Wednesday, November 18, 2009

Costochondritis- Two Different Types of Costo.

Contrary to popular belief. Well...maybe not popular- since no one seems to know what in the world costo is. =) Anyway. The different kinds of costochondritis are inflammatory costo and Infectious Costo. Below you'll find the different kinds and how they are generally daignosed. You'll read about the different causes of infectious costochondritis as well. My goal is to put as much information out there so all of us crazy cats can heal!

Costochondritis - The Different Kinds of Costo. by Richard M. Kravitz

  • Inflammation of unknown or known (such as fibromyalgia) origin (histologic examination can be normal if origin is unknown)
  • Infection:
    • Can present months to years after surgery (the costal cartilage is avascular, making it vulnerable to infection if it has been exposed, injured, or denuded of perichondrium)
    • Complication of median sternotomy
    • Occurs by spread from adjacent osteomyelitis or may arise de novo during surgery

Costochondritis - How you got it

  • Infectious:
    • Bacterial:
      • Staphylococcus aureus (especially after thoracic surgery)
      • Salmonella (in sickle cell disease)
      • Escherichia coli
      • Pseudomonas species
      • Klebsiella species
      • OR
    • Fungal:
      • Aspergillus flavus
      • Candida albicans
      • OR
  • Posttraumatic injury
  • Inflammation costo from known or unknown origin

Costochondritis - Diagnoses, signs & symptoms

Costochondritis - history

  • Inflammatory costochondritis:
    • Pain usually preceded by exercise or an upper respiratory tract infection
    • Description of pain:
      • Usually sharp
      • Affects the anterior chest wall
      • Localized or radiates to the back or abdomen
      • Usually unilateral (left side greater than right side)
    • The 4th to 6th costochondral junction is the usual site of pain.
    • Motion of the arm and shoulder on the affected side elicits the pain.
    • Girls are affected more often than are boys.
  • Tietze syndrome:
    • Onset is usually abrupt, but can be gradual.
    • Believed to be caused by a minor trauma, though etiology is unknown
    • Description of pain:
      • Radiates to arms or shoulder
      • May last up to several weeks
      • Swelling at the sternochondral junction may persist for several months to years
    • Usually affects the 2nd or 3rd costochondral joint
    • Pain is aggravated by sneezing, coughing, deep inspiration, or twisting motions of the chest
    • No differences in frequency between sexes
  • Infectious costochondritis:
    • Slow, insidious course
    • Usually unimpressive clinical symptoms

Costochondritis - physical exam

  • Usually normal
  • Inspect for evidence of trauma, scars, bruising, and swelling
  • Palpation and percussion of the costochondral and costosternal junctions should reproduce and localize the pain.
  • In Tietze syndrome, spindle-shaped swelling is visible at the sternochondral junction.

Costochondritis - tests that have been used and not been helpful

Costochondritis - lab

  • WBC count not helpful (even when infection present)
  • EKG (may be helpful if cardiac etiology is being considered)

Costochondritis - The different types of imaging used to try and diagnose Costo.

  • Radiologic studies (chest x-ray, CT) usually not helpful
  • Gallium scan:
    • May be useful in some cases of infectious origin
    • Not highly specific
    • May show increased radionuclide uptake
    • No evidence of osteomyelitis of the sternum in most cases
  • Technetium bone scan:
    • Not highly specific
"Infectious (bacterial or fungal) costochondritis should be treated initially with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another two to three weeks to complete the therapy." (information from webmd.com)

35 comments:

  1. I know I'm not the only one whose costo appeared in tandem with fibromyalgia, in fact my fibro was only dxed after it was determined that I had costo of an unknown origin. Mayo Clinic indicates fibro can cause costo. Is that the case, does anyone know? Or are they simply co-morbidities, fellow travelers?

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  2. That is an excellent question. I so wish I knew the answer. You so right, tons of people have both Costo and fibro. Very tough to have both. Sorry I'm of no help. =(

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  3. Hello its Joanne,
    I had several good days ( minimun pain), then yesterday it began again for no apparent reason, except that its colder. When it get cold I tense up and that brings it on... ick!
    I have some information about bras. I take Bragg apple cider vinegar and honey daily, I mentioned that before. But just got their newsletter, Patricia Bragg had some interesting insight. Her father, they say, had the first health food store and they eat and live amazingly healthy. She said that she has never worn a bra, or any tight fitting clothing and advocates that we all do the same. She recommended a book, Dressed to Kill, The Link between Breast Cancer and Bras by Sydney Ross Singer and Somo Greemaijer. They say toxins can pool in the areas where tight fitting clothing is.
    It helps me so much when I do not wear one. So I wear mostly a slightly snug cammie. The flexess can get too tight.
    Costo is so constant, and getting so old!!
    Thanks for all the info, and letting me, a novice, put in my two cents worth.

