Tietze Syndrome

 

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Synonyms of Tietze Syndrome

  • Chondropathia Tuberosa
  • Costochondral Junction Syndrome

Subdivisions of Tietze Syndrome

  • Costosternal Chondrodynia

General Discussion

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

Tietze syndrome (also called chondropathia tuberosa or costochondral junction syndrome) is a benign inflammation  of one or more of the costal certilages . It was first described in 1921 by the German  surgeon Alexander Tietze (1864–1927).

Tietze syndrome is not the same as  costochondritis. Tietze syndrome is differentiated from costochondritis by swelling of the costal cartilages, which does not appear in costochondritis. Like costochondritis, it was at one time thought to be associated with, or caused by, a viral infection acquired during surgery. This is now known not to be the case, as most sufferers have not had recent surgery.

Cause

While the true causes of Tietze’s Syndrome are not well understood, it often results from a physical strain or minor injury, such as repeated coughing, sneezing, vomiting, or impacts to the chest. It has even been known to occur after hearty bouts of laughter. It can occur by over exerting or by an injury in the chest and breast.

Psychological stress can exacerbate Tietze’s Syndrome, but there is no evidence to suggest that it is a direct cause.

Patients who have had radiation therapy to the chest/breast will often experience this syndrome which can occur shortly after therapy or years later. It is found more often in teens than adults.

Sign and symptom

The pain and tenderness associated with Tietze’s syndrome may happen gradually or suddenly. Symptoms include:

  • a sharp pain in your upper ribs
  • tenderness around the area of your upper ribs
  • swelling around the area of your upper ribs

Sudden movements of your ribs, during physical activity or when you cough or sneeze, may make the pain worse.

The pain of Tietze’s syndrome may be confused with a heart attack. However, the pain of a heart attack is usually more widespread, while the pain of Tietze’s syndrome usually affects only a small area.

Differential diagnosis

Although patients will often mistake the pain of Tietze’s Syndrome for a myocardial infraction  (heart attack), the syndrome does not progress to cause harm to any organs.

It is important to rule out a heart attack, as the symptoms can be similar. After assessment, providers often reassure patients that their symptoms are not associated with a heart attack, although they may need to treat the pain, which in some cases can be severe enough to cause significant but temporary disability to the patient.

Investigations

  • Diagnosis can usually be made by careful history and examination.
  • Investigations may be required to rule out other possible causes of chest pain:
    • ECG to exclude cardiovascular conditions.
    • CXR to exclude other pathologies.
    • Ultrasound may have a role in assessment and diagnosis.
    • Magnetic resonance imaging (MRI) may also be useful and effective for some patients.

Treatment
Tietze’s syndrome tends to improve on its own after a few weeks, although you may still be left with some swelling after the pain and tenderness have gone.

Many people can relieve the symptoms of Tietze’s syndrome themselves with rest and by using non-steroidal anti-inflammatory drugs (NSAIDs) to control the pain and swelling. If pain is severe, your GP may prescribe a stronger painkiller, such as a corticosteroid injection.

Rest

Tietze’s syndrome can be aggravated by any activity that places stress on your chest area, such as racket sports, athletics or simply reaching up to a high cupboard.

Any activity that makes the pain in your chest area worse should be avoided until the inflammation in your ribs and cartilage has gone down.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The symptoms of Tietze’s syndrome can be treated with non-steroidal anti-inflammatory painkillers (NSAIDs), which can help to relieve inflammation and pain.

NSAIDs include ibuprofen, naproxen and aspirin.
Do not use NSAIDs if you have asthma, high blood pressure, or kidney or heart problems. You should not take aspirin if you are under 16.

Corticosteroids

In severe cases of Tietze’s syndrome, corticosteroid injections may also be used to treat the condition.

Corticosteroids are medicines that help to reduce swelling and pain, and can be injected into and around your costochondral joint. Before having a corticosteroid injection, you will be given a local anaesthetic to numb the area around the injection.

Having too many corticosteroid injections can damage your costochondral joint, so you may only be able to have this type of treatment once or twice.

Prognosis

  • The pain usually subsides within a few weeks, with some residual swelling persisting for longer periods of time.
  • However, the course of the disease varies from spontaneous remission to persistent symptoms over years.

Reference:

http://rarediseases.org/rare-diseases/tietze-syndrome/

https://en.wikipedia.org/wiki/Tietze_syndrome

http://patient.info/doctor/tietzes-syndrome-costochondritis

https://www.hse.ie/eng/health/az/T/Tietze’s-syndrome/Treating-Tietze’s-syndrome.html

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