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Last updated: October 07, 2016
Years published: 1989, 1990, 1997, 2002, 2016
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.
Treatment
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 donโt respond to pain relievers (refractory cases). Usually the pain subsides after several weeks or months, but the palpable swellings may persist for some time.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
For information about clinical trials sponsored by private sources, contact:
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For more information about clinical trials conducted in Europe, contact: https://www.clinicaltrialsregister.eu/
TEXTBOOKS
Tanner J. Chest Wall Pain. In: Oxford Textbook of Musculoskeletal Medicine, 2nd edition. Hutson M, Ward A, editors. 2016 Oxford University Press. Oxford, UK. pp. 319-321.
Imamura M, Imamura ST. Tietze syndrome. In: Essentials of Physical Medicine and Rehabilitation. Musculoskeletal Disorders, Pain, and Rehabilitation, 3rd edition. Frontera WR, Silver JK, Rizzo Jr. TD, editors. 2015 Elsevier Saunders, Philadelphia, PA. pp. 582-587.
Brummett CM, Cohen SP. Managing Pain: Essentials of Diagnosis and Treatment. Oxford University Press. New York, NY; 2013:370-371.
JOURNAL ARTICLES
Kaplan T, Gunal N, Gulbahar G, et al. Painful chest wall swellings: Tietze syndrome or chest wall tumor? Thorac Cardiovasc Surg. 2015;[Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pubmed/25742551
McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013;87:177-182. https://www.ncbi.nlm.nih.gov/pubmed/23418761
Gijsbers E, Knaap SFC. Clinical presentation and chiropractic treatment of Tietze syndrome: a 34-year-old female with left-sided chest pain. J Chiropr Med. 2011;10:60-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110396/
Brunse MH, Stochkendahl MJ, Vach W, et al. Examination of musculoskeletal chest pain โ an inter-observer realiability study. Man Ther. 2010;15:167-172. https://www.ncbi.nlm.nih.gov/pubmed/19962338
Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am. 2010;94:259-273. https://www.ncbi.nlm.nih.gov/pubmed/20380955
Proulx AM, Zyrd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;15:617-620. https://www.ncbi.nlm.nih.gov/pubmed/19817327
Fioravanti A, Tofi C, Volterrani L, Marcolongo R. Malignant lymphoma presenting as Tietzeโs syndrome. Arthritis Rheum. 2002;47:229-230. https://www.ncbi.nlm.nih.gov/pubmed/12115149
Thongngarm T, Lemos LB, Lawhon N, Harisdangkul V, et al. Malignant tumor with chest wall pain mimicking Tietzeโs syndrome. Clin Rheumatol. 2001;20:276-78. https://www.ncbi.nlm.nih.gov/pubmed/11529637
Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietzeโs syndrome. Br J Rheumatol. 1997;36:547-50. https://www.ncbi.nlm.nih.gov/pubmed/9189056
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