Costochondritis: Are the symptoms and signs due to neurogenic inflammation. Two cases that responded to manual therapy directed towards posterior spinal structures

Published:March 15, 2007DOI:https://doi.org/10.1016/j.math.2006.12.007
      Approximately 50% of patients attending accident and emergency departments and outpatient cardiac clinics because of chest pain have a non-cardiac basis for their symptoms. They are often given a non-specific diagnosis (
      • Mayou R.
      • Bryant M.
      • Sanders D.
      • Bass C.
      • Klimes I.
      • Forfar C.
      A controlled trial of cognitive-behavioural therapy for non-cardiac chest pain.
      ,
      • Capewell S.
      • McMurray J.
      ). One possible diagnosis these patients may receive is costochondritis. Possible causes of costochondritis will be discussed and a group of these patients delineated for whom there is no documented underlying pathophysiology. This paper then presents two such case reports and goes on to question whether costochondritis is simply localised anterior chest wall pathology. It is considered whether positive responses to manual therapy directed towards the spine and posterior rib articulations are indicative of a more widespread neuropathic contribution to the condition.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Bogduk N.
        The nervous system.
        in: Palastanga N. Field D. Soames R. Anatomy and human movement. 2nd ed. Butterworth Heinemann, London1994: 795-878
        • Bogduk N.
        • Engel R.
        The menisci of the lumbar zygapophyseal joints.
        A review of their anatomy and clinical significance. Spine. 1984; 8: 454-460
        • Boyle J.
        Is the pain and dysfunction of shoulder impingement lesion really second rib syndrome in disguise? Two case reports.
        Manual Therapy. 1999; 4: 44-48
        • Boyle J.
        • Singer K.
        • Milne N.
        Pattern of intervertebral disc degeneration in the cervicothoracic junctional region.
        Manual Therapy. 1998; 3: 72-77
        • Boyling J.
        Editorial.
        Manual Therapy. 1999; 4: 61-62
        • Capewell S.
        • McMurray J.
        “Chest pain-please admit”: Is there an alternative? British Medical Journal. 2000; 320: 951-952
        • Devor M.
        • Dubner R.
        Centrifugal activity in afferent C-fibers influences the spontaneous afferent barrage generated in nerve end neuromas.
        Brain Research. 1998; 446: 396-400
        • Elvey R.
        Treatment of arm pain associated with abnormal brachial plexus tension.
        Australian Journal of Physiotherapy. 1986; 32: 225-230
        • Erwin W.
        • Jackson P.
        • Homonko D.
        Innervation of the human costovertebral joint: implications for clinical back pain syndromes.
        Journal of Manipulative and Physiological Therapeutics. 2000; 23: 395-403
        • Fallon J.
        Chiropractic manipulation in the treatment of costovertebral joint dysfunction with resultant intercostal neuralgia during pregnancy.
        Journal of the Neuromusculoskeletal System. 1996; 4: 73-75
        • Kang J.
        • Stephanovic-Racic M.
        • McIntyre L.
        • Georgescu H.
        • Evans C.
        Toward a biochemical understanding of human intervertebral disc degeneration and herniation.
        Spine. 1997; 22: 1065-1073
        • Levine J.
        • Clark R.
        • Devor M.
        • Helms C.
        • Moskowitz M.
        • Basbaum B.
        Interneuronal substance P contributes to the severity of experimental arthritis.
        Science. 1984; 222: 547-549
        • Lovick T.
        Interactions between descending pathways from the dorsal and ventrolateral periaquaeductal gray matter in the rat.
        in: Depaulis A. Bandler R. The Midbrain periaquaeductal gray matter. Plenum Press, New York1991: 101-134
        • Maitland G.
        • Hengeveld E.
        • Banks K.
        • English K.
        Maitland's vertebral manipulation.
        7th ed. Butterworth Heinnemann, London2005
        • Mayou R.
        • Bryant M.
        • Sanders D.
        • Bass C.
        • Klimes I.
        • Forfar C.
        A controlled trial of cognitive-behavioural therapy for non-cardiac chest pain.
        Psychological Medicine. 1997; 27: 1021-1031
        • Mendelson G.
        • Mendelson H.
        • Horowitz S.
        • Goldfarb C.
        • Zumoff B.
        Can sup 99m technetium methylene diphosphonate bone scans objectively document costochondritis? Chest. 1997; 6: 1600-1602
        • Mense S.
        Considerations concerning the neurobiological basis of muscle pain.
        Canadian Journal of Physiology and Pharmacology. 1991; 69: 610-616
      1. Olmarker K, Rydevik B. Selective inhibition of TNF—a prevents the nucleus pulposus-induced reduction of nerve conduction activity. Proceedings of international society for the study of the lumbar spine, Adelaide; 2000. pp. 13.

      2. Okawa A, Haro H, Takahashi M, Komori H, Shinomiya K, Yokoyama M. Biochemical response of the intervertebral disc cells induced by an acute shear force in a rat tail model. Proceedings of international society for the study of the lumbar spine, Adelaide; 1998. pp. 27.

      3. Reinecke J, Wehling P, Granrath M, Meijer H. The use of interleukin-1-receptor antagonist (IL-1 ra) in the treatment of “lumbar facet syndrome”. Proceedings of international society for the study of the lumbar spine, Adelaide; 2000. pp. 173.

        • Scott E.
        • Scott B.
        Painful rib syndrome—a review of 76 cases.
        Gut. 1993; 34: 1006-1008
        • Skyba D.
        • Radhakrishnan R.
        • Rohlwing J.
        • Wright A.
        • Sluka K.
        Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord.
        Pain. 2003; 106: 159-168
        • Triano J.
        • Erwin M.
        • Hanson D.
        Costovertebral and costotransverse joint pain: a commonly overlooked pain generator.
        Topics in Clinical Chiropractic. 1999; 6: 79-93
        • Wadhwa S.
        • Phan T.
        • Terei O.
        Anterior chest wall pain in postpartum costochondritis.
        Clinics in Nuclear Medicine. 1999; 24: 404-406
        • Woolf C.
        • Doubell T.
        The pathophysiology of chronic pain—increased sensitivity to low threshold A-beta fibre inputs.
        Current Opinion in Neurobiology. 1994; 4: 525-534
        • Wright A.
        Hypoalgesia post-manipulative therapy: a review of a potential neurophysiological mechanism.
        Manual Therapy. 1995; 1: 11-16