Tietzes Syndrome

Definition

“A benign, painful, non-suppurative localised swelling of the costosternal, sternoclavicular or costochondral joints, most often involving the area of the 2nd and 3rd ribs.”

n Tietze’s syndrome, the cartilage of the costochondral joint becomes inflamed and swollen, causing pain and tenderness.

Tietze’s syndrome is very similar to another condition called costochondritis, which also causes pain in the costochondral joint. Sometimes, Tietze’s syndrome and costochondritis are thought to be the same, although only Tietze’s syndrome results in both pain and inflammation.

 

Aetiology

The cause is unknown but may occur following upper respiratory infections and excessive coughing.

The cause of Tietze’s syndrome is not fully understood, although it may be linked to upper respiratory tract infections, such as sinusitis and laryngitis. In some people with Tietze’s syndrome, it is thought that severe coughing may be a cause.

Anyone can develop Tietze’s syndrome, although it is most common among people who are between 20-40 years of age. The condition affects twice as many men as women.

Tietze’s syndrome could be more a part of seronegative disease than has been previously recognized (Aeschlimann A, Kahn MF 1990)

 

Pathological Process

Relatively unkown, nutritional and vitamin dificiencies have been suggested as well as traumatic pathogenesis including recurrent microtrauma, severe coughing and alterations of the ligamentus structures. There has also been an association reported with respiratory tract infections. Histological descriptions vary from unchanged costal cartilages to increased vascularity and degenerative changes with calcification or loss of ground substance resulting in a fibrillar appearace.

 

Clinical Presentation

Subjective

sharp pain at the sternum

Can be gradual or sudden onset

Can also affect the 2nd and 3rd ribs

Aggravated by physical activity, movement, coughing, sneezing, deep breath

 

Objective

Localised tenderness

Localised swelling, normally at the 2nd and 3rd ribs.

Pain may radiate to the arm.

 

Differential Diagnosis

MI

Pneumonia

Malignancy

Rheumatoid disorders

Infection

Non-Traumatic conditions affecting the SCJ

Fracture

Gout

Trigger points

 

Investigations

USS may aid diagnosis

Chest X-ray to rule out other pathologies

ECG to exclude cardiovascular conditions

CT scan

MRI

 

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.

 

a combination of X-ray, CT, MRI and nuclear medicine is the best way to diagnose the disease and rule out other disorders. (Guglielmi G et. al. 2009)

Treatment

Reassurrance

NSAIDs

Local corticosteroid injection

Intercostal nerve blocks

Resection of the involved cartilage

Ice packs applied to local swelling can sometimes help to reduce pain and inflammation

Local lidocaine analgesic patch (Lidoderm) application can reduce pain.

 

Prognosis

Pain usually subsides within a few weeks, with some residual swelling persisting.

The course of the condition varies from spontaneous recovery to persistent symptoms over years.

 

References

 

Guglielmi G, Cascavilla A, Scalzo G, Salaffi F, Grassi W. Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions. Clin Exp Rheumatol. 2009 May-Jun;27(3):402-8.

 

http://www.nhs.uk/Conditions/Tietzes-syndrome/Pages/Symptoms.aspx

 

Aeschlimann A, Kahn MF Tietze’s syndrome: a critical review. Clin Exp Rheumatol. 1990 Jul-Aug;8(4):407-12.

 

About these ads

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s