TIETZE SYNDROME: CAUSES, SYMPTOMS, AND TREATMENT

Tietze syndrome is a rare condition indicative of cartilage inflammation connecting the upper ribs to the sternum (breastbone). This condition is named after Alexander Tietze, a German surgeon who first described the condition in 1921. While it is not life-threatening, it can cause significant discomfort and pain in the affected area.

This blog reviews the causes, symptoms, and treatment options for Tietze syndrome.

What is Tietze Syndrome?

Tietze syndrome is a rare musculoskeletal condition that causes pain and swelling in the chest wall, often confused for costochondritis. The hallmark of Tietze syndrome is inflamed, swollen costal cartilage, which allows for breathing and fuses the ribs to the breastbone. Inflammation in this area can cause sharp, stabbing chest pain, which can appear as a heart attack.

There are seven ribs joined to the sternum by costal cartilage, of which the 2nd and 3rd are commonly affected in those with Tietze syndrome.^[1]

Tietze syndrome has a higher prevalence in children, adolescents, and individuals under the age of 40. It affects men and women equally.

Causes and Risk Factors

The exact cause of Tietze syndrome is unknown, and there is a lack of research on possible underlying contributions, such as environmental factors and genetics.

Doctors believe the cause pertains to an injury, strain to the chest area, or micro trauma leading to costal inflammation. Other triggers include respiratory infections, frequent vomiting, contact sports, high-intensity physical activity, car accidents, or falls.

Individuals with a history of chest wall wounds or surgeries are at a greater risk of contracting Tietze syndrome. Additionally, certain conditions, such as arthritis and sinusitis, may raise the odds of developing Tietze syndrome.^[2]

Tietze Syndrome Symptoms

Tietze syndrome is characterized by a sharp pain and swelling in the chest wall. This pain can range from mild to severe and can be felt on one or both sides of the chest. The pain sometimes feels as though it radiates from the chest to the arms and shoulders, making it difficult to differentiate from a heart attack.^[3]

Other symptoms may include:

• Pain when lifting the arms or using the shoulders
• Joint swelling
• A lump in the affected area
• Tender to touch

In some cases, individuals may also experience difficulty breathing, bending over, eating, hugging, wearing a seatbelt, or coughing due to the inflammation of the chest wall.

What conditions are similar to Tietze syndrome?

Tietze syndrome shares symptoms similar to other conditions, making it difficult to diagnose. Some conditions with similar symptoms include:

• Costochondritis: This condition also causes inflammation of the costal cartilage, yet it tends to have an older age of onset and a lack of swelling^[4]. Costochondritis also tends to affect the lower part of the costal cartilage, as opposed to the 2nd and 3rd costal rib joints affected in Tietze syndrome. It is also more common than Tietze syndrome.
• Heart attack: The chest pain caused by Tietze syndrome is often easily misinterpreted as a heart attack, especially in individuals with a history of heart disease.
• Fibromyalgia and other pain-related conditions: These conditions lead to widespread musculoskeletal pain. Some people can experience radiating chest pain, which can emulate symptoms of Tietze syndrome.
• Pleurisy: Pleurisy refers to inflammation of the internal tract of the lungs. In some, the pain and difficulty breathing can elevate Tietze syndrome risk and may overlap.

There are a few reports of other conditions that mimic Tietze syndrome, such as tumors in the chest wall area^[5] and non-Hodgkin's Lymphoma^[6].

Diagnosis of Tietze Syndrome

Diagnosing Tietze syndrome is challenging, as it is rare, there is no specific test for it, and it often resembles other conditions.^[7]

Aside from costochondritis, a doctor needs to rule out arthritis, tumors, slipping rib syndrome, cardiovascular problems, and more.

A doctor diagnoses Tietze syndrome through a process of elimination. A physical examination in which gentle chest palpation helps the physician locate the source of the chest pain.

Ultrasound is one of the best ways to diagnose Tietze syndrome, as it clearly reveals swelling and inflammation of the cartilage in the chest wall. The doctor will look over the patient's medical records and may perform a series of tests, such as an electrocardiogram, a bone test, and other imaging tests, such as X-rays or MRI, to rule out other conditions.

