Tietze's syndrome was initially described almost 100 years ago and is an inflammatory process affecting the costochondral cartilages [1] [2] [3]. The etiology and pathogenesis are yet to be elucidated but it is most frequently diagnosed in adults less than 40 years of age who suffer from numerous conditions of rheumatic and non-rheumatic origin [1] [2]. Rheumatoid arthritis (RA), seronegative spondyloarthropathies, trauma, various infections (tuberculosis, brucellosis) and malignant diseases (multiple myeloma, chondrosarcomas, local invasion of breast and lung tumors, but also metastatic dissemination) are mentioned as disorders that may cause Tietze's syndrome [1] [3] [4]. Although it is often mistaken with costochondritis, however, several well-established features distinguish the two clinical entities [4]. The clinical presentation of Tietze's syndrome is demarcated by swelling and tenderness of the costosternal, costochondral and/or sternoclavicular joints, suggesting that the upper ribs are more commonly affected, whereas the manubrium of the sternum and the xiphoid process are rarely involved [1] [2]. Costochondritis, on the other hand, develops in older adults (> 40 years of age) and without swelling of the adjacent tissues [4]. Moreover, only one costal cartilage exhibits inflammatory changes (either the third or second rib) in 80% of patients with Tietze's syndrome, while multiple sites are affected in more than 70% of patients suffering from costochondritis [2] [3] [4]. In addition, one of the most important features of Tietze's syndrome is pain at the site of inflammation, which is often aggravated by coughing, deep breathing or lying prone [1] [2] [4]. Although this syndrome is benign, a relapsing/remitting course is observed, as pain can disappear spontaneously and then reappear and be present for weeks or months, often followed by swelling [1].

• Pain

  Treatment focuses on pain relief. [mayoclinic.com]

• Swelling

  Tietze syndrome, on the other hand, exhibits swellings at the rib-cartilage junction. Costochondritis has no noticeable swelling. Neither condition involves pus or abscess formation. [webmd.com]

  Costochondritis, on the other hand, develops in older adults (> 40 years of age) and without swelling of the adjacent tissues. [symptoma.com]

  Costochondritis is inflammation of the costochondral joints without swelling. Tietze's syndrome, on the other hand, implies swelling and tenderness at the costochondral joints with an insidious onset of pain. [ajol.info]

• Inflammation

  Blood testing ( sedimentation rate or C-reactive protein test) can show signs of inflammation in patients with Tietze syndrome, whereas patients with costochondritis alone typically have normal tests for inflammation. [medicinenet.com]

  a benign inflammation of one or more of the costal cartilages Definition (CHV) a benign inflammation of one or more of the costal cartilages Definition (CHV) a benign inflammation of one or more of the costal cartilages Definition (CHV) a benign inflammation [fpnotebook.com]

  Costochondral cartilage MayoClinic.com Benign Tender Chest Wall Pain of Costosternal Joints Inflammation at patient.info Costochondritis and Tietze Syndrome [en.wikipedia.org]

  Blood testing can show signs of inflammation in patients with Tietze syndrome, whereas patients with costochondritis alone typically have normal tests for inflammation. [arthritis-unplugged.com]

• Wound Infection

  – including respiratory tract infections (RTIs) and wound infections wear and tear – your chest moves in and out 20 to 30 times a minute, and this motion can, over time, lead to discomfort in these joints Costochondritis tends to be more common in adults [knowyourdoctor.com.cy]

  – including respiratory tract infections (RTIs) and wound infections wear and tear – your chest moves in and out 20 to 30 times a minute, and over time this motion can lead to discomfort in these joints Diagnosing costochondritis If you have symptoms [nhs.uk]

• Cough

  Heavy lifting, strenuous exercise and severe coughing have been linked to costochondritis. Arthritis. Costochondritis might be linked to specific problems, such as osteoarthritis, rheumatoid arthritis or ankylosing spondylitis. Joint infection. [mayoclinic.com]

• Chest Wall Pain

  Treatment of musculoskeletal chest pain. http://www.uptodate.com/home. Accessed Feb. 4, 2015. McMahon SB, et al. Thoracic pain. In: Wall & Melzack''s Textbook of Pain. 6 th ed. [mayoclinic.com]

• Sneezing

  In many cases, physical movements like excessive coughing, sneezing or vomiting causes Tietze syndrome that leads to chest pain. The syndrome is most common in teenagers and adults. [syndromespedia.com]

  Symptoms The pain associated with costochondritis usually: Occurs on the left side of your breastbone Is sharp, aching or pressure-like Affects more than one rib Can radiate to arms and shoulders Worsens when taking a deep breath, coughing, sneezing or [mayoclinic.org]

  The condition usually starts with an ache between the shoulder blades, possibly after a shower of sneezes or a chronic cough. Asthmatics are particularly prone, children too. Trauma to the ribcage is another cause. [news24.com]

  The pain may be made worse by: a particular posture, such as lying down pressure on your chest, such as wearing a seatbelt or hugging someone deep breathing, coughing and sneezing physical activity In cases of Tietze’s syndrome, there may also be some [healthinmotion.org.uk]

