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.
Tim Pigott - Health and Performance 3 