Costochondritis is a common cause of musculoskeletal chest-wall pain, particularly in adolescent patients (12). The onset of the pain may be preceded by a respiratory illness, although the exact etiology is unknown. The pain typically involves two to four contiguous costochondral or costosternal junctions, between the second and fifth costal cartilages (1,12). The joints are not inflamed, and there is no swelling of the joints. The pain is most commonly unilateral, and may affect the left side more frequently than the right. The patient will complain of a sharp pain lasting from several seconds to several minutes, which is exacerbated by deep breathing. Direct palpation of the affected joint(s) will reproduce the pain. The patient may describe a “burning” sensation for a few minutes after deep palpation. It is important to apply sufficient pressure during this palpation, as light touch may not reproduce the pain. A firm “rocking” motion just lateral to the sternum may be effective in eliciting this pain. Costochondritis typically is self-limited (13). Treatment consists of reassurance, rest from athletic or strenuous activities and occasionally may require the use of nonsteroidal anti-inflammatory medications at least in the acute phase.

Tietze syndrome involves the inflammation of a single costochondral junction (14). While this syndrome has been reported in children and even infants, it remains relatively uncommon in childhood (14). The affected joint will be swollen and tender to palpation, and may be warm to the touch. Its etiology is unknown. The pain typically is self-limited, lasting anywhere from a few weeks to a few months. When necessary, nonsteroidal anti-inflammatory medications can be used.

Nonspecific (idiopathic) chest-wall pain is the most common type of chest pain in children and adolescents (see Table 70.2). The pain is described as sharp, lasting several seconds to several minutes. The pain often is exacerbated by deep breathing, and may occur during exercise or while at rest. It is most often located in the center of the chest or just below the breast. Sometimes, squeezing the chest cage or gently pressing on the sternum can reproduce the pain. More frequently, the pain cannot be reproduced by palpating or pushing on the chest, but the costochondral and costosternal joints are not tender. There are no associated symptoms, but patients may feel anxious while experiencing the pain (15). Most patients are able to continue activities despite the pain. Children with idiopathic chest pain tend to have longer courses than children with other etiologies, and may have intermittent chest pain for many months (1,6,16). A thoughtful explanation of the cause and benign nature of the pain frequently is enough to reassure the patient with idiopathic chest-wall pain.

Precordial catch syndrome is a brief (several seconds), sharp, stabbing pain occurring in healthy children, most commonly in patients between 6 and 12 years of age (17). The pain typically is located below the left breast or at the lower left sternal border (17,18). It frequently is pleuritic in nature, worsening with deep inspiration. It also may worsen when the patient bends forward. The pain can be so sharp that the patient will breathe shallowly for several seconds. It can occur at rest or with exercise. If it occurs during exercise, the patient may have to stop and breathe shallowly until the pain subsides. The patient is able to resume activities immediately after pain resolution. The physical examination typically is unremarkable. The etiology is unknown. Treatment typically is unnecessary and ineffective, due to the random nature of the pain (17). Reassurance often is helpful.