  Sneezing Straining Lying down on my back (I slept propped up with many pillows). Lying on my back forced pressure onto my breastbone. Anti-inflammatory drugs Cortisone shots into the cartilage can relive pain. 1-3 shots may be needed. [orthohyd.com]

• Rib Tenderness

  Symptoms include: a sharp pain in your upper ribs tenderness around the area of your upper ribs swelling around the area of your upper ribs Sudden movements of your ribs, during physical activity or when you cough or sneeze, may make the pain worse. [hse.ie]

  Palpation with anterior to posterior pressure up to the point of initiation of rib movement at the costosternal joints reproduced the subjects’ symptoms and demonstrated tenderness of at least two consecutive costosternal junctions from the second to [ncbi.nlm.nih.gov]

• Chest Wall Tenderness

  Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation. [ncbi.nlm.nih.gov]

• Chest Pain

  The condition is a common cause of chest pain. [en.wikipedia.org]

  Treatment of musculoskeletal chest pain. http://www.uptodate.com/home. Accessed Feb. 4, 2015. McMahon SB, et al. Thoracic pain. In: Wall & Melzack''s Textbook of Pain. 6 th ed. [mayoclinic.com]

• Hypertension

  Tietze syndrome is ... (41 of 736 words, 1 image ) en.wikipedia.org/wiki/Tietze syndrome American Heritage Dictionary: Collins Dictionary: syndrome | white-coat hypertension [medicine] any combination of signs and symptoms that are indicative of a particular [memidex.com]

  […] 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 [en.wikipedia.org]

  Wrist Training Headache Hearing Heart Condition Heart Rate Heart Rate Monitor Hernia Hiking Hip Injury Hip Replacement Hip Training Hiring HIV/AIDS Holistic Health Hormones Horseback Riding Human Learning Hydration Hydrotherapy Hygiene Hyperglycemia Hypertension [ptonthenet.com]

  It can cause: Panic attacks Anxiety Hyperventilation Temporary hypoesthesia (numbness) paralysis Syncope (passing out) It can also cause pain due to hypertension or high blood pressure. [marijuanadoctors.com]

  Ramsaran EK, Benotti JR, Spodick DH (1995) Exacerbated tamponade: deterioration of cardiac function by lowering excessive arterial pressure in hypertensive cardiac tamponade. Cardiology 86:77–79 CrossRef PubMed Google Scholar 32. [doi.org]

• Localized Chest Pain

  Persistent chest pain of any type associated with nausea, sweating, left arm pain, or any generalized chest pain that is not well localized. [webmd.com]

• Musculoskeletal Pain

  Practical, clinically relevant material facilitates the diagnosis and treatment of musculoskeletal, pain, and chronic disabling conditions. [books.google.com]

  After all, it is assumed that can be traced back to " musculoskeletal chest pain " or " chest wall pain " up to 30 % of all emergency room visits due to chest pain. [memim.com]

  Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Oct. Son MBF, Sundel RP. Musculoskeletal Causes of Pediatric Chest Pain. [emedicine.medscape.com]

  Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013; 40 ( 4 ):863-887, viii. [ PubMed ] [ Google Scholar ] 10. Habib PA Huang GS Mendiola JA Yu JS. Anterior chest pain: musculoskeletal considerations. [ncbi.nlm.nih.gov]

• Muscle Strain

  It is a gradual onset overuse injury caused by traction of the intecostal muscles between the ribs. Side strain A side strain is a tear of the internal oblique muscle, often at its attachment to the ribs. [sportsinjuryclinic.net]

  Causes can be grouped due to the system involved (musculoskeletal, gastrointestinal, respiratory, cardiac) with more common causes including rib stress fractures, costochondritis, muscle strain, gastroesophageal reflux, and exercise-induced asthma. [doi.org]

• Seizure

  The anti-seizure medication gabapentin (Neurontin) has also proven successful in controlling chronic pain. [9] If the pain is severe enough and reoccurring, a doctor may prescribe a medication containing codeine, such as Codeine/Acetaminophen (Tylenol [en.wikipedia.org]

  Anti-seizure drugs. The epilepsy medication gabapentin (Gralise, Neurontin) has also proved successful in controlling chronic pain. Therapies Physical therapy treatments might include: Stretching exercises. [nchmd.org]

• Insomnia

  Some patients with the above symptoms in costal chondrite accompanied by shortness of breath, loss of appetite, insomnia and tachycardia. [noillen.bitballoon.com]

The diagnosis of Tietze's syndrome may be difficult to make without a properly obtained patient history, which provides important clues regarding the onset and course of symptoms. Furthermore, swelling and pain can be assessed only if a thorough physical examination is performed, and the exact location of pain is identified during palpation of the chest wall. Tietze's syndrome is considered to be a diagnosis of exclusion, making imaging studies an essential component during workup [1]. Various techniques have been evaluated for their benefit in diagnosing Tietze's syndrome, including plain radiography, computed tomography (CT) and ultrasonography (US), all showing limited use [2] [3]. Magnetic resonance imaging (MRI) and bone scintigraphy, on the other hand, are currently recommended due to their ability to show inflammatory changes in the cartilage, and also because they are able to exclude other etiologies (tumors, abscesses, etc.) [2] [3]. Certain reports, however, suggest that a biopsy is the only reliable method to confirm the clinical suspicion of Tietze's syndrome, typically revealing nonspecific findings (increased vascularity, patchy loss of ground substance and degenerative changes) on histological examination [2] [5].

