Tietze's syndrome
Tietze's disease / inflammation of the costal cartilages

Tietze's syndrome is a condition that causes inflammation of the cartilage connections between one or more ribs and the breastbone. This results in annoying pain in the chest, which may sometimes feel as if there is something wrong with the heart.

Tietze's syndrome is a relatively unknown rheumatic condition. As the symptoms caused by the condition are sometimes similar to a heart attack, it is very important to have a specialist evaluate the symptoms.

Description of condition

Along the front of the body, the chest (rib cage) is formed by the ribs, the breastbone and a number of vertebrae. The ribs are connected to the breastbone via cartilage structures. These cartilage structures, called "costal cartilage", provide the ribs with space to move and allow the rib cage to expand and contract.

If the cartilage becomes inflamed between one or more ribs and the breastbone, and this is accompanied by swelling of the cartilage, this is referred to as Tietze's syndrome. If there is no swelling, or it is the cartilage along the back of the ribs that is inflamed, this is referred to as costochondritis.

Cause and history

The cause is currently unknown. However, there are factors that have been linked to the development of Tietze's syndrome:

• Physical exertion.
  
• Incorrect posture (for example, a stooped posture with your back rounded and shoulders protruding forward).
  
• Overloading or trauma (for example, falling or a blow to the chest).
  
• Pregnancy.
  
• Respiratory tract infection.
  
• Emotional struggles/tension.
  
• Stress.
  
• Repetitive movements that expand the rib cage, exerting forces on the cartilage of the ribs (for example, deep inhalation, frequent coughing or repeated clearing of the throat).
  

It is thought that people with a family history of rheumatic conditions have an increased risk of developing Tietze's syndrome. Other factors that result in an increased risk include: postural abnormalities, limited muscle strength, fear of movement and a low resilience.

Signs & symptoms

Tietze's syndrome often affects only one cartilage connection at a time. Usually the second or third rib is affected. The pain is usually located on one side. The most important symptoms are summarized below:

• Pain in the chest at the level of the breastbone.
  
• Swelling of the cartilage.
  
• The pain may be sharp in nature and occur in waves.
  
• The skin above the inflammation may be red.
  
• Pressure pain at the inflamed cartilage.
  
• Coughing, sneezing or deep inhalation is extremely painful.
  
• Sometimes the pain may radiate into the ribs, the arm, the shoulder or the abdomen.
  
• Movements of the upper body cause additional pressure or stretching of the ribs and the cartilage. This can make the pain worse.
  
• The rib cage also moves along with the arm movements that we make. Therefore, certain arm movements may provoke the symptoms.

Diagnosis

The diagnosis is made based on a physical examination and the patient's story. Blood tests often do not reveal any abnormalities. X-rays of patients with Tietze's syndrome reveal swelling at the base of the breastbone.

Treatment

As no real treatment has been found yet for the condition, the treatment is often aimed at reducing the pain. Patients are therefore often prescribed analgesics or anti-inflammatories. Sometimes injections are administered at the site of the inflammation.

The symptoms usually disappear on their own within a few months. However, the condition can become chronic, causing problems for months or years. Sometimes the symptoms never go away completely.

A physiotherapist can help to achieve improved posture. This reduces the pressure on the painful cartilage connections. Other techniques include stretching the pectoralis major muscle and strengthening the rhomboid muscles located between the shoulder blades. Relaxation exercises and breathing exercises can also be of value.

Exercises

Follow this exercise program with specially compiled exercises for Tietze's syndrome.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Albarran, J.W. & Tagney, J. (2007). Chest Pain. Advanced assessment and management skills. Blackwell Publishing.
Haga, P., Biesen-’t Riet, J. van der & Broekema, A. (2008). Protocol syndroom van Tietze en costochondritis. Oefentherapeuten Mensendieck.
Lawless, C.E. (2011). Sports cardiology essentials: Evaluation, management and case studies. Springer: New York, Dordrecht, Heidelberg, London.
Proulx, A.M. & Zyrd, T.W. (2009). Costochondritis: Diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.