The exact incidence of occurrence is not known. It is seen most commonly in the 2 nd to 5 th decades of life. Both sexes are affected equally. It is characterized as a tender, non-suppurative swelling in the upper costosternal region.
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Language: English Polish. The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints. The characteristic symptoms are tenderness, pain and edema involving one of the aforementioned joints on one side. Most commonly the treatment is conservative, in resistant cases surgical. This clinically individual disease unit is often confused with other painful conditions within the thoracic skeletal structures such as costochondritis, which is not accompanied by tissue swelling inside the sternocostal joint [ 2 , 4 , 5 ].
This syndrome of clinical symptoms was first described in by the German professor of surgery Alexander Tietze, who was an assistant to Jan Mikulicz-Radecki [ 6 ]. It is recommended that during the physical examination, with a single finger, one should apply gentle pressure to the front, lateral and posterior chest wall in order to accurately locate the discomfort [ 9 , 10 ]. Significant differences between these two disease entities are presented in Table I [ 12 ].
Ultrasound imaging is the most common method, which shows swelling of soft tissues at the site of the ongoing inflammatory process. In turn, the nuclear magnetic resonance NMR very accurately shows inflammatory changes in the surrounding fat tissue along with bone marrow edema causing compression and close adherence of the joint surfaces forming the articulation.
There are no destructive changes in cartilage and bone. Another recommended method is skeletal scintigraphy using technetium or radioactive gallium. Particularly, conservative methods of treatment are used, which include pain management using analgesics and non-steroidal anti-inflammatory drugs. In rare cases resistant to the above-mentioned pharmacological methods, the site of the pain can be injected with a solution of lignocaine in combination with a steroid.
Warming wraps for the painful place are also recommended. In individual cases, resection of the cartilage has been described. A few-week limitation of physical activity is also recommended. Treatment with the aforementioned methods should be continued until the pain is completely resolved.
On average, the symptoms disappear after 1—2 weeks of such treatment. In rare cases, the pain may remain chronic [ 3 , 12 , 13 ]. The most frequently reported differences are presented in Table II [ 16 ]. National Center for Biotechnology Information , U. Journal List Kardiochir Torakochirurgia Pol v. Kardiochir Torakochirurgia Pol. Published online Sep Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Feb 5; Accepted Apr 3. Usually second to fifth costochondral junctions involved Usually single and unilateral. Corticosteroid or sulfasalazine injections in refractory patients Reassurance, pain control with nonsteroidal antiinflammatory drugs, and application of local heat. Corticosteroid and lidocaine injections to the cartilage, or intercostal nerve block in refractory patients.
Open in a separate window. Disclosure The authors report no conflict of interest. References 1. Aeschlimann A, Kahn M. TS: a critical review. Clin Exp Rheumatol. Fam A, Smuythe H. Musculoskeletal chest wall pain.
Can Med Assoc J. Kamel M, Kotob H. Br J Rheumatol. Peyton F. Unexpected frequency of idiopathic costochondral pain. Obstet Gynecol. Chest pain in focal musculoskeletal disorders. Med Clin N Am. Tietze A. Berliner klinische Wochenschrift. Jurik AG, Graudal H. Report of sixteen cases and review of the literature. Scand J Rheumatol. J Clin Rheumatol. Musculoskeletal chest wall syndromes in patients with noncardiac chest paIn: a study of patients.
Arch Phys Med Rehabil. Cayley WE. Am Fam Physician. Evaluation and treatment of musculoskeletal chest pain. Prim Care Clin Office Pract. The causes of musculoskeletal chest pain in patients admitted to hospital with suspected myocardial infarction.
Eur J Intern Med. Can 99m technetum methylene diphosphate bone scars objectively document costochondritis? Acute pain-costochondritis demonstrated by galium scintigraphy.
Aching, sharp, stabbing initially, later persists as dull aching. Repetitive physical activity provokes pain, rarely occurs at rest. New vigorous physical activity such as excessive cough or vomiting, chest impact. Movements of upper body, deep breathing, exertional activities. Crowing rooster maneuver and other physical examination findings. Physical examination, exclude rheumatoid arthritis, pyogenic arthritis. Chest radiograph, computed tomography scan, or nuclear bone scan to rule out infections or neoplasms if clinically suspected.
Bone scintigraphy and ultrasonography can be used for screening for other conditions. Reassurance, pain control, nonsteroidal antiinflammatory drugs, application of local heat and ice compresses, manual therapy with stretching exercises. Corticosteroid or sulfasalazine injections in refractory patients. Reassurance, pain control with nonsteroidal antiinflammatory drugs, and application of local heat.
What You Need to Know About Tietze Syndrome
Tietze syndrome is a rare condition that involves chest pain in your upper ribs. This article will take a closer look at the symptoms, possible causes, risk factors, diagnosis, and treatment of Tietze syndrome. The main symptom of Tietze syndrome is chest pain. With this condition, pain is felt around one or more of your upper four ribs, specifically where your ribs attach to your breastbone. In 70 to 80 percent of cases , the pain is located around a single rib. Usually only one side of the chest is involved. Inflammation of the cartilage of the affected rib causes the pain.
What do we know about Tietze’s syndrome?
Tietze syndrome also called costochondral junction syndrome is a benign inflammation of one or more of the costal cartilages. Tietze syndrome is not the same as 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.