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Integrated Pain Management


Tietze’s syndrome

Tietze’s Syndrome refers to a benign inflammation of the costal cartilage. This condition was first described by Alexander Tietze a German surgeon in 1921.

In a lot of cases, Tietze syndrome has been thought to be the same as costochondritis but this is not the case.

Tietze’s Syndrome

To be more specific, Tietze syndrome is described as a benign, but painful swelling of the costosternal, costochondral or sternoclavicular joint mostly involving the 2nd and the 3rd ribs. This condition affects one area only and most patients are young adults.

This condition has no known cause and is self-limiting which means that it goes away with time.

Most patients suffering from his condition have reported having suffered from excessive coughing, and infections in the upper respiratory area.

To differentiate Tietze syndrome from costochondritis, it is important to note specific symptoms such as the swelling of the costal cartilages, something that does not occur in costochondritis.

Like in the case for costochondritis, this syndrome was once linked to viral infections acquired during a surgical procedure. Because of the fact that there are many patients who have not had a surgical procedure in recent times, this theory was disapproved.

Tietze syndrome is more common in people under the age of 40 years, more men than women are affected by this syndrome. Most people mistake this illness with other condition but Tietze syndrome does not progress to affect any other body organs as long as it is not as a result of a greater underlying cause.

Signs and Symptoms

Acute chest pain, tenderness and swelling of the affected cartilages are some of the most outstanding symptoms.

The perceived pain is in most cases worsened by respiration. Albeit Tietze syndrome is a condition that has the ability to lead to pain that can be severe enough to result in debilitation, it is benign and is self limiting and will mostly go away in a period of about 12 weeks.

In some cases, the condition becomes chronic and requires advanced treatment methods.

The pain described by Tietze syndrome patients has been equaled to the type of pain felt by heart attack victims and has been found to cause anxiety attacks, hyper ventilating, panic attacks, temporary paralysis/numbness and passing out.

Because of the identical nature of the symptoms of Tietze syndrome and heart attack, many heart attack victims have been misdiagnosed. In female patients, the condition is mistakenly diagnosed as mastalgia.

The symptoms of costochondritis are similar to those experienced by Tietze syndrome patients only that the latter will be characterized by pain that will radiate to the shoulder and arms of the patient.

Most of the patients will complain of either acute or gradual onset. The associated pain is localized or located in the costal cartilage. Though the pain might disappear with time, the swelling might last long even after the tenderness has disappeared.


The true or exact causes of Tietze syndrome are not clearly understood. Though this is the case, the condition is believed to be as a result of minor injuries such or physical strains like sneezing, coughing, vomiting, and chest impacts.

Hearty laughter bouts have also been identified as possible causes. Tietze syndrome can also occur as a result of injury or over exerting in the breast and chest area.

Psychological stress has been found to worsen Tietze syndrome but there is no proof that it can cause the condition. Patients who have gone through radiation therapy to the breast or chest might experience Tietze syndrome.

In this case, the syndrome will either appear immediately after the radiation therapy or after a number of years. This case has been identified in more teens than adults.



Differential Diagnosis

There are other causes of chest pain and there is a chance that this condition will be confused with myocardial infarction which is in most cases unilateral on the left.

Tietze syndrome and costochondritis are not as synonymous as some people will want to believe. Tietze syndrome is more localized and will include the swelling of the costochondral cartilage, something that lacks in costochondritis, which is more diffuse.

It is very important that the medical practitioner rules out heart attack first because there are symptoms that are similar in the two conditions.

The doctor should assure the patient that their pain is not emanating from heart problems. The pain should be treated immediately because while it can be mild to moderate in most cases, there are cases where the pain might be chronic enough to render the patient temporarily disabled and in deep agony.

Examination and Patient History

Most medical practitioners will use examinations and the patient’s history in the diagnosis of Tietze syndrome. The diagnosis might take the direction of ruling out other conditions with similar symptoms but far more dangerous than Tietze syndrome.

To eliminate any cardiovascular conditions, ECG will be used. Other pathologies will be ruled out using CXR and ultrasound may be used in the assessment and the diagnosis of Tietze syndrome. MRI can also be used in some cases.


The first step in the treatment of Tietze syndrome is to assure the patient that there are no underlying serious conditions behind the Tietze syndrome. Medications used in the treatment of the condition may include the use of non-steroidal anti-inflammatory drugs.

Long-acting corticosteroid local injections may help in managing the syndrome. Though rarely required and rarely used, intercostals nerve block may be administered in some cases. Albeit without firm evidence, chiropractic treatment has been used in some cases and helped in the alleviation of the pain and the management of the syndrome.


In most mild to moderate cases, the pain will disappear in a few weeks but the swelling might last longer than the pain.

In some cases, the disease will vary from spontaneous remission due to the self-limiting nature to the persistence of symptoms for years in chronic cases.

Any individual experiencing chest pains that render them disabled or are caused by certain physical activities, should see a medical practitioner for better investigation and management of the syndrome.

This is especially important because chest pains can be as a result of cardiac problems that might be life threatening.