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  4. Joanne,

    So glad you had a few good days. Bummer that when it got cold, it got worse. EEk!

    Great post, thanks for sharing all that info! My mom is recovering from breast cancer (cancer free as of last week!). I think you shared great counsel.

    I'll remember next time I'm all "free" that I'm helping myself stay cancer free. =)

    Thanks for your comment, love hearing from all of you and really appreciate your thoughts, comments, and advice.
    Lucy

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  5. PS- i do just a camisole with a jacket a lot too. The flexees can be a little tight sometimes for me too. Ouch!

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  6. Just wanted to say yeah for your mom!!! Great, cancer free!!!!
    And here's to cute little cammies! Underwire bra's will never touch my skin again!...Joanne

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  7. Thanks Joanne for celebrating with me!! -) I'm so happy for her! Huge blessing!

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  8. Hi. Thanks for your blog. I just noticed here that costo can come on after an infection such as E. Coli. Which is interesting because just before I had my first attack, I had a round of food poisoning on a vacation in Florida. I thought the costo came on because I spent a lot of time riding in a small car. But maybe it was the infection.

    Anyway, my story is that my costo came on in the early 80s, has been off and on ever since, but I once really helped it with 6 aspirins a day for six weeks and ice for 15 minutes 4 times a day. I'd no longer recommend all those aspirin, but the ice might be a good idea.

    I am currently having a bad attack in my back because my massage therapist insisted on working on my lower back and poked around with her thumb under my lower rib and now I'm in agony. We have to be assertive with people who don't know what costo is.

    Anyway, thanks for making a place to share info.
    Alison

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  9. Alison,

    Thanks so much for your comment and for sharing your story with everyone!

    Yes, you are so right, the E. Coli angle is very interesting. Wow...you've had it since the 80's??!! Alison, WOW, I'm so sorry! =( And I'm sorry you are having a tough time right now with it- Ugg. Not fun at all. And you're so right, we have to be assertive and our own advocates. Took me a long time to learn that.

    Hugs to you, I'm always here to chat or listen. Hope you have a better pain day tomorrow.
    Lucy

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  10. After 6 years, my story is much too long to tell in any detail. The short version...I had a wisdom tooth removed;developed a dry socket infection followed by 6 mos of sinusitus; began experiencing unbearable jaw pain which was diagnosed as neuralgia after x-ray & nuclear scan(wrong diagnosis); 2 1/2 years later, my dentist decides to drill into the tooth adjacent to the removed wisdom tooth & finds INFECTION; abscessed tooth is pulled and 3 days later jaw swells and & I feel a sense of swelling then a "pop" near my left sternum; developed excruciating chest pain and now seem to have the symptoms of Costo/Tietze; have been to Mayo several times with no diagnosis, but did not see a Rheumatologist - I have been injected in my sternum 3 times with no improvement; have had every test imaginable & have probably seen as many doctors as you have.

    Just recently, I had a Technetium bone scan done that show "arthritic changes" in my sternum, but my Internal Medicine doctor does not think it should cause this much pain. I've been doing a lot of my own research over the years, and asked to see an Infectious Disease doctor to see if Infectious Costo was a possiblity. He said absolutely NOT - that after 4 years the infection would have grown and been seen by a CT scan (I've had at least 3 of these - the latest about 6 months ago).

    My question is, do you know or have any way of finding out, how long Infectious Costo can stay localized and/or hard to find or diagnose? I wish I could find a doctor who specializes in this disorder, but don't know how to go about it. My pain is disabling & I am not able to do much. I can't wear a bra either...glad I'm not the only one;-). I am determined to get some type of diagnosis & will go anywhere to do it. The newest research I've read says that if Costo cannot be controlled by meds, surgical removal of the inflamed cartilege is an option. But first I have to get a diagnosis!!

    Happy your Mom is doing well.

    Jean

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  11. Just want to share a few more comments. The Infectious Disease doctor claims a Gallium Scan is of no use. He thinks a chest MRI would be better, but really doesn't think either are called for.(Grrrr - this is how my search for help keeps going. No doctor willing to spend more than the 15 minutes of your appt time to do research) My research from the National Health Institue says the MRI is good in detecting Tietze, but doesn't say anything about Costo.

    I have tried everything under your "How are you Coping" survey. Presently, I am on a narcotic pain killer, an anti-inflammatory, and tranquilizers. Nothing seems to help that much, so any advice of info I can get would be helpful.

    Jean

    Jean(again:-)

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  12. Jean,

    Thanks for sharing all of that with us, my heart really goes out to you. Have you had some time to read through the entire blog? It may give you a lot of info as to how so many are coping, and so many reasons for this crazy pain. I wish I could be of more help, but I'm afraid I don't know much about infectious costo, except that it's most common in drug users. However, I'm not calling you a druggy. =)

    I too thought about the surgery. However, I do know that after all these years with the condition, that if it won't go away, there is always a deeper cause, and thus the surgery rarely helps. Hope I'm not dashing any hopes, I just want to be honest and encourage you to keep digging for reasons for your issues, I know it's exhausting. Maybe look at what your family medical history is. Even if it doesn't seem connected to you- look into this and how it could be manifesting itself in your body.

    I'd also look at auto-immune disorders.

    I'll pray for you tonight, I can feel the depth of your pain and know how you feel. Sending you support from here.

    Hugs and healing,
    Lucy

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  13. Lucy,
    Ha! No, I understand that you are not calling me a druggy (although with all the presciption meds I've been on, you might not be far from the truth:-) By looking at your photo, I think I'm probably old enough to be your Mom - not that it means anything.

    The reason I am so interested in infectious Costo is that I had an abscessed, infected tooth in my mouth for 2 1/2 years - talk about agony! And now this! I've researched repeatedly that infection from an abscessed tooth can migrate, and one of the places it likes to go is the sternum. My pain started immediately after that tooth was pulled (although I had some tingling down my sternum all during that time) and my jaw began swelling - my chest became tight & I felt something pop.

    Even tho I've been to almost as many doctors as you have, no doctor has ever heard of that, which is amazing to me given the evidence I've found at reliable sites.

    I'm so frustrated that as good as I am at researching on the internet (a hobby of mine), I cannot find out how Infectious Costo is diagnosed other than a gallium scan which even your blog says isn't very reliable. The only thing I can find is that it is slow & insidious (also on your blog & another site). My current Infectious Disease doctor says not possible as my symptoms would have been acute and seen on CT. That doesn't sound like "slow & insidious" "or possibly seen by gallium scan" to me. I had x-rays and nuclear scans on my jaw that never detected my abscessed tooth - my dentist just decided to drill in because of my agony and the sensitivity of the tooth...it was a guess on her part.

    Yes, I probably need to pursue auto-immune disease if they already haven't ruled that out at Mayo...had so many tests & bloodwork I can't remember.

    And yes, I am reading through your boards - and commenting:-). I am reluctant to take many supplements as my daughter has a doctorate in pharmaceutical science who often works at Mayo and is constantly warning me of the unknown side-effects & interactions that could happen. It's not that she doesn't believe in supplements - it's just that she feels strongly you have to be extremely careful. Sorry if that offends anyone.

    Thanks for your prayers - so important.
    Ecclesiastes 4:9-10 NIV
    Two are better than one, because they have a good return for their work; If one falls down, his friend can help him up.

    Jean

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    1. This comment has been removed by the author.

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    2. jean, can you please msg me via e-mail. cajunomics@gmail.com

      i would like to know how you are doing and wondering if i have same thing as you. thanks. hope you get this

      (ignore the double post, i deleted the first one, please reply to this one so it notifies me when you get this) thanks again!!!

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  14. Jean,

    Wow, the tooth thing sounds terrible and really really rough. I ache for you and the journey you've been through. i totally hear your frustration.

    I hear ya about taking all the supplements and interactions. Sounds like you have a smart daughter! No one is offended here!

    Love the verse! From one sister to another, thank you!

    Lucy

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  15. I was recently dx with tietze syndrome. But I wonder if it's infectious costo, since prior to it I had sinusitis, strep, conjunctivitis, and after 20 days of antibiotics I got a yeast infection. I had to take two courses of antibiotics. Then about 2 months later I get this pain: costo or tietze. It's not getting any better, even with the 600 mg of ibuprofen. Any thoughts? I've been in pain for 2 months now.

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  16. I am having a root canal tooth pulled. I had the root canal done a year ago March, it got infected. I had an allergic reaction to antibiotics. I woke up 2 months later with horrible pain in my chest. After a year of tests and turmoil, I have been diagnosed with Tietzes. I am pulling the tooth in hopes it is a bacteria issue. The pain is crazy, and seemingly hopeless. I also work in a hospital, and still no hope!

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    1. That's interesting as my costo also started after having a root canal, sinusitis, soft tissue infection and tooth extraction. I also have a root retained in sinus from 5 years ago (which is when I got my first 'bout' of costochondritis). Could there be a connection?
      The pain from this is horrendous. This time, it appears to have come along with other autoimmune issues, e.g. itching. I did have a reaction to something while having the root canal.

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  17. I'll try to keep this brief ...I have not been diagnosed with costo but it fits my symptoms. Last year I went to the ER with chest pain....blood work said no heart attack....doc ordered stress test.....echo showed heart damage...was sent for a heart cath to check for blockage...no blockage...was diagnosed with viral cardiomyopathy....but the chest pain that sent me to the hospital had nothing to do with my heart...I had heart damage and was ordered to rest and put on meds....went to ER again with chest pain...cardiologist has no idea but suggests I see my primary doctor...meanwhile my heart has healed itself my last echo was clear...still having chest pains that radiate to back...elbows starting to bother me and pain is almost constant...was feeling a little better a couple weeks ago and decided to mow the lawn on riding lawn tractor....next day thought I would die the pain was really bad...it has lessened but still there....can't wait to get home from work to remove my bra.....it feels like there is a belt around my chest that someone keeps making tighter.......so I have had ultra sound to check gallbladder and also had a cat scan of my chest ...gallbladder is fine cat scan found small nodule on right lung which I now have to keep a check on but found nothing to cause the pain I am in.....I think the viral infection that caused my heart damage may be the cause of the costochondritis.......have you heard or talked to anyone with viral costo? Of course a viral infection cannot be treated with antibiotics it's a virus......help....what do you think? I will be returning to my primary in a few days...is he who I should be seeing.....I didn't know since it is affecting the ribs and cartilage if I should see an orthopedic doctor????????

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  18. I'm in the same boat...no bra for me unless absolutely necessary. I started have pain after I had swine flue, which later became pneumonia. I then was diagnosed as having asthma resulting from long term damage from the year of sickness. Well, that turned into severe allergies and the specialist thought my chest pain (Front ribs) was muscle spasms from breathing difficulties over the past couple of years. Then he changed his mind after another year of pain complaints and said it's cartilage and finally figures Costo. I've had ongoing sinus infections which lead me to needing sinus surgery and drainage done. The infection is now much worse and I am on CEFTIN for a month. Hope it clears up but my Costo seems to have flared up more. If I had infectious costo, all the different antibiotics I have been on over the last four years maybe helped put it in check. What drug would be used to clear of infectious costo? I am just wondering if this round of antibiotics I'm on would maybe fix the problem if it is infectious??? If I have regular costo I guess I have it for life... Have to wonder if all this infection in my body - lungs, sinus, throat, saliva glands - could all be related in some way

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  19. Hello everyone , I hate to say its nice that I have found others with the same terrible painful issues ,I have had Costo for 5 years this March, mine happened when I helped a neighbor push start a car and as I was pushing the car came back at me. The over extension of the rib cage was felt to be the cause of the costo. I also go to the Mayo, have had high dose steroids with some relief if I had a really long bad flare. We tried it when it was at its most "calm" which is still very painful, and it did no good. I just got back from Arizona and I got stem cell injections into all of the joints. (the stem cells were from myself) I will let you know if it helps. The doc there thought I may have a fungal infection also so that is why its not able to heal. I had a profolatcic mastectomy 15 years ago and I had a time that the area was open due to complications. She put me on anti fungal also so I am some what hopeful this will help. Other than pain meds what helps me the most is heat. Get the kind you can put into the microwave, it helps so much!(the kind with seeds or rice) Especially at night. I also can not wear a bra so I just wear tank tops under everything. Thank goodness for layering. Thanks for all the info, Best wishes everyone!