Treatment focuses on pain relief. [mayoclinic.com]

The long-term prognosis is good. [ncbi.nlm.nih.gov]

Prognosis References Aeshilmann, A, Kahn MF (1990) Tietze's syndrome: a critical review. Clinical Experimental Rheumatology 8:407 Google Scholar Copyright information [link.springer.com]

What is the prognosis for costochondritis and Tietze syndrome? The outlook for costochondritis and Tietze syndrome is generally very good. Most patients respond well to conservative treatments. [medicinenet.com]

Treatment and prognosis It is a benign condition that may subside spontaneously. Some authors suggest local steroid injection as a possible treatment option 6. [radiopaedia.org]

The prognosis is good. Constant complaints are not expected. [memim.com]

Imaging studies, such as magnetic resonance imaging or computed tomography, are useful in excluding other etiologies or to confirm an ongoing inflammatory process in the chondrosternal joints. [symptoma.com]

Epidemiology Frequency United States The exact prevalence of a musculoskeletal etiology for chest pain is not known, although overall prevalence of a musculoskeletal etiology for chest pain was approximately 10% in one study. [emedicine.medscape.com]

Thoracic pain is an entity that can be difficult to diagnose etiologically. Once the cardiac origin has been ruled out, the rheumatologic, neoplastic, and infectious causes have to be taken into account. [ncbi.nlm.nih.gov]

In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. [doi.org]

Etiology (causes) : Direct injury to the chest, viral infections (cold / flu), idiopathic (the cause cannot be found). Its clinical manifestations : Pain, tenderness in those joints I already mention earlier. [unboundedmedicine.com]

Epidemiology Frequency United States The exact prevalence of a musculoskeletal etiology for chest pain is not known, although overall prevalence of a musculoskeletal etiology for chest pain was approximately 10% in one study. [emedicine.medscape.com]

Epidemiology [ 1, 2 ] Chest pain accounts for 1-2% of consultations in primary care, in which setting a cardiac cause is significantly less likely than in presentations to emergency departments [ 3 ]. [patient.info]

These articulations are called the costovertebral joints. [11] Epidemiology /Etiology The etiology of Tietze syndrome is unknown but Tietze syndrome is often associated in acute cases associated with viral respiratory tract infections. [physio-pedia.com]

Thus, cervical or shoulder problems may refer pain to the chest wall. 2 Epidemiology Costochondritis can affect children as well as adults. [aafp.org]

It does not appear to be an inflammatory disorder, and although the pathophysiology is unkown, could result from injury to costosternal, sternoclavicular, or costochondral articulations from severe or protracted coughing. [link.springer.com]

Pathophysiology Costochondritis is an inflammatory process of the costochondral or costosternal joints that causes localized pain and tenderness. Any of the 7 costochondral junctions may be affected, and more than 1 site is affected in 90% of cases. [emedicine.medscape.com]

Is it possible to prevent costochondritis and Tietze syndrome? Costochondritis and Tietze syndrome cannot be prevented. Although aggravating the symptoms can be minimized by avoiding injury to the chest wall. [medicinenet.com]

Together, we’re preventing, diagnosing and treating diseases with greater precision — an approach we call The Keck Effect. [keckmedicalcenterofusc.org]

Develop a thorough, clinically relevant understanding of interventions such as physical agents and therapeutic exercise in the prevention, diagnosis, treatment, and rehabilitation of disorders that produce pain, impairment, and disability. [books.google.com]

Costochondritis Prevention Because inflammatory costochondritis has no definite cause, there is no good way to prevent it. Costochondritis Outlook Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. [webmd.com]

1. Gijsbers E, Knaap SFC. Clinical presentation and chiropractic treatment of Tietze syndrome: A 34-year-old female with left-sided chest pain. Journal of Chiropractic Medicine. 2011;10(1):60-63.
2. Volterrani L, Mazzei MA, Giordano N, Nuti R, Galeazzi M, Fioravanti A. Magnetic resonance imaging in Tietze's syndrome. Clin Exp Rheumatol. 2008 Sep-Oct;26(5):848-53.
3. Fioravanti A, Tofi C, Volterrani L, Marcolongo R. Malignant lymphoma presenting as Tietze's syndrome. Arthritis Rheum. 2002;47(3):229-230.
4. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80(6):617-620.
5. Kaplan T, Gunal N, Gulbahar G, et al. Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor? Thorac Cardiovasc Surg. 2016;64(3):239-244.