractic practice often puts doctor and patient in a compromising situation. If you enjoy reading, you will certainly love this chiropractic book, and the chapter where Bernard Preston DC is fired for doing a breast examination on a patient with Tietze's syndrome. Ultimately it turned out to be a blessing in disguise...

Stones in my Clog cover by Bernard Preston.

Google appears to frown on too many links, so phrases in bold, like that Stones in my Clog below, need to be put into the Site Search function in the navigation bar on your left if you want more information.

› Costosternal chest pain

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

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