Tietze's Syndrome Research Articles

EP.14C.06 Surgical and Local Treatment of Pain in Tietze Syndrome: Our Experience in University Hospital “Shefqet Ndroqi” Tirana Albania

EP.14C.06 Surgical and Local Treatment of Pain in Tietze Syndrome: Our Experience in University Hospital “Shefqet Ndroqi” Tirana Albania

Spondyloarthritis and Tietze's syndrome: A Re-evaluation.

Spondyloarthritis comprises a number of related but different disorders with distinct phenotypes: psoriatic arthritis, reactive arthritis, arthritis related to inflammatory bowel disease, undifferentiated arthritis, and ankylosing spondylitis (the well-known prototypic subtype). Differentiating rheumatic diseases, such as rheumatoid arthritis, synovitis-acne-pustulosis-hyperostosis-osteitis syndrome, pustulotic arthro-osteitis, gout and spondyloarthritis, is difficult because they all may manifest swelling at the upper anterior chest wall, often involve the sternocostal and/or sternoclavicular joints, and clearly show cutaneous nodