Diagnosis for<unk>  is primarily a clinical one, though some studies suggest the use of radiologic imaging. Musculoskeletal conditions are estimated to account for 20-50% of non-cardiac related chest pain in the emergency department. Ruling out other conditions, especially potentially life-threatening ones such as myocardial infarction (heart attack) and angina pectoris, is extremely important as they can present similarly to<unk> . These can usually be ruled out with diagnostic tools such as an electrocardiogram and a physical examination showing reproducible chest wall tenderness, . After eliminating other possible conditions, physical examination is considered the most accurate tool in diagnosing<unk> . Physical examination consists of gentle pressure to the chest wall with a single finger to identify the location of the discomfort. Swelling and tenderness upon palpation at one or more of the costochondral, sternocostal, or sternoclavicular joints, is a distinctive trait of<unk>  and is considered a positive diagnosis when found. There are some pathological features that can be observed with<unk> , including degeneration of the costal cartilage, increase in vascularity, and hypertrophic changes (enlarged cells). However, these features can only be identified from a biopsy. Some studies have begun exploring and defining the use of radiographic imaging for diagnosing<unk> . This includes computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, and ultrasound, though these are only case studies and the methods described have yet to be thoroughly investigated. Methods such as plain radiographs, better known as an x-ray, are helpful in the exclusion of other conditions, but not in the diagnosis of<unk> . Some researchers believe that ultrasound is superior to other available imaging methods, as it can visualize the increased volume, swelling, and structural changes of the costal cartilage. Differential diagnosis The symptoms of<unk>  can display as a wide variety of conditions, making it difficult to diagnose, especially to physicians unaware of the condition. Due to its presentation,<unk>  can be misdiagnosed as a number of conditions, including myocardial infarction (heart attack), angina pectoris, and neoplasms. Costochondritis is most commonly confused with<unk> , as they have similar symptoms and can both affect the costochondral and sternocostal joints. Costochondritis is considered a more common condition and is not associated with any swelling to the affected joints, which is the defining distinction between the two.<unk>  commonly affects the 2nd or 3rd rib and typically occurs among a younger age group, while costochondritis affects the 2nd to 5th ribs and has been found to occur in older individuals, usually over the age of 40. In addition, ultrasound can diagnose<unk> , whereas costochondritis relies heavily on physical examination and medical history. Another condition that can be confused for<unk>  and costochondritis is slipping rib syndrome (SRS). All three conditions are associated with chest pain as well as inflammation of the costal cartilage. Unlike both costochondritis and<unk> , which affect some of the true ribs (1st to 7th), SRS affects the false ribs (8th to 10th). SRS is characterized by the partial dislocation, or subluxation, of the joints between the costal cartilages. This causes inflammation, irritated intercostal nerves, and straining of the intercostal muscles. SRS can cause abdominal and back pain, which costochondritis does not.<unk>  and SRS can both present with radiating pain to the shoulder and arm, and both conditions can be diagnosed with ultrasound, though SRS requires a more complex dynamic ultrasound. The vast differential diagnosis also includes: * Pleural diseases including pleurisy, pneumonia, pulmonary embolism, and pneumothorax. * Rheumatic disorders such as rheumatoid arthritis, ankylosing spondylitis, and rheumatic fever. * Arthritis of the costal cartilages, including rheumatoid arthritis, septic arthritis (pyogenic), monoarthritis, and psoriatic arthritis. * Neoplasms, both benign and malignant (cancerous), including chondroma, osteochondroma, multiple myeloma, osteosarcoma, Hodgkin lymphoma, and carcinoma. * Nerve pain, specifically intercostal neuritis and intercostal neuropathy. *Aortic dissection, a serious condition involving a tear in the body's largest artery.
Tietze syndrome
Costochondritis
Galloway Mowat syndrome
Zechi-Ceide syndrome
Mungan syndrome
Schimmelpenning syndrome
Antley–Bixler syndrome
Havana syndrome