Tietze syndrome refers to the inflammation of the costal cartilages, leading to pain localized between the ribs and the sternum. Formerly, Tietze’s syndrome was believed to be distinct from an entity called costochondritis, but is now recognized as the severe form of the latter. The severity of this syndrome is characterized by cartilage swelling and pain extending to the arms and shoulders, both of which are not present in the milder forms of costochondritis. Like other inflammatory conditions, this syndrome is treated through rest, ice packs or heat therapy, physical therapy, pain relievers, and anti-inflammatory medications such as corticosteroids.
The underlying cause of the syndrome is not known, but the precedent is often a mechanical event that causes stretching of the costal cartilages. Examples of such events include repeated episodes of coughing, vomiting, sneezing, laughing, or physical impact to the chest. Overexertion of the chest wall during exercise could also injure the costal cartilages. It was formerly thought this syndrome occurs after surgery, but this is not the case, particularly because the majority of those who are affected have not previously undergone surgery.
Cartilage injury results in inflammation, which manifests with swelling of the affected cartilages, and severe pain that is worsened by respiration. Although the pain due to cartilage inflammation is sometimes debilitating, Tietze syndrome is a benign condition and should not be mistaken for a heart attack. This syndrome usually resolves within 12 weeks, as the inflamed cartilages heal. It can, however, become a chronic condition.
For the physician to determine whether a person has a case of costochondritis or a more severe case of Tietze syndrome, questions about both the location and radiation of pain as well as the presence of swelling may be asked. In costochondritis, the third, fourth, and fifth costal cartilages are usually involved. Only one joint is usually affected in this syndrome. The pain frequently radiates to the arm or back, and the affected person is usually unable to point to the origin of the pain. In terms of epidemiology, most cases of costochondritis occur among women of ages 40 years and above, while cases of this syndrome equally affect men and women who are between the ages 20 and 40 years old.
Treatment of this syndrome involves letting the cartilages heal through the avoidance or reduction of activities such as coughing, intense exercise, pulling or pushing, straining, and lying supine. Ice packs or heating pads may decrease inflammation and improve circulation to the inflamed area. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used. Patients in severe pain often derive benefit from local anesthetics such as lidocaine injection. For chronic cases, steroid injections may be used.
