The costosternal syndrome is a painful condition of the joint where the sternum (breastbone) articulates with the ribs.  The ribs join with the spine in the  back of the body and with the sternum (breastbone) in the front of the chest.  There are twelve ribs.  Only the first seven ribs actually form joints with the sternum.  Patients with costosternal syndrome have chest pain which is worsened with inspiration or motion of the shoulders.  There may be tenderness over the joints or a clicking sensation with movement.  Costosternal syndrome is caused by overuse or trauma.  Plain X-rays may reveal fractures or tumors.  Laboratory exam is useful to look for inflammation or arthritis.  A bone scan can also look for fractures that may be too small to see with an X-ray.  The pain from costosternal syndrome can sometimes be mistaken for a heart attack.  Initial treatment of costosternal syndrome is with non-steroidal anti-inflammatories and physical modalities such as heat and cold.  Injection of the costosternal joints may be useful in those cases that do not respond to conservative treatment.