Chest Pain in a Teen or Twenty-Something?

In otherwise healthy young adults, chest pain is rarely a serious medical problem. The vast majority of the time, chest pain is coming from the chest WALL, not the heart- which is typically the concern of the patient or his/her family. This chest wall pain is medically labeled as “costochondritis.” We see this more in young females than males, most often between the ages of 20 and 40 years, though younger teenagers may have this as well.

What causes costochondritis?

Sometimes the cause is obvious, such as a new weight lifting regimen or workout routine, or perhaps after a lingering upper respiratory infection that left you coughing for a month. Often, however, we cannot identify a trigger or likely cause.

What does it feel like?

As opposed to the squeezing or pressure sensation that we associate with cardiac pain, chest wall pain tends to be more achy and actually tender to touch. Although the pain may be in multiple locations, it is typically one-sided and often right along the junction of the ribs with the sternum (your breast bone).

Do you need a chest x-ray to diagnose costochondritis?

While chest x-rays may be ordered to rule out other causes of chest pain, there is no specific clinical finding that you can see on a chest X-ray film to “show” costochondritis. Along the same lines, there is no blood test to prove or disprove this diagnosis.

How do we treat costochondritis?

Topical ice massage, stretching and anti-inflammatory medications such as ibuprofen, or straight pain-relievers such as acetaminophen (tylenol) may all be tried to see if they offer improvement. Often people with this complaint are less concerned about making the discomfort go away, but are seeking reassurance there is not something wrong with their heart. The symptoms of costochondritis have an annoying tendency to wax and wane over weeks to months, regardless of what intervention is attempted. Changing behaviors is also critical if there is a concern of an overuse injury as a cause.

The good news is that this is not a medically dangerous condition that leads to scarier diagnoses, and while the symptoms seem to hang on “forever”, the vast majority of the time the symptoms seem to fully resolve by the end of a year.

BOTTOM LINE: Chest pain that is actually tender to touch in an otherwise healthy young person is often “costochondritis”, a benign but annoying chest wall problem that tends to last for weeks to months, then spontaneously resolve.

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