Tietze / Teitze syndrome

Tietze syndrome is a benign inflammation of one or more of the costal cartilages. It was first described in 1921 by the German surgeon Alexander Tietze (1864-1927).^[1][2]

Though they were once considered separate conditions, Tietze syndrome is now recognized as a severe form of costochondritis. Tietze syndrome is differentiated from the less severe forms of costochondriris by swelling of the costal cartilages, which does not appear in costochondritis. It, like costochondritis 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.

Signs and symptoms

The primary presentation of the syndrome is significant, acute pain in the chest, along with tenderness and some swelling of the cartilages affected, which is commonly palpable on examination. Although many times it can be extremely painful, to the point of being debilitating, Tietze's Syndrome is considered to be a benign condition that generally resolves in 12 weeks. However, it can often be a chronic condition.

Perceived pain is often exacerbated with respiration.

Costochondritis symptoms are similar to Tietze's, the prime difference being that the pain radiates to the arms and shoulders in the latter.

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 it is not 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.

Differential diagnosis

Although patients will often mistake the pain of Tietze's Syndrome for a myocardial infarction (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.

What are the best treatments for Tietze’s Syndrome?

Rest

Being barely able to move for six weeks due to Tietze’s syndrome was incredibly hard for me—I was a very active person and walked several miles a day. However, avoiding many “normal” activities were a must, to allow my ribs to heal. These included:

• • Coughing

  • Heavy breathing (i.e. no intense exercise)

  • Lifting

  • Pulling

  • Pushing

  • Repetitive motions (tennis, baseball, scrubbing floors etc.)

  • Sneezing

  • Straining

  • Lying down on my back (I slept propped up with many pillows). Lying on my back forcedpressure onto my breastbone.

Anti-inflammatory drugs

Cortisone shots into the cartilage can relive pain. 1-3 shots may be needed. These shots do have some side effects (such as temporary pain at the injection site). An Intercostal nerve block is a steroid injected around the intercostal nerves located under each rib. One of the pain relief methods of last resort, an intercostal nerve block might help with Tietze’s Syndrome pain if all other methods have been exhausted.

Pain relief is by the following steps:

Anti-inflammatory medication in correct dose

Ice pack/ Hot packs

Deep breathing exercises & streching exercises slowly, hourly.

Gentle massage with Brugel, Voveron gel and oil feels comfortable.

Belts and braces

Target injection at painful sites, if severely painful.

Local Anesthetic Injection

A local anesthetic injection (sometimes in combination with a steroid as seen in this study) can be successful in reducing pain in the vast majority of Tietze’s syndrome patients; some reports state it can be up to 97% effective. You can read about stellate ganglion block therapy–where a local anesthetic is introduced into the C7 vertebrae, in this article.

Ice packs and/ or heat

Massage Therapy

There’s no doubt about it, poor posture and stress can worsen the symptoms of Tietze’s Syndrome.

And it’s a vicious cycle: the pain of Tietze’s can lead to tense muscles and poor posture.

Massage therapy can aid in relaxation—an important part of dealing with the disorder.

The more relaxed you are, there less likely you are to tense the muscles around your chest.

Plus, people who are relaxed are more inclined to breathe deeply through the stomach (the type of breathing that is most beneficial for Tietze’s Syndrome).