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Symptoms, Causes, Diagnosis, and Treatment

Tietze syndrome is a rare condition that involves chest pain in your upper ribs. It’s benign and mostly affects people under age 40. Its exact cause isn’t known.

The syndrome is named for Alexander Tietze, the German doctor who first described it in 1909.

This article will take a closer look at the symptoms, possible causes, risk factors, diagnosis, and treatment of Tietze syndrome.

The main symptom of Tietze syndrome is chest pain. With this condition, pain is felt around one or more of your upper four ribs, specifically where your ribs attach to your breastbone.

According to research that’s been done on the condition, the second or third rib is typically involved. In 70 to 80 percent of cases, the pain is located around a single rib. Usually only one side of the chest is involved.

Inflammation of the cartilage of the affected rib causes the pain. This area of cartilage is known as the costochondral junction.

The inflammation can cause swelling that becomes hard and spindle shaped. The area may feel tender and warm, and look swollen or red.

Tietze syndrome pain may:

  • come on suddenly or gradually
  • feel sharp, stabbing, dull, or aching
  • range from mild to severe
  • spread to your arm, neck, and shoulders
  • get worse if you exercise, cough, or sneeze

Although the swelling may persist, the pain usually decreases after a few weeks.

The exact cause of Tietze syndrome is unknown. However, researchers believe that it may be the result of small injuries to the ribs.

The injuries may be caused by:

  • excessive coughing
  • severe vomiting
  • upper respiratory tract infections, including sinusitis or laryngitis
  • strenuous or repetitive physical activities
  • injuries or trauma

The biggest risk factors for Tietze syndrome are age and possibly the time of year. Beyond that, little is known about factors that may increase your risk.

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What’s known is that:

  • Tietze syndrome mostly affects children and people under age 40. It’s most common in people who are in their 20s and 30s.
  • A 2017 study noted that the number of cases was higher in the winter-spring period.
  • This same study found a higher proportion of women develop Tietze syndrome, but other studies have found that Tietze syndrome affects both women and men equally.

Tietze syndrome and costochondritis both cause chest pain around the ribs, but there are important differences:

Tietze syndrome can be challenging to diagnose, especially when it comes to differentiating it from costochondritis, which is more common.

When you see a healthcare provider for chest pain, they’ll first want to rule out any serious or possibly life-threatening condition that requires immediate intervention like angina, pleurisy, or a heart attack.

The healthcare provider will perform physical exam and ask about your symptoms. They’ll likely order specific tests to rule out other causes and to help them determine the right diagnosis.

This could include:

  • blood tests to look for signs of a heart attack or other conditions
  • ultrasound imaging to look at your ribs and to see if there’s any cartilage inflammation
  • a chest X-ray to look for the presence of disease or other medical concerns involving your organs, bones, and tissues
  • a chest MRI to take a closer look at any cartilage thickening or inflammation
  • a bone scan to take a closer look at your bones
  • an electrocardiogram (EKG) to look at how well your heart is working and to rule out heart disease

A diagnosis of Tietze syndrome is based on your symptoms and ruling out other possible causes of your pain.

The general treatment regimen for Tietze syndrome is:

  • rest
  • avoiding strenuous activities
  • applying heat to the affected area

In some cases, the pain may resolve on its own without treatment.

To help with the pain, your healthcare provider may suggest pain relievers such as over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs).

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If your pain persists, they may prescribe a stronger pain reliever.

Other possible treatments for ongoing pain and inflammation include steroid injections to reduce swelling or lidocaine injections at the affected site to ease pain.

Although the swelling may persist longer, Tietze syndrome pain usually improves within months. Sometimes the condition can resolve and then recur.

In extreme cases where conservative therapies don’t help reduce the pain and swelling, surgery may be needed to remove extra cartilage from the affected ribs.

Tietze syndrome is a rare, benign condition that involves a painful swelling and tenderness of the cartilage around one or more of your upper ribs where they attach to your breastbone. It mostly affects people under age 40.

It’s different from costochondritis, a more common condition that also causes chest pain, that mostly affects people over age 40.

Tietze syndrome is typically diagnosed by ruling out other conditions that cause chest pain. It usually resolves with rest and by applying heat to the affected area.

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