Diseases

Tietze syndrome - Tietze disease - causes and therapy

Tietze Syndrome: Inflamed rib cartilage causes chest pain

Sudden or even chronic chest pain may in rare cases be the so-called Tietze syndrome (also known as Tietze's disease). Inflammation and swelling of the costal cartilage at the base of the sternum can cause severe pain, often referred to as rib pain. By mistake, the symptoms are often associated with heart disease, such as a heart attack. The Tietze syndrome is a harmless disease that usually heals spontaneously after some time. Careful differential diagnosis allows differentiation from other more serious diseases.

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Tietze Syndrome: Inflamed rib cartilage causes chest pain
definition
symptoms
causes
diagnosis
treatment
Osteopathic treatment

definition

Tietze syndrome (Tietze disease) is a rare, usually chronic inflammation of the costal cartilage at the base of the breastbone (sternum). The disease causes swelling at the joints (joints) between the cartilage and the rib bones or the sternum. This, accompanied by chest pain, inflammatory process can occur on one or more ribs (Costae) and is also called Costochondritis or Chondropathia tuberosa (Greek for cartilage: chondrosis). Most of the upper rib cartilage is affected, especially on the second and third real rib (Costae verae).

Severe chest pain can have many causes. In some cases, they are an indication of the rare Tietze syndrome. (Image: Paolese / fotolia.com)

The exact cause is unknown until today. For the first time, the symptoms were described in 1921 by the surgeon Alexander Tietze, who is also the eponym of the disease. Most commonly, the condition occurs in adolescents and young adults, between the ages of 20 and 40 years.

Not to be confused with this disease is the so-called Tietz syndrome, which is a rare congenital disorder with albinism and deafness.

symptoms

Those affected complain mainly of chest pain, especially severe chest pain. In most cases, a pressure applied carefully to the affected ribs from the outside causes a pain attack. Sudden chest movements (thorax), such as a deep inhalation or exhalation, coughing or sneezing lead to short-term attacks of pain. Sometimes the pain is described by those affected as a rib pain, burning in the chest or piercing.

The pain usually occurs on one side and can also radiate into other areas such as arms, shoulder, neck and back. Complaints are only on the left side, often suspected heart attack, although this is not cardiogenic pain.

In most cases, swellings of the (upper) costal cartilages are externally visible and red spots on the breast may appear.

Inflamed costal cartilages at the base of the breastbone cause painful discomfort in Tietze's disease. (Image: bilderzwerg / fotolia.com)

The following non-specific symptoms may also occur in connection with the disease:

palpitations,
accelerated pulse,
difficulty in breathing,
tightness,
Pressure sensation (including swallowing difficulties),
feeling hot.

The complaints can be triggered by movement and occur quite suddenly and in high intensity. But also a rather chronic nature of the disease is possible. This leads to a slow development of the symptoms and to continuously existing pain.

The symptoms described often cause the victims to suspect quite different diseases, primarily heart disease. Therefore, often comes to the admission in the emergency department, the heart is healthy.

causes

The described disease is one of the "idiopathic diseases" in which the causes are usually unknown. Nevertheless, case studies suggest that inflammation of the costal cartilage may be favored by some factors. These include the following possible triggers:

mental trauma,
unusual physical stress,
microfractures,
Operations on the ribcage.

Magnetic resonance imaging is used to visualize swollen costal cartilage. (Image: Golden Sikorka / fotolia.com)

diagnosis

The inflammation of the costal cartilage can not be detected in the radiograph or in the blood picture. Only methods of special imaging diagnostics such as magnetic resonance imaging (MRI) can visualize a swollen costal cartilage. If the swellings are also recognizable on the outside and severe pain arises when applying pressure in this area, these are also important indications for the diagnosis.

Since the syndrome is very rare, a detailed patient survey (history) and the described symptoms often lead to a thorough medical examination with elaborate methods to exclude other more serious diseases. Heart diseases such as angina pectoris and lung diseases should be excluded. It should also be clarified whether it is not a rheumatic disease (soft tissue rheumatism) or a fibromyalgia syndrome (chronic muscle fiber pain).

treatment

As a rule, the disease is harmless and heals spontaneously after a few weeks or months. Sometimes, however, a visible swelling of the costal cartilage can persist - without pain.

There is no concrete treatment approach. The therapeutic measures focus on the symptoms or the pain relief. For this purpose, drugs for pain (analgesics) and inflammation (anti-inflammatory drugs) in the form of tablets or ointments are often administered. Even so-called non-steroidal anti-inflammatory drugs (NSAIDs) help temporarily in severe pain and are both analgesic and anti-inflammatory. In case of extremely severe pain local anesthetics can also be injected into the affected areas.

Alternative therapies such as osteopathy can help alleviate the pain. (Image: Adam Gregor / fotolia.com)

Osteopathic treatment

During the persistent symptoms, various treatment options can reduce the discomfort and especially the pain.

For example, it is possible to use manual methods. In particular, physiotherapy and osteopathy measures can help to dissolve blockages and consequent stress on the transitions between the rib bones and the sternum. These measures are also used to release possible tension and to maintain flexibility of the ribcage and joints.

To support the further healing process, homeopathy, acupuncture, and heat therapy also find individual applications.

In addition, the alternative method of proliferation therapy has already been used to relieve pain in those affected. It is a neural therapy that injects a high percentage sugar local anesthetic solution under the skin. For the effectiveness of this form of therapy, there are primarily from the USA a number of studies. In the "Journal of Back and Musculoskeletal Rehabilitation" a study describes the positive effects of a long-term therapy of Tietze syndrome. (tf, cs; updated on 25.11.2018)