Tietze syndrome

Tietz syndrome

Not to be confused with Tietz syndrome.

Tietze syndrome
Synonyms	Chondropathia tuberosa, costochondral junction syndrome
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Symptoms
Complications
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Duration
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Differential diagnosis
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Tietze syndrome (also called costochondral junction syndrome) is a benign inflammation of one or more of the costal cartilages.<ref name=":1">

Tietze Syndrome(link). NORD (National Organization for Rare Disorders).

Accessed 2016-03-01.

</ref> It was first described in 1921 by the German surgeon Alexander Tietze (1864–1927).<ref>synd/2640 at Who Named It?</ref><ref>Tietze A,

 Über eine eigenartige Häufung von Fällen mit Dystrophie der Rippenknorpel, 
 Berliner klinische Wochenschrift, 
 1921,
 Vol. 58,
 pp. 829–831,</ref>

Tietz syndrome

Tietze syndrome is not the same as costochondritis.<ref name="National Health Service">

Tietze's Syndrome(link). {{{website}}}.

</ref> Tietze syndrome is differentiated from costochondritis by swelling of the costal cartilages, which does not appear in 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.

Signs and symptoms

The main presentation of the syndrome is significant, acute pain in the chest, along with tenderness and some swelling of the cartilages affected, which is commonly palpable on examination. Perceived pain is often exacerbated with respiration.<ref name=srb>Sriram,

 Tietze's disease, 
  
 New Delhi, India:SRB's Manual of Surgery, 
 2010,</ref> Although many times it can be extremely painful, to the point of being debilitating, Tietze's syndrome is considered to be a benign condition that generally resolves in 12 weeks. However, it can often be a chronic condition.

The associated chest pain may present similarly to angina pectoris, normally associated with heart disease, and can cause hyperventilation, anxiety or panic attacks, syncope (passing out), and temporary hypoesthesia (numbness) paralysis, and due to pain high blood pressure or hypertension. In some cases, the pain may be perceived as 10 to 20 times more painful than normalized costochondritis.

Many cases of myocardial infarction (heart attack) patients have been re-considered and improperly diagnosed, due to the identical nature of the symptoms. In females, it is often misdiagnosed as mastalgia. Costochondritis symptoms are similar to Tietze's, the prime difference being that the pain radiates to the arms and shoulders in the latter.

Cause

While the true causes of Tietze's syndrome are not well understood, it often results from a physical strain or injury, such as repeated coughing, sneezing, vomiting, or impacts to the chest ^{(November 2019)} . It has even been known to occur after hearty bouts of laughter ^{(November 2019)} . It can occur by overexertion or by an injury or trauma to the thorax ^{(November 2019)} .

Tietze's syndrome is not thought to be an inherited condition<ref>

Tietze syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program(link). rarediseases.info.nih.gov.

Accessed 2018-04-25.

</ref> and it affects males and females equally.<ref name=":1" />

Psychological stress can exacerbate Tietze's syndrome through chest muscle contraction, but there is no evidence to suggest that it is a direct cause ^{(November 2019)} .

Patients who have had radiation therapy to the chest/breast will often experience this syndrome which can occur shortly after therapy or years later. It is found more often in teens than adults. ^{(November 2019)}

Diagnosis

Differential diagnosis

Although patients will often mistake the pain of Tietze's syndrome for a myocardial infarction (heart attack), the syndrome does not progress to cause harm to any organs. Other potential causes for chest pain include cardiac, gastrointestinal, or traumatic injury.

It is important to rule out a heart attack, as the symptoms may be similar or severe. After assessment, providers often reassure patients that their symptoms are not associated with a heart attack, although they may need to treat the pain, which in some cases can be severe enough to cause significant, though temporary, disability to the patient. Pain relief is achieved with the use of analgesics.

Treatment

After medical assessment and confirmation of no immediate cardiology events, especially heart attack, normal treatment includes rest by reducing activities affecting the chest. Administering anti-inflammatory drugs including naproxen, ibuprofen, aspirin, and acetaminophen<ref name=":0">

Tietze Syndrome - Symptoms, Causes, Treatment, Pictures(link). syndrome.org.

Accessed 2018-01-29.

</ref> is recommended. For very painful and debilitating events, where the pain is unbearable or requires emergency care, Toradol is generally prescribed and administered by direct injection.<ref>

Costochondritis Treatment(link). Anxiety Keep.

Accessed 2018-01-29.

</ref> This can relieve most of the pain in 5 to 10 minutes. Other treatment steps include physical therapy, applying ice packs on the chest area to reduce the swelling, and applying an analgesic patch that may also contain lidocaine. Glucocorticoid steroids may be prescribed in order to reduce the inflammation.<ref name=":0" /> If the pain is reoccurring, doctors may also recommend tricyclic antidepressants such as amitriptyline, which is often used to control pain when patients find it difficult to sleep at night. The anti-seizure medication gabapentin (Neurontin) has also proven successful in controlling chronic pain.<ref>

Costochrondritis: Diagonosis and Treatment.(link). {{{website}}}. Mayo Clinic.

Accessed 2018-08-05.

</ref> If the pain is severe enough and reoccurring, a doctor may prescribe a medication containing codeine, such as Codeine/Acetaminophen (Tylenol No.1, No.2, No.3 or No.4). However, because codeine can be habit forming, it is generally only prescribed when Toradol or other analgesics have failed to provide sufficient relief.<ref>Phillips K, et al. Treatment of musculoskeletal chest pain. http://www.uptodate.com/home. Retrieved 2018-08-05</ref><ref>McMahon SB, et al. "Thoracic pain" in Wall & Melzack's Textbook of Pain. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 20015.Retrieved 2018-08-05. </ref>

External links

• Overview at About.com
• NetDoctor
• Overview at Mayo Clinic
• Costochondritis and Tietze Syndrome
• Costochondritis at WebMD
• Clinical presentation and chiropractic treatment of Tietze syndrome at National University of Health Sciences

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