Tietze’s Syndrome

THE CLINICAL SYNDROME

Tietze’s syndrome is a common cause of chest wall pain encountered in clinical practice. Distinct from costosternal syndrome, Tietze’s syndrome was first described in 1921 and is characterized by acute painful swelling of the costal cartilages. The second and third costal cartilages are most commonly involved, and in contradistinction to costosternal syndrome, which usually occurs no earlier than the fourth decade, Tietze’s syndrome is a disease of the second and third decades. The onset is acute and is often associated with a concurrent viral respiratory tract infection. It has been postulated that microtrauma to the costosternal joints form severe coughing or heavy labor may be the cause of Tietze’s syndrome. Painful swelling of the second and third costochondral joints is the sine qua non of Tietze’s syndrome. Such swelling is absent in costosternal syndrome, which occurs much more frequently than Tietze’s syndrome.

Swelling of the second and third costochondral joints is the sine qua non of Tietze's syndrome.

SIGNS AND SYMPTOMS

Physical examination will reveal that the patient suffering form Tietze’s syndrome will vigorously attempt to splint the joints by keeping the shoulders stiffly in neutral position. Pain is reproduced with active protraction or retraction of the shoulder, deep inspiration, and full elevation of the arm. Shrugging of the shoulder may also reproduce the pain. Coughing may be difficult, and this may lead to inadequate pulmonary toilet in patients suffering from Tietze’s syndrome. The costosternal joints, especially the second and third, will be swollen and exquisitely tender to palpation. The adjacent intercostal muscles may also be tender to palpation. The patient may also complain of a clicking sensation with movement of the joint.

TREATMENT

Initial treatment of the pain and functional disability associated with Tietze’s syndrome should include a combination of the nonsteroidal anti-inflammatory drugs or the cyclooxygenase-2 inhibitors. The local application of heat and cold may also be beneficial. The use of an elastic rib belt may also help provide symptomatic relief and help protect the costovertebral joints from additional trauma. For patients who do not respond to these treatment modalities, the following injection technique using local anesthetic and steroid may be a reasonable next step. Injection for Tietze’s syndrome is performed by placing the patient in the supine position, and proper preparation with antiseptic solution of the skin overlying the affected area costosternal joints is carried out.

Patients suffering from pain emanating form the costosternal joint will often attribute their pain to a heart attack. Reassurance is required, although it should be remembered that this musculoskeletal pain syndrome and coronary artery disease can coexist. Tietze’s syndrome, which is painful enlargement of the upper costochondral cartilage associated with viral respiratory tract infections, can be confused with the more commonly occurring costosternal syndrome, although both respond to the aforementioned injection technique. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for costosternal joint pain. Vigorous exercises should be avoided as they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.