Pain in the chondrosternal joints: Costochondritis?

Patient

Q: Male 33 years old - my husband . Diagnosed cu GERD and hiatal hernia in 2009 treated correctly with Esomeprazol 40mg per day and with a proper diet but with progressive oesophagitis, laringitis post reflux, incompetent cardia etc . Since 9 months ago he started to acuse a pain localised parasternal on the right side. At that moment it thought to be from the hiatal hernia. A laparoscopic hiatal hernia surgery was performed 3 months ago but the pain didn't go away and iradiates interscapulovertebral. After lasertherapy the pain had a smaller intensity. Can it be costochondritis? Physical exam: pain at the palpation of the condrosternal joints. EKG, CK, CK-MB, biologic inflammatory factor negative -VSH, CRP -; biologically nothing pathological; chest X ray normally. Since 1 month ago he accuses backpain with severe paravertebral muscle contracture on the right side. Thoracic X ray was normal. Maybe a costovertebral disorder? It may seem like a connective tissue disease..but which one? Rheumatoid factor negative, no inflammation. So this joint problems and hiatal hernia plus a bad movement of the bowel could mean something?What? Please help, i don't know what to do.

Doctor

A:   Certainly, it is possible that your husband is having a Costochondritis, this pain is usually well localized but it may radiate across the chest and and over the arms. On the other hand, anterior and posterior chest pain may also result from involvement of the nerve roots of the cervical and upper thoracic spine by osteoarthritis, disc disease, etc. In the view that all the tests done for autoimmune disorder came back negative, he has history of GI problems, maybe I would have him a cardiology evaluation and if this comes back negative, most likely he has a Costochondritis, which is not a serious condition but very annoying indeed and slow healing. Usually by a spasm or a direct trauma the costochondral cartilage and nerve get injured, causing a stabbing pain to the palpation and every time you take a deep breath, sneeze or cough. The suggested strategy would be: please, try to be patient and do not expect an overnight improvement, take anti inflammatory medication (“Aleve”, “Motrin”), and also Vitamin B12 supplement. Local moist heat helps to ease the pain. Try to avoid activities that worsen the pain.

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