Tietze syndrome is a rare, inflammatory disorder characterized by chest pain and swelling of the cartilage of one or more of the upper ribs (costochondral junction). Onset of pain may be gradual or sudden and may spread to affect the arms and/or shoulders. Tietze syndrome is considered a benign syndrome and, in some cases, may resolve itself without treatment. The exact cause of Tietze syndrome is not known.
Tietze syndrome is characterized by mild to severe localized pain and tenderness in one or more of the upper four ribs. The second or third ribs are most often affected. A firm, spindle-shaped swelling occurs in the cartilage of these ribs. An aching, gripping, sharp, dull, or neuralgic pain occurs in this area. In some cases, the pain may spread to affect the neck, arms and shoulders.
The pain associated with Tietze syndrome may worsen due to sneezing, coughing, or strenuous activity or exercise. The pain usually subsides after several weeks or months, but the swelling may persist.
Costosternal chondrodynia is a rare variant of Tietze syndrome that is characterized by severe breast pain in individuals who have had reconstructive breast surgery. The pain, which occurs several months following surgery, affects the breastbone (sternum) and ribs (costosternal area).
The exact cause of Tietze syndrome is not known (idiopathic). Some researchers have speculated that multiple microtrauma to the anterior chest wall may cause the development of Tietze syndrome.
Some cases of Tietze syndrome may occur secondary to other disorders such as psoriatic arthritis.
Tietze syndrome usually affects older children and young adults. Most cases occur before the age of 40. Males and females are affected in equal numbers.
A diagnosis of Tietze syndrome is made based upon a thorough clinical evaluation, a detailed patient history, identification of characteristic symptoms, and exclusion of other causes of chest pain. A variety of tests including electrocardiogram, x-rays, and biopsies may be performed to rule out more serious causes of chest pain including cardiovascular disorders or malignant conditions.
In some cases, pain associated with Tietze syndrome resolves itself without treatment. Specific treatment for individuals with Tietze syndrome consists of rest, avoidance of strenuous activity, local heat, and pain medications such as steroids or a mild pain reliever (analgesic). Usually the pain subsides after several weeks or months, but the palpable swellings may persist for some time.
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