Tietze syndrome is also known as costochondral junction syndrome and it is a rare condition that generally involves chest pain in the upper ribs. We will take a closer look at the symptoms, possible causes, risk factors and treatments of Tietze syndrome in this article.
What is Tietze Syndrome?
Tietze syndrome is known to be a benign inflammation of one or more of the costal cartilages.(1) It affects mostly people below 40 years of age. This syndrome was described first in the year 1921 by a German surgeon Alexander Tietze.
We must mention here that Tietze syndrome is not something similar to costochondritis, and it differs from the condition of costochondritis by swelling that occurs in the costal cartilages, which generally does not appear in costochondritis.
Symptoms of Tietze Syndrome
Chest Pain: The primary symptom of Tietze syndrome is chest pain. In this condition, the affected person feels pain around one or more of the upper four ribs, especially where the ribs are attached to your breastbone. In around 70% to 80% of cases, the pain is located around only a single rib and usually, only a single rib of the chest is involved. (2) Inflammation of the cartilage of the affected rib leads to chest pain. This area of the cartilage is known to be the costochondral junction. The pain in the chest can appear all of a sudden and also disappear suddenly, or they might develop in a gradual way then come and go for several years. Sneezing, coughing, exercising, or any other physical activity, laughing, deep breathing, hugging someone, wearing the seatbelt, or even simply lying down might worsen the pain. The pain in Tietze syndrome sometimes might extend to the neck, arms, and shoulders. This pain can be mild or severe, dull or sharp. For some people, this pain feels as if being stabbed with a knife. One might mistake the chest pain from Tietze syndrome for a heart attack; however, there are some differences. In the case of Tietze syndrome, the pain affects only a small area of your chest while a heart attack covers the entire chest. You might also be short of breath, suffering from nausea, and sweating when you have a heart attack, which is not experienced in the case of Tietze syndrome.
Swelling: The pain in the chest in Tietze syndrome is accompanied by swelling. There is actually a firm, spindle-shaped swelling that occurs in the cartilage of your affected rib.
The inflammation can result in swelling and the area might also feel tender and warm, and also look red and swollen.
Even though the pain might reduce after a few weeks, the swelling may persist for a longer time.
Causes Of Tietze Syndrome:
The exact causes of Tietze syndrome are not understood well, and it usually results from an injury or any kind of physical strain, such as repeated coughing, vomiting, sneezing, or impacts to the chest. It is also known to occur even after bouts of laughter. Moreover, overexertion or an injury or trauma to the thorax can also result in the pain. The upper respiratory tract infections, such as laryngitis or sinusitis can also cause pain in Tietze syndrome.
Tietze syndrome is not known to be an inherited condition and it generally affects both, males and females equally.
Psychological stress can exacerbate the condition through chest muscle contraction. However, there is no evidence to suggest that this is a direct cause of Tietze syndrome. Patients who have had radiation therapy to the breast or chest will generally experience Tietze syndrome which starts occurring shortly after the therapy or might occur years later. This is found more in the case of teens than in adults.
Risk Factors Of Tietze Syndrome:
The biggest risk factors for the occurrence of Tietze syndrome are age and also possibly the time of year. Beyond these, only little is known about factors that might increase your risk of developing Tietze syndrome.
Tietze syndrome mostly affects children and those below the age of 40 years. A study conducted in the year 2017 noted that the number of cases of Tietze syndrome was higher in winter to the spring period. (3) The same study also found a higher proportion of women develop this syndrome.
However, there are several other studies that have found that Tietze syndrome affects both, men and women equally.
Treatments Of Tietze Syndrome:
It can be really hard to diagnose Tietze syndrome, as the symptoms, in this case, are like those of several other problems besides a heart attack. They can seem like angina or chest pain that occurs when your heart muscles do not get enough oxygen. The pain in the condition is also similar to some lung problems, costochondritis, and rheumatoid arthritis.
There is no special test recommended for diagnosing Tietze syndrome. Thus, doctors will usually want you to know about your symptoms well. Your doctor will do a physical examination that could involve pressing on your chest. Some tests might also be required to do so as to rule out other things and these tests might include X-rays, ultrasound, MRI or magnetic resonance imaging, biopsy, and an electrocardiogram so as to see the electrical activity in your heart.
General Treatment Regimen:
The general treatment regimen for Tietze syndrome is rest, avoiding any sort of strenuous activity and applying heat to the affected area.
In certain cases, the chest pain might resolve on its own without any treatment.
NSAIDs: Your doctor might prescribe you with some pain relievers like the OTC Nonsteroidal anti-inflammatory drugs or the NSAIDs for helping you out with the pain that occurs due to Tietze syndrome. In case your pain persists then you might be prescribed with a stronger pain reliever.
Injections: There are some other possible treatments for pain and inflammation in Tietze syndrome, and these treatments include steroid injections for reducing swelling or lidocaine injections at your affected area so as to ease the pain.
Though swelling might persist for a long time, pain in Tietze syndrome will generally improve within months. At times, the condition might get resolved and then recur.
Surgery: In some extreme cases where pain and swelling don’t reduce through painkillers or by other means, then a surgery might be required to remove extra cartilage from the affected ribs of the patient with Tietze syndrome.
Take Away:
Tietze syndrome is a rare benign condition involving a chest pain and swelling and tenderness in the cartilage around one or more of the upper ribs where they are attached to the breastbone; and also that this condition affects mostly people below 40 years of age. This condition usually resolves with rest and by applying heat to the affected area. It might also require some painkillers to take so as to reduce the chest pain in Tietze syndrome.
A proper diagnosis is required for this condition, and this can be done only by a consultation with a medical professional. So, if you are experiencing chest pain you need to talk to your doctor and get yourself well diagnosed and treated.
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