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Tietze Syndrome

Synonyms of Tietze Syndrome

  • Chondropathia Tuberosa
  • Costochondral Junction Syndrome

Disorder Subdivisions

  • Costosternal Chondrodynia

General Discussion

Tietze syndrome is a rare, inflammatory disorder characterized by chest pain and swelling of the cartilage of one or more of the upper ribs (costochondral junction). Onset of pain may be gradual or sudden and may spread to affect the arms and/or shoulders. Tietze syndrome is considered a benign syndrome and, in some cases, may resolve itself without treatment. The exact cause of Tietze syndrome is not known.

Symptoms

Tietze syndrome is characterized by mild to severe localized pain and tenderness in one or more of the upper four ribs. The second or third ribs are most often affected. A firm, spindle-shaped swelling occurs in the cartilage of these ribs. An aching, gripping, sharp, dull, or neuralgic pain occurs in this area. In some cases, the pain may spread to affect the neck, arms and shoulders.

The pain associated with Tietze syndrome may worsen due to sneezing, coughing, or strenuous activity or exercise. The pain usually subsides after several weeks or months, but the swelling may persist.

Costosternal chondrodynia is a rare variant of Tietze syndrome that is characterized by severe breast pain in individuals who have had reconstructive breast surgery. The pain, which occurs several months following surgery, affects the breastbone (sternum) and ribs (costosternal area).

Causes

The exact cause of Tietze syndrome is not known (idiopathic). Some researchers have speculated that multiple microtrauma to the anterior chest wall may cause the development of Tietze syndrome.

Some cases of Tietze syndrome may occur secondary to other disorders such as psoriatic arthritis.

Affected Populations

Tietze syndrome usually affects older children and young adults. Most cases occur before the age of 40. Males and females are affected in equal numbers.

Related Disorders

Symptoms of the following conditions can resemble those of Tietze syndrome. Comparisons may be useful for a differential diagnosis:

Spinal root lesions or compression can cause chest pain in the form of a deep, boring, aching discomfort, or a sharp sudden and piercing pain. This pain usually occurs after sudden movement of the body, such as sneezing, coughing, laughing or straining.

Chest wall pain is a term given to several conditions characterized by anterior chest pain. A dull, aching pain occurs which varies in response to strain, inflammation, malposition or infiltration of muscles, ligaments, cartilage, or bones in the chest wall. Irritation of a nerve root from the neck or upper spine, or a fractured rib, can also cause chest wall pain. Treatment is aimed at the underlying cause of the pain. Tietze syndrome is part of this group of painful conditions.

Costal chondritis or costochondritis is a common condition characterized by inflammation of the cartilage part of the rib. It may affect one or more rib (costal) cartilages. It is characterized by pain of the chest wall that may spread (radiate) to surrounding areas. Sometimes, the terms costochondritis and Tietze syndrome are used interchangeably. However, the two disorders are differentiated by the presence of swelling, in addition to pain, in Tietze syndrome. In costochondritis, there is no swelling.

Standard Therapies

Diagnosis
A diagnosis of Tietze syndrome is made based upon a thorough clinical evaluation, a detailed patient history, identification of characteristic symptoms, and exclusion of other causes of chest pain. A variety of tests including electrocardiogram, x-rays, and biopsies may be performed to rule out more serious causes of chest pain including cardiovascular disorders or malignant conditions.

Treatment
In some cases, pain associated with Tietze syndrome resolves itself without treatment. Specific treatment for individuals with Tietze syndrome consists of rest, avoidance of strenuous activity, local heat, and pain medications such as steroids or a mild pain reliever (analgesic). Usually the pain subsides after several weeks or months, but the palpable swellings may persist for some time.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Tietze Syndrome

References

TEXTBOOKS
Fauci AS, et al., eds. Harrison's Principles of Internal Medicine, 14th Ed. New York, NY: McGraw-Hill, Inc; 1998:1958.

Magalini SI, et al., eds. Dictionary of Medical Syndromes. 4th ed.New York, NY: Lippincott-Raven Publishers; 1997:791.

Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders Co; 1996:1528.

Behrman RE, ed. Nelson Textbook of Pediatrics, 15th ed. Philadelphia, PA: W.B. Saunders Company; 1996:689.

Kelley WN, et al., eds. Textbook of Rheumatology. 4th ed. Philadelphia, PA: W.B. Saunders Company; 1993:550.

JOURNAL ARTICLES
Thongngarm T, et al. Malignant tumor with chest wall pain mimicking Tierze's syndrome. Clin Rheumatol. 2001;20:276-78.

Van Schalkwyk AJ, et al. A variant of Tierze's syndrome occurring after reconstructive breast surgery. Aesthetic Plast Surg. 1998;22:430-32.

Mukamel M, et al. Tierze's syndrome in children and infants. J Pediatr. 1999;131:774-75.

Kamel M, Kotob H. Ultrsonographic assessment of local steroid injection in Tierze's syndrome. Br J Rheumatol. 1997;36:547-50.

Pappalardo A, et al. Reflexions on the Tietze syndrome: Clinical contribution. Clin Ter. 1995;146:675-82.

Yang W, eta l. Pinhole skeletal scintigraphic manifestations of Tierze's syndrome. Eur J Nucl Med. 1994;21:947-52.

Martino G, et al. Tierze's syndrome in the elderly: description of a case and review of the literature. G Chir. 1994:15:119-23.

Aeschlimann A, Kahn MF. Tierze's syndrome: a critical review. Clin Exp Rheumatol. 1990;8:407-12.

Pye JK, et al. Clinical experience of drug treatments for mastalgia. Lancet. 1985;2:373-77.

Fam AG, et al. Musculoskeletal chest wall pain. Canadian Med Assoc Journal. 1985;133:379-89.

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Report last updated: 2008/04/16 00:00:00 GMT+0

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