What Is a Costochondral Separation

What Is A Costochondral Separation?

A costochondral separation (CS) is a condition where one or both of your ribs are missing. CS occurs when the cartilaginous tissue covering your ribs separates from the bone underneath it. You may have had a previous injury that caused some damage to these tissues which then became detached. The cartilage will eventually grow back together but not always right away, leaving you with a gap between your ribs.

In most cases, the gap is very small and there are no symptoms. However, if left untreated, it can lead to other problems such as:

Heart disease

Kidney failure (kidney stones)

Lung cancer (cancer of the lungs)

How Common Is Costochondral Separation?

The incidence of CS varies greatly depending on age group and gender. It’s estimated that around 1 in every 500 people have a CS. There are many different causes of CS including:

Trauma to the chest

Chest injuries such as a fall or car accident

Cancer treatments (chemotherapy)

Smoking and alcohol abuse (alcoholism)

Causes Of Costochondral Separation And How To Treat Them?

As mentioned above, there are many different causes of costochondral separation. Each one of these causes is unique and requires a different treatment for recovery.


If you are in an accident or fall that involves trauma to your chest then you may suffer from a costochondral separation. These types of injuries usually occur between the ribs, but can also occur at the sternum (breastbone).

The main types of trauma that can cause a costochondral separation include:

A car accident

A fall

Slapping the chest wall (if you are prone to habitually slap yourself for fun, this may lead to costochondral separation later in life as the repeated trauma can eventually lead to a tear in your chest wall)

In order to treat a trauma-related costochondral separation, you’ll need to see a doctor immediately. They can assess your injury and let you know if surgery is required or not. The treatment for this type of costochondral separation is to surgically reattach the cartilage to the rib.

Chest Injury

If you suffer from a chest injury then this may lead to a costochondral separation. These types of injuries are usually caused by blunt force trauma that causes tearing of the ribs and/or cartilage. This can also occur due to rapid changes in air pressure. For example, you may suffer a chest injury if you get hit by a car while riding your bike or if you are scuba diving and get stuck at the bottom of the ocean.

With costochondral separation due to chest injury, surgery is only required in rare cases. Most of the time, the cartilage will grow back together on its own within a few months. However, if it doesn’t then surgery can help.

In addition to chest surgery, you may also need treatment for any other injuries you have such as a broken arm or leg.

If you were injured in an accident that wasn’t your fault then contact a personal injury lawyer immediately. You may be eligible for financial compensation to cover your medical bills and other expenses.

Cancer Treatments

A costochondral separation can occur if you’re suffering from cancer and going through chemotherapy or radiation therapy. These treatments can damage the rib cartilage. The most common types of cancer that lead to costochondral separation are lung cancer and esophageal cancer.

The treatment for a costochondral separation that is caused by cancer treatments depends on several factors. For example, how severe your injury is and how advanced your cancer is will determine the recommended treatment plan.

If you’re going through cancer treatment, make sure you speak with your doctor right away if you start to experience any rib pain or separation.

Smoking And Alcoholism

Smoking and alcoholism can lead to a costochondral separation because both alcohol and nicotine are diuretics, which means they dehydrate your body. This dehydration weakens your cartilage and makes it more prone to tearing.

In most cases, costochondral separation caused by smoking or alcoholism will heal on its own within a few weeks. However, if the pain persists then you may need surgery to reattach the cartilage to the rib.

Risk Factors

There are several risk factors that can make you more prone to a costochondral separation. If you’ve recently undergone any of the following, you may be more at risk:


Severe allergies

Recent viral infection

Chest surgery

Symptoms Of A Costochondral Separation

The symptoms of a costochondral separation vary based on whether it is a primary or a secondary injury.

Secondary Injury

If you come into contact with something that directly injures your rib cage, then you’ll experience immediate sharp pain in the area of your injury. The pain will get worse if you try to move the area and you may even find it difficult to take a deep breath. You may also experience some bruising, redness, and swelling in this area.

Primary Injury

These types of injuries are much more common than secondary ones. They usually happen as a result of a minor incident such as:

Slipping on the ice and throwing out your arm when trying to catch yourself from falling

Getting punched in the chest during a fist fight

Tearing a rib away from the cartilage while moving a heavy object

With a primary costochondral separation, you may not experience any pain or symptoms right after the injury. It’s not until several weeks later, when the soft tissue around the rib starts to abscess, that you begin to experience severe pain in that area. This pain may get worse if you take a deep breath or try to move that part of your body.

In some cases, surgery is required to remove the infected tissue. In other cases, antibiotics can kill the infection and allow the body to heal the injury on its own.

Diagnosing A Costochondral Separation

To properly diagnose your injury, your doctor will ask you several questions about your medical history. They’ll also give you a physical exam. During the exam, they’ll press on the area around your rib to see if they can detect any signs of separation.

In some cases, you may need an x-ray to confirm a diagnosis. This will allow the doctor to see whether there is any separation, subluxation, or dislocation present in your rib.

Treating A Costochondral Separation

Treating a costochondral separation will largely depend on the type and severity of the injury. Minor tears and sprains may heal on their own with time and rest. More severe injuries may require surgery to repair the separated cartilage back to the rib.


The most important thing you can do if you’ve suffered this type of injury is rest. You should limit any activities that will put strain or weight on your rib cage.

Taking pain medication

Over-the-counter pain medications like Tylenol (acetaminophen) or Advil (ibuprofen) can help lessen the pain and reduce any swelling, but they won’t do much for inflammation or muscle spasms. These medications can also prevent your body from making any pain you feel a priority, which can be dangerous if the pain is a symptom of a more serious underlying condition.

Taking prescription pain medication might be necessary after some time. These drugs will be more effective at treating the pain and possibly any accompanying inflammation and spasms. They can also help you sleep without being as concerned about side effects like constipation or gastrointestinal bleeding.

Not everyone experiences pain when suffering a costochondral separation, so medication may not be necessary for pain management.


In some cases, injections of steroids or numbing medicine can help reduce pain and swelling caused by injuries like this one. These types of injections can also help provide immediate relief when it just isn’t practical to rest or take pain medication.

Physical therapy

Physical therapy is a good option for treating costochondral separations that are affecting your mobility. A physical therapist can use heat, cold, massage, stretching, and strengthening to help treat the injury and improve your range of motion. In some cases, treatments may include ultrasonic therapy, phonophoresis, or diathermy to speed up recovery time.


Surgery may be required if the bone has broken through the skin, or if there is an object stuck in between the separated bones. Other times, surgery may be needed to remove any loose fragments of bone and cartilage that can’t be repaired with a cast or other external fixator device.

Recovery Time

The recovery time for a costochondral separation can range from weeks to months. Any associated pain or discomfort should subside after several weeks of proper rest and treatment, but it may take longer before you’re able to resume strenuous physical activity again.

In some cases, an injury like this one may be a sign of a more serious underlying condition. If your symptoms persist for more than several months, you should consult with your doctor for further evaluation.


The best way to prevent a costochondral separation is to limit any activity that could lead to this type of injury. Kit your body for the activity you’re about to engage in and don’t push yourself too hard. If you start to feel sharp pain when doing something, then stop and consult your doctor if the pain persists.

Did you know?

A costochondral separation is the most common rib injury.

In some cases, it may be difficult to detect this type of injury if there is no pain or visible deformity.

Most costochondral separations occur in young adults and adolescent males between the ages of 15-25 years old.

Most of these injuries involve falls on the outstretched arm or a direct blow to the ribs. Car accidents, assault, and contact sports are other common causes of this injury.

Sources & references used in this article:

Hepatic injury after costochondral separation in a rugby football player by C Willis-Owen, SP Kemp… – Clinical Journal of Sport …, 2009 – journals.lww.com

Factors affecting morbidity and mortality in flail chest: comparison of anterior and lateral location by D Kilic, A Findikcioglu, S Akin, TH Akay… – The Thoracic and …, 2011 – thieme-connect.com

External cardiac massage device by MJ Waide, PA Waide, EL Cheminant – US Patent 5,399,148, 1995 – Google Patents

Predictors of mortality in patients with flail chest: a systematic review by CE Battle, PA Evans – Emergency Medicine Journal, 2015 – emj.bmj.com

A rare complication of cardiopulmonary resuscitation by DT Kottachchi, J Dong, S Reid – Canadian Journal of Surgery, 2009 – ncbi.nlm.nih.gov

Sternal displacement with different loads: an investigation into some factors related to external cardiac compression by H Ruben, SH Johansen – Acta anaesthesiologica Scandinavica, 1966 – Wiley Online Library

Thoracic incisions by RF Heitmiller – The Annals of thoracic surgery, 1988 – annalsthoracicsurgery.org

Penetrating lung hernia with pulmonary evisceration: case report by DMG Bowley, KD Boffard – Journal of Trauma and Acute Care …, 2001 – journals.lww.com