What is Tietze Syndrome?
Tietze syndrome is a rare condition that involves inflammation, resulting in chest pain and swelling where the ribs meet the breastbone. Despite causing discomfort, Tietze syndrome is harmless and typically features swelling in a specific area, often on only one side, primarily at the second and third joints where the ribs connect to the breastbone. Although less common, it can also affect the joint where the collarbone meets the breastbone.
What Causes Tietze Syndrome?
The exact cause of Tietze syndrome, a disorder that results in swelling of the cartilage in the upper ribs, is still not known. However, some research suggests that repeated minor injuries to the front area of the chest might lead to its development. People with conditions like psoriatic arthritis, a type of arthritis that affects some people who have psoriasis, may have a higher chance of getting Tietze syndrome.
Possible causes could also include falls, car accidents, or conditions that cause coughing, like sinusitis (inflammation of the sinuses) or laryngitis (an inflammation of the voice box or vocal cords). In some cases, Tietze syndrome might develop following heavy and persistent coughing, throwing up, injuries to the chest, viral or bacterial infections, or surgery around the chest area.
A recent case report has also suggested that Tietze syndrome can occur in the aftermath of a non-symptomatic Covid-19 infection. Some studies propose that Tietze’s syndrome might not be a standalone condition, and may be associated with conditions that affect the front chest wall, such as spondyloarthritides, arthritis that may also affect the spine, and sternocostoclavicular hyperostosis, a rare condition characterized by bony overgrowth of the collar bone and first rib.
Risk Factors and Frequency for Tietze Syndrome
The exact number of people affected by Tietze syndrome isn’t known. Factors such as biological gender, ethnicity, location, or job do not seem to influence the chance of getting it. It affects men and women about equally. People under the age of 40 get it more often than those over 40. However, it is rare for those aged 40 or older, though there have been cases reported.
Signs and Symptoms of Tietze Syndrome
Tietze syndrome is a condition where patients typically experience sudden acute chest pain without any previous occurrences of trauma. This syndrome often affects younger people who are otherwise healthy. The pain is generally described as dull and aching when resting, but can become sharp during movement or as your body position changes. This pain can also extend to places like the neck, arms, or shoulders.
During a physical examination, a sharp stabbing pain is usually found over a swollen area and it might also extend to the shoulder and the nearby arm. A doctor may sometimes be able to feel a hard, elongated swelling over the cartilage of the affected rib. Depending on the individual, this localized pain could be mild, or it could be severe. The syndrome usually affects the upper ribs, specifically T1 through T4, with the 2nd and 3rd ribs being most commonly affected.
- Described as dull and aching pain at rest
- Becomes sharp during movement or positional changes
- Pain can ramp up quickly but may also develop gradually
- Pain worsens with the movement of the affected arm, twisting of the torso, coughing, sneezing, or deep breathing
Although there is typically some swelling, it is not usually accompanied by heat or noticeable redness. However, some discoloration and mild redness might be present, and at times patients may feel a sense of warmth in the affected area. However, results from heart, lung, or nervous system examinations are usually normal in relation to Tietze syndrome. If any abnormalities related to these systems are found during examination, they should be further investigated to rule out other conditions.
Testing for Tietze Syndrome
When doctors are trying to diagnose Tietze syndrome, a condition that causes chest pain and swelling in the upper ribs, they first rule out other, more common or serious conditions. If you visit a doctor with chest pain, they’ll perform a test called an electrocardiogram to check whether your heart is working normally.
Laboratory tests don’t usually reveal anything specific about Tietze syndrome. A doctor might decide to take a small sample of your rib cartilage to help make a diagnosis; this is known as a biopsy. If it’s done early in the progression of the disease, it can help get a diagnosis sooner.
One of the better ways to diagnose Tietze syndrome is using ultrasound. This test uses sound waves to produce images and can show if there’s swelling where the inflammation is occurring.
Another useful diagnostic tool is nuclear magnetic resonance, a type of scan that can pinpoint changes in the fat tissue and bone marrow close to the inflammation. When these changes compress the joint and narrow the space in it, it’s a sign of Tietze syndrome.
Your laboratory results might also show that you have high levels of certain substances in your blood, like ESR or CRP, which can be signs of inflammation in your body.
X-rays are usually read as normal, but a CT scan might show slight swelling or hardening of the joint that’s causing symptoms. Some doctors are starting to use a type of imaging test called positron emission tomography that includes a CT scan and a tracer called fluorodeoxyglucose. This test can highlight areas of high metabolic activity in the joint and dense calcifications, or hardened areas.
So when you present with chest pain, doctors should definitely order imaging and lab tests. However, interpreting the results and ruling out other potential causes is where medical professionals can be most effective in diagnosing Tietze syndrome. Standard MRI scans for this condition can sometimes reveal some enlargement or thickening of the affected cartilage and perhaps some swelling in the tissue surrounding the affected rib joints.
Treatment Options for Tietze Syndrome
Tietze syndrome is typically treated using gentle care and methods that aim to ease symptoms. It’s important to note that, in many cases, this condition will often improve on its own, often within a few weeks, although it can sometimes last for several months or even up to a year. The main treatments include rest and anti-inflammatory medicines, which can be taken orally or applied as a cream. These medications are intended to reduce inflammation, which is the root cause of this condition.
It’s generally recommended to take anti-inflammatory medicines regularly for up to ten days, provided there are no reasons that make it unsuitable for you. In some cases, short courses of specific anti-inflammatory steroids, such as prednisone or methylprednisolone, can also be considered.
If rest and medicines don’t relieve symptoms substantially, health professionals can give an injection of local anaesthetic, steroid, or a combination of both directly into the swollen area, which can be monitored with a type of scan called a sonogram. Some individuals have found comfort from applying warm pads to the affected area.
In rare cases where symptoms are especially persistent and severe, doctors have sometimes removed the inflamed cartilage through a medical procedure. However, this is generally not the recommended approach and considered on an individual basis.
What else can Tietze Syndrome be?
When someone first experiences severe chest pain, it’s important for doctors to consider a variety of possible causes before diagnosing Tietze syndrome. Tietze syndrome is often misidentified as another condition called costochondritis, since both cause pain in the front of the chest where the sternum and ribs meet. Costochondritis usually involves the 2nd to 5th ribs, but it doesn’t cause swelling at the painful sites. On the other hand, Tietze syndrome can be detected using an ultrasound, as it causes visible inflammation and swelling.
To make a proper diagnosis, doctors also need to rule out other potential causes of the chest pain. These might include:
- Heart-related conditions, such as acute coronary syndrome (heart attack)
- High blood pressure emergencies
- Inflammation or infections in the lungs and surrounding tissue
- Cancers
- Chest injuries, such as fractures
- Joint conditions, such as rheumatoid arthritis or infection-based arthritis
- Gastroesophageal reflux disease (GERD, often called heartburn)
- Mental health disorders
- Other conditions like rib fractures, lupus, and fibromyalgia
By considering all these possibilities and conducting the right tests, doctors can accurately diagnose Tietze syndrome or another condition that better explains the patient’s symptoms.
What to expect with Tietze Syndrome
Tietze syndrome is typically a condition that improves on its own over time and usually has a positive outcome. It’s not yet clear how to prevent this disease, simply because we don’t fully understand what causes it in the first place.
Most people get better within 1 to 2 weeks through conservative management, which might include resting and taking care of their health. But in some instances, the swelling and pain associated with Tietze syndrome may persist for up to a year. It’s important to note that the condition can sometimes rear its head again, even after you’ve recovered.
Despite this, most people will make a full recovery from Tietze syndrome.
Possible Complications When Diagnosed with Tietze Syndrome
Complications linked with Tietze syndrome are usually uncommon, but they can occur due to treatments like injections, medications, or surgery. Possible problems can include infection, a collapsed lung, possible negative responses to medicine, side effects, and scarring.
Possible complications include:
- Infection
- Collapsed lung (pneumothorax)
- Negative reactions to medication
- Side effects from treatment
- Scarring
Recovery from Tietze Syndrome
Tietze syndrome is a condition that usually gets better over time with simple treatments. These treatments could include rest and taking anti-inflammatory medication, which helps to reduce inflammation and pain. It’s also important to avoid heavy or demanding activities that could make the condition come back, especially just after a bout of the condition.
During the recovery phase, it’s also crucial to manage any conditions that might cause a person to cough, sneeze, throw up, or have a dry heave, as these can all contribute to the return of Tietze syndrome.
Preventing Tietze Syndrome
Patients should be encouraged to stay away from intense physical activities for 1 to 2 weeks. This is because such actions might actually make their discomfort worse and potentially slow down the improvement of their symptoms. If the patient has any worry about their symptoms getting worse or noticeable swelling, then the doctor should keep a close eye on their progress.
