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].

• Chest Wall Pain

  Abstract Costochondritis is a common diagnosis in patients with anterior chest wall pain in whom serious disease has been excluded. [ncbi.nlm.nih.gov]

  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]

• 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]

• Non-Cardiac Chest Pain

  Tietze's syndrome ; www.whonamedit.com Lanham DA, Taylor AN, Chessell SJ, et al ; Non-cardiac chest pain: a clinical assessment tool. Br J Hosp Med (Lond). 2015 May76(5):296-300. doi: 10.12968/hmed.2015.76.5.296. [patient.info]

• 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]

• 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]

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]

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]

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]

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]

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

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.