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  20. Sorry about the Anonymous, I didn't know what my URL is....Im Carrie by the way:)

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  21. Hello all I am a 37 y/o female nurse dealing with chost going on 5 months. It really really stinks. ome today from work because pain is so intense. Had a stress echo last week due to very intense chest pain, as you know it was normal. This agonizing pain in my chest & back really stinks! I have a dr appt today at 1:45 with my pcp who has just been telling me to take NSAIDS. I can't take ibuprofen, toradiol, or voltaren forever?? I will ave no stomach left. I HATE this! I have been healthy ny whole life until last year/this year. Had a URI in Jan which pain has really increased since then. God help me get through this and everyone on here too?? I am Melissa I don't know my URL either ;)

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    1. Hi Melissa I hope you are starting to feel better. I also hope you are being really careful and limiting your movements. I know even breathing is stretching it but take extra care. I had physical therapy for 7 months right after I was injured and all the docs I have spoke to after said that was the worse thing to do. Its such a hard and painful thing to go through. I spoke to so many docs that had never heard of this. and look on here, so many of us in pain. I will keep all of you in my thoughts and hope for some kind of cure. I had stem cell injections and it seemed to help at first, I still can reach my arms up to my head and I couldn't do that for almost 5 years, but if mine is caused by infection it cant heal until its cleared up. I go to my regular doc the 20th. If I find anything that helps I will let you all know. (this is carrie from above)

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  22. Hi I am a 52 yr. old female and I was diagnosed with Fibromyalgia 20 yrs. ago. In late 2009 I had a bout of bronchitis and coughed so much and so hard for over a month. When the coughing finally subsided but I was still getting these pains. Also at the same time I was suffering from a racing heart and high blood pressure. I went to urgent care and although they took care of the high blood pressure and my racing heart the pains were still present. I had a complete work up, thallium stress test, echo, ekg, holter monitor, CT of chest, and exrays. My heart and lungs are fine. Diagnosis by my doc was costochondritis. I can not take any NSAIDS because of my blood pressure so eventually after changing doctors I am managing the pain. She put me on long acting codeine and Elavil and I have some ratio codeine smaller doses when I am having a really bad day. I haven't had to visit an ER for almost a year now. The pain was always so bad I would be in tears and scared, Usually a shot of Toradiol took care of it. the last time I had a shot of toradiol and Tylenol #3 together. Worked well. You can't keep taking Tylenol cause it will wreck your liver and Ibuprofen raises blood pressure. So here we are and we are doing not to bad. I have osteoarthritis in my feet and 1 knee and shoulder, but feeling not to bad.

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  23. Wow! I'm NOT alone!

    Quick history... 43 yr old woman. Fibro dx in 2009. I manage it with being active and have just accepted it for what it is. But have not been active for a few months because of shoulder issues. Had shoulder surgery in May (adhesive capsulitis) and then had Strep Throat and an ear infection at the end of June. 2 weeks after that, I developed Costo. I woke up one day and I had this pain in my chest when I coughed or took a deep breath. I ignored it for a few days and then ended up in the ER diagnosed with Costochondritis.

    I spent a week on percocet unable to do much of anything because I was in a fog (work hates me right now). Then I got on Prednisone, which has done very little. It's only been 2 weeks, but I know I'm stuck with this for a while. My rheumatologist says it's more a "fibro" thing and that's why the steroids aren't working. He prescribed a lidocaine patch; however, not really effective since the worst of the pain seems to be under my breast. But good to have for other fibro-related issues. I now have vicodin, which dulls the pain enough so that I can function, and I try to take it only when needed the most.

    This is so frustrating for me because I don't understand it. I hate not understanding things! But we still don't know what fibro is, so I guess I should just deal.

    Thanks for posting this and letting me know that I'm not alone. I hate it for all of you who have to deal with it - but relieved that others at least understand my pain.

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  24. Hello, my name is Jess, i'm 26 years old and have been suffering Costochondritis for 9 years, had loads to anti inflammatories and now my stomach is ruined, i've had bone scans MRI scans steriod injections and nothing helps, it gets wrse with exercise and stress, it dissappeared from my chest about 3 years ago but it has been in my shoulder ever since, i've had surgery n my shoulder for tendonitis and it has got worse, i've heard Chiropractors help but i had to speak to the chiropractors themselves and most don't know what it is. Hopefully it will help, if it does i'll let you know!

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  25. Hello, From my comment above, i went to the chiropractor yesterday, and it turns out my spine is twisted to the left whichs pulls everything to the right and i have shoulder seperation because of this, last night was the first time in years i could sleep on my side after one session of treatment, i need to go back a few me times but well worth going! If any of you guys try it, good luck, it seems to have worked for me so far so hope it does for you too!

