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NEW TREATMENT for COSTOCHONDRITIS

What is Costochondritis?

Your ribs connect with the sternum (breastbone) via cartilage at synovial-lined joint. Costochondritis is rib pain, specifically a chest wall pain caused by inflammation of the rib cartilages or the area where the ribs meet the sternum, known as sternal articulations (1). In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, Costochondritis was the diagnosis in 36 of the patients (30%) (2). Costochondritis is very painful. Though often self limiting, it can also become chronic, so a new treatment for Costochondritis is a welcome development. new treatment for costochondritis

Why is Costochondritis so painful?

 

Patients give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath. That pain comes from irritation of the small nerves that wrap along the ribs. The rib attachment becomes inflamed and can compress and irritate this nerve, creating the pain. The pain quality is variable, but it may be described as sharp or dull pain. So many physicians will run tests to rule these more serious conditions out such as blood tests, xrays, ECG (electrocardiograms)(3)

Is Costochondritis serious?

Commonly Costochondritis is not serious or life threatening but this can mimic other conditions that can be fatal such as a heart attack or blood clot that is lodged in your lungs called pulmonary embolism(3).

How long does it take for it to go away?

Most cases of Costochondritis are self-limiting, meaning that if you wait long enough it most likely will resolve on its own. Because of this fact, most doctors don’t try at treat it and just send you home with instructions to ice it and take medications such as NSAIDs. In some cases, if becomes a chronic or re-occurring episodes of pain, which can be debilitating!

PRP treatment for Costochondritis

The use of precise image guided injections of PRP is a new treatment for Costochondritis.  PRP stands for Platelet Rich Plasma. PRP consist of growth factors isolated from your own blood. PRP is a preparation of autologous plasma enriched with a platelet concentration above that normally contained in whole blood. The rationale for use and therapeutic potential of a high concentration of platelets is based on their capacity to supply supraphysiologic amounts of essential growth factors to provide a regenerative stimulus that promotes repair in tissues with low healing potential(4). With Costochondritis specifically, aims to reduce inflammation and stabilize the rib connection to the sternum. Here is a quick video on what PRP does:

Are there different kinds of PRP?

Yes, not all PRP is created equal and can be a big determinant on weather it works or not. Here is another video on how to differentiate between good and bad PRP:

Are There Dangers with PRP Injection for Costochondritis?

These injections, while they can be very helpful in treating costochondritis, need to be performed by qualified physicians under ultrasound guidance! This is critical to have licensed and qualified physicians doing the injections, as errors in the injection could cause lung collapse, and wrong placement of the PRP and can worsen your pain.

Here is an ultrasound image of an injection in PRP treatment for costochondritis and you can see the close proximity of the lung field, so poor needle skills or blind injections have a high probability of causing complications from the injection, worst being lung puncture

The Upside:

At the Centeno-Schultz Clinic, our physicians are board certified and fellowship trained in the use of PRP and stem cell treatments for orthopedic injuries. We also utilize the best platform in creating the best quality PRP or stem cell injectate by using the regenexx flexible lab platform! So if you are suffering from costochondritis or another orthopedic condition, feel free to contact us to set up an evaluation to see if there are any treatment options to improve your condition.

References:

1.       Schumann JA, Parente JJ. Costochondritis. [Updated 2019 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532931/

2.       Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch. Intern. Med. 1994 Nov 14;154(21):2466-9. https://www.ncbi.nlm.nih.gov/pubmed/7979843

3.       ANNE M. PROULX, DO, and TERESA W. ZRYD, MD, MSPH Costochondritis: Diagnosis and Treatment, Wright State University Boonshoft School of Medicine, Dayton, Ohio; https://www.aafp.org/afp/2009/0915/p617.pdf

4.       Wu PI, Diaz R, Borg-Stein J. Platelet-Rich Plasma. Phys Med Rehabil Clin N Am. 2016;27(4):825-53.

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