NORD gratefully acknowledges Simone F.C. Knaap DC, MAppSc., for assistance in the preparation of this report.
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), specifically where the ribs attach to the breastbone (sternum). 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 is not known. Tietze syndrome was first described in the medical literature in 1921 by Alexander Tietze, a German surgeon.
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. In most people, the cartilage of only one rib is affected. A firm, spindle-shaped swelling occurs in the cartilage of the affected rib. An aching, gripping, sharp, dull, or neuralgic pain occurs in this area. Sometimes, the pain may spread to affect the neck, arms and shoulders. Redness (erythema) and warmth of the affected area may be present.
The onset of pain may be gradual or sudden, and can vary in intensity. 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.
The exact cause is not known (idiopathic). Some researchers have speculated that multiple microtrauma to the anterior chest wall may cause the development of Tietze syndrome. Sometimes, the development of the disorder may be preceded by chronic, excessive coughing, vomiting, trauma or impact to the chest, viral or bacterial infections, or surgery to the thoracic area.
Tietze syndrome usually affects older children and young adults. Most cases occur before the age of 40, most often during the second or third decade of life. Although rare, Tietze syndrome has been reported in infants, children or the elderly. Males and females are affected in equal numbers. The exact incidence or prevalence of the disorder is unknown.
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. Magnetic resonance imaging (MRI) can show thickening and enlargement of affected cartilage.
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, the application of heat to the affected area, and pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or a mild pain reliever (analgesic). Local corticosteroid or lidocaine injections directly into the affected area may be beneficial for people who don’t respond to pain relievers (refractory cases). Usually the pain subsides after several weeks or months, but the palpable swellings may persist for some time.
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