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  26. Hello,
    Gee, I'm amazed at how many people have similar problems. I was beginning to think I was imaging all my problems. Another coming on & being diagnosed one after the other.
    Five years ago (I'm 56). I was diagnosed with Celiac & Lactose intolerant. Then Osteo-Arthritis, Rhuemotoid Arthritis,Osteo-porosis Fibromyalgia& Chronic Fatigue...Then Superior Limbic Keratoconjunctivitis & Dry Eye, Dry Mouth. And just a few weeks ago, Costochondritis.
    It seems that I have had a lot of these problems for longer than 5 years, but wasn't that bad.
    Taking lots of drugs, pain killers to the max as well as anti-inflams.
    BUT,I have lots of loving family & friends, and a great job with an understanding boss & co-workers.
    I can't seem to get pain free, no matter what I do....I can't use cold packs, that makes the Costo worse. But can only use heat in short intervals.
    It sounds like I'm complaining.....don't get me wrong...I have GREAT sympathy for all you suffer ANY type of condition.
    I think myself lucky that this is all I have wrong with me, & I am alive and able to do what I do and enjoy my amazing grandsons.
    I go to an Osteopath, and it helps a little for a few days.
    I too find it better to not wear a bra, but have to wear one to work, because of the shirt I have to wear.
    Good luck to all...stay positive & take care. :-)

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  27. Hello....long story short....i have had bell's palcy in 2010...treated and recovered...
    Deudenitis and easophagitis in 2012....treated and recovered..but in september 2012 i was involved in push ups and all that...and one day i was doing the push ups so fast that suddenly i felt and heard something in my sternum region...ever since i am in pain...before seeing the doctor i tried noni juice...honey walnuts...it worked wonders...but somehow after sometime the pain came back and i went to d doc...he gave me nsaid and mecobalamine ...for few months it really worked...mind u he told me that i have costo..after few weeks i was almost healed but it came back again..
    In august 2013 and afterwards...i am having this tremendous chest pressure and pain and also alot of itching..
    I dont know what to do...is it costo...tietze...RA...INFECTIOUS COSTO OR WHAT..SOME KIND OF CANCER MAY BE...I AM SO NERVOUS

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  28. Hello, I have been having stomach pains for the last couple months. Then one day at work i could not exhale properly i had laboured breathing for two days which was weird i did not feel anxious or anything. Then the next day i had a sharp pain on my sternum and breathing was fine. But lots of pain there. Then a week later i had a chest pain in the middle of my chest that felt like a bruise. Went to the emergency as many of you have also which was scary and they did NO xray or blood tests or anything which bothered me sooo much. Went home unsatisfied in pain and went to family doctor and he diagnosed me with costo. Still have chest pain more all over the place now, and feels like my breast is sore, but not as tender as they day i went to the emergency but more sharp. It is scary i am not sure if it is the right diagnosis or not....any advice?

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  29. I have costochondritis as a result of gallbladder removal surgery late February. It so sucks that I get over the op but have this to contend with. Pain in lower right ribs and sternum varies from pressure to stabbing or clenching to one night's bout that almost had me rushing off to the ER. I'm on Nurofen (Ibufrofen), an anti-depressant and an anti-anxiety/muscle relaxant which I'm having to wean myself off as it's a benzodiazepine which is very addictive. Unfortunately it helps the most! Right now I'm coping with the costo pain and withdrawal symptoms from the drug. Not fun. Hope it goes away soon and that you all get relief as well!

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  30. Hi, I was diagnosed with Costo around 5 months ago after several tests for Heart, Reflux CT scans on lungs etc etc. The pain came around the same time I was doing upper body TRX band workouts but never had this problem before. Had a cortisone injection last week but did not help, next they suggest is a bone scan to rule out any other problems. Not keen on the bone scan, but need to make sure everything in the bone area is okay. The pain can be really bad one week and then okay the next, Randomly it comes and goes. Has anyone else had a bone scan?

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  31. Thankyou for sharing your stories. I have been recovering from a flu bug with a dry cough. Now have excrutiating pain in my right rib cage. I can press on the areas which are tender. I have just taken an anti inflammatory, as from what I have read it sounds like chosto. If doesn't improve over next few days it will be a trip to the doctor.

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