Is Tietze Syndrome Dangerous?

Tietze syndrome is not a life-threatening condition, yet it can cause significant discomfort and pain. In rare cases, the inflammation of the chest wall can lead to a swollen rib, which can be dangerous if it puts pressure on the lungs or heart.

If you encounter stabbing chest pain or difficulty breathing, seek medical attention immediately.

When to See a Doctor

If you experience chest pain or swelling, it is essential to see a doctor for a proper diagnosis. If you have a history of heart disease or are at risk of heart attacks, it is crucial to rule out any cardiac issues. Additionally, if you experience severe chest pain or difficulty breathing, seek medical attention immediately.

Treatment Options for Tietze Syndrome

In some cases, Tietze syndrome pain can last for several months to a year before abating. Treatment consists of pain management and rest. In some cases,The best treatment options for pain management include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, can help lower costal inflammation and relieve pain associated with Tietze syndrome. These medications are available over-the-counter and can be taken as needed.
• Corticosteroids: In extreme cases, your doctor may prescribe more potent medications, such as corticosteroids, to manage the inflammation associated with Tietze syndrome, especially if NSAIDs fail to control pain.
• Nerve Blocks: In some circumstances, a nerve block offers great relief to the patient, with a very high efficacy. A nerve block is an anesthetic or pain-relieving medication injected into a nerve that is responsible for signals of pain.^[8]
• Complementary Treatments: In some cases, complementary approaches such as acupuncture or chiropractic care may help lower pain intensity and inflammation associated with Tietze syndrome. There is no research to confirm their efficacy for Tietze syndrome, yet they benefit some individuals in pain. A doctor should review these treatments before trying them for Tietze syndrome.

Aside from pain management, it is important to rest without aggravating the pain. It is common for people to sleep propped up on several pillows to alleviate pressure from the ribs.

Physical Therapy

Physical therapy can assist with broadening the range of motion in the affected area and reducing pain. A physical therapist can also suggest exercises to strengthen the muscles in the chest and improve posture, which can help prevent future flare-ups after the main symptoms subside.^[9]

A recommended exercise includes stretching the pectoralis major, a prominent chest muscle. To stretch the muscle, the patient stands in a corner with hands pushing off against the wall as though one is performing a push up. It is best done for 1-2 minutes, multiple times a day.

Other benefits of physical therapy include:

• Helping the patient adapt their posture during daily activities without causing pain or exacerbating symptoms.
• Teaching breathing exercises to improve respiratory function.

Alternative Treatment Approaches

• Introducing cognitive-behavioral therapy and pain neuroscience education to help patients cope with pain.
• Transcutaneous electrical stimulation and electroacupuncture were used on the affected area. Low-frequency electrical currents run through acupuncture needles inserted within the involved spinal segment.
• Dry needling, which has shown promise in treating chest wall pain related to musculoskeletal conditions. This approach involves the use of acupuncture needles to alleviate pain, and for some individuals, it is as effective as injection therapy for various conditions.

Managing and Living with Tietze Syndrome

Tietze's syndrome patients may have limitations in daily activities such as lifting, carrying, brushing, or combing. However, the disability caused by Tietze's syndrome is usually minor.

If you are suffering from Tietze syndrome, there are measures you can take to keep the symptoms under control and improve your quality of life. These include:

• Avoiding activities that worsen the chest pain, such as bending over too much, heavy lifting, or strenuous exercise.
• Adding heat or ice to the area to reduce pain and inflammation.
• Keeping your posture good to prevent strain on the chest muscles.
• Using relaxation practices, such as deep breathing or meditation, to manage stress and reduce pain.

Conclusion

Chest pain and swelling are the symptoms of Tietze syndrome, a rare condition that inflames the costal cartilage. While there is no cure for this condition, various treatment options can make the symptoms more manageable and improve the quality of life. If you experience chest pain or swelling, visiting a doctor’s office is crucial for a proper diagnosis and treatment plan.

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