Costochondritis (Chest Wall Pain)

Common Symptoms

• Sharp or aching pain at the front of the chest, typically reproducible by pressing on the affected rib cartilage
• Pain that worsens with deep breathing, coughing, certain arm movements, or lying on the affected side
• Localized tenderness over one or more costal cartilage joints, usually without swelling
• Pain that can mimic cardiac chest pain, which is exactly why it must first be ruled out

Why It Happens

The cause often isn't entirely clear, but repetitive strain (including from coughing, certain exercise, or unusual physical activity), minor trauma, or viral illness can irritate the costal cartilage joints connecting the ribs to the breastbone.

Why It Can Become Persistent

Because breathing and many everyday arm and trunk movements load the chest wall, ongoing use can continue to irritate the area, and the condition can wax and wane over weeks to months.

Who Commonly Gets It

Costochondritis can affect anyone, but is somewhat more common in young adults and in people with recent unusual physical exertion, a viral illness, or minor chest trauma.

How It Is Usually Diagnosed

Diagnosis is one of exclusion — a medical evaluation, sometimes including an EKG, chest X-ray, or other testing, is used first to rule out cardiac, pulmonary, or other serious causes of chest pain. Once those are excluded, reproducible tenderness over the costal cartilage supports the diagnosis.

Traditional Treatment Options

• NSAIDs: A common first-line treatment for pain and inflammation.
• Activity modification: Reducing aggravating activity, particularly heavy upper-body exertion, during flare-ups.
• Heat or ice: For symptomatic relief.
• Corticosteroid injection: Used for persistent cases that don't respond to conservative measures.

Why Someone Might Start Looking for Another Option

Once serious causes of chest pain have been ruled out, and if costochondritis persists despite conservative measures, people look for additional non-invasive options, including shockwave therapy.

Where Shockwave Therapy May Fit

A randomized trial of 67 patients with confirmed costochondritis compared shockwave therapy with corticosteroid injection and found the shockwave group had significantly better improvement in pain and a physical measure of tenderness (pressure pain threshold) than the injection group. This is real comparative-trial evidence, though from a single, fairly small trial with only 1 month of follow-up and no untreated comparison group.

How Shockwave Treatment Works for This Area

Once your evaluation has confirmed costochondritis as the diagnosis, acoustic pressure waves are applied over the affected costal cartilage joints.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation over the chest wall; your provider will discuss what to expect.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not yet had a medical evaluation to rule out cardiac, pulmonary, or other serious causes of chest pain — this is essential before assuming a musculoskeletal cause
• Active infection, open wounds, or certain bone conditions at the treatment site
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.