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Tietze syndrome: inflamed rib cartilages cause chest pain
Sudden or chronic chest pain can in rare cases be the so-called Tietze syndrome (also known as Tietze's disease). Inflammation and swelling of the costal cartilage at the base of the sternum can cause severe pain, which is often described as rib pain. The symptoms are often wrongly assigned to heart diseases, such as a heart attack. Tietze syndrome is a harmless disease that usually heals spontaneously after some time. Careful differential diagnostics allow differentiation from other more serious diseases.
Tietze syndrome (Tietze disease) is a rare, mostly chronic inflammation of the costal cartilage at the base of the sternum (sternum). The disease causes swelling at the transitions (joints) between the cartilage and the costal bones or the breastbone. This inflammatory process, accompanied by chest pain, can occur on one or more ribs (Costae) and is also called Costochondritis or Chondropathia tuberosa (Greek for cartilage: chondros). The upper costal cartilage is mostly affected, especially on the second and third true costal verae.
The exact cause is still unknown. The symptoms were first described in 1921 by surgeon Alexander Tietze, who is also the eponym for the disease. Suffering is most common in adolescents and young adults, between the ages of 20 and 40.
Not to be confused with this disease is the so-called Tietz syndrome, which is a rare congenital disease with albinism and deafness.
Those affected mainly complain of chest pain, especially severe pressure pain on the breastbone. Usually, a painful attack occurs when pressure is exerted on the affected ribs from the outside. Sudden movements of the chest (thorax), such as deep breathing in or out, coughing or sneezing, lead to brief attacks of pain. Sometimes the pain is described by those affected as rib pain, a burning sensation in the chest or a stinging heart.
The pain usually occurs on one side and can also spread to other areas such as arms, shoulders, neck and back. If there are only complaints on the left side, it is often suspected to have a heart attack, although this is not cardiogenic pain.
Most of the time, swellings of the (upper) costal cartilage are externally visible and red spots on the chest can appear.
The following non-specific symptoms may also occur in connection with the disease:
- Racing heart,
- accelerated pulse,
- Shortness of breath,
- Feeling of oppression,
- Feeling of pressure (including difficulty swallowing),
- Feeling of heat.
The complaints can be triggered by movement and occur suddenly and with great intensity. But a more chronic nature of the disease is also possible. The symptoms develop slowly and the pain persists.
The described symptoms often lead to suspected completely different illnesses, primarily heart diseases. Therefore, admission to the emergency room is common, and the heart is healthy.
The disease described is one of the “idiopathic diseases”, the causes of which are generally unknown. However, case studies suggest that inflammation of the costal cartilage can be favored by several factors. These include the following possible triggers:
- psychological trauma,
- unusual physical stress,
- Chest surgery.
The inflammation of the costal cartilage can neither be detected in the X-ray picture nor in the blood picture. Only methods of special imaging diagnostics such as magnetic resonance imaging (MRI) can make a swollen rib cartilage visible. If the swelling can also be seen on the outside and there is severe pain when pressure is exerted in this area, this is also important information when making a diagnosis.
Since the syndrome only occurs very rarely, a detailed medical examination and the described symptoms often result in a thorough medical examination with elaborate methods to rule out other more serious diseases. In particular, heart diseases such as angina and lung diseases should be excluded. It should also be clarified whether it is not a rheumatic disease (soft tissue rheumatism) or a fibromyalgia syndrome (chronic muscle fiber pain).
As a rule, the disease is harmless and heals spontaneously after a few weeks or months. Sometimes, however, there can be a visible swelling of the costal cartilage - without pain.
There is no specific treatment approach. The therapy measures focus on the symptoms or pain relief. Medicines for pain (analgesics) and inflammation (anti-inflammatory drugs) are often administered in the form of tablets or ointments. So-called non-steroidal anti-inflammatory drugs (NSAID preparations) also help with severe pain for a short time and are both analgesic and anti-inflammatory. If the pain is extremely severe, local anesthetics can also be injected into the affected areas.
During the persistent symptoms, various treatment options can reduce the discomfort and especially the pain.
For example, the use of manual procedures is possible. Measures from physiotherapy and osteopathy in particular can help to resolve blockages and the associated incorrect loading at the transitions between the costal bones and the breastbone. These measures are also used to relieve tension and maintain mobility of the chest and joints.
To support the further healing process, homeopathy, acupuncture and heat therapy are also used individually.
In addition, the alternative method of proliferation therapy has already been used to relieve pain in those affected. It is a neural therapy in which a high-proof sugar local anesthetic solution is injected under the skin. There are a number of studies on the effectiveness of this form of therapy, primarily from the USA. In the "Journal of Back and Musculoskeletal Rehabilitation", a study describes the positive effects of long-term therapy for Tietze syndrome. (tf, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- National Organization for Rare Disorders (NORD): Tietze Syndrome (accessed: July 8, 2019), rarediseases.org
- National Health Service UK: Costochondritis (accessed: July 8, 2019), nhs.uk
- Hutson, Michael / Ward, Adam: Oxford Textbook of Musculoskeletal Medicine, Oxford University Press, 2nd edition, 2017
- Gijsbers, Eefje / Knaap, Simone F.C .: Clinical presentation and chiropractic treatment of Tietze syndrome: A 34-year-old female with left-sided chest pain, Journal of Chiropractic Medicine, Volume 10, Issue 1, 2011, sciencedirect.com
- Rokicki, Wojciech / Rokicki, Marek / Rydel, Mateusz: What do we know about Tietze’s syndrome? Polish Journal of Thoracic and Cardiovascular Surgery, 2018, termedia.pl
ICD codes for this disease: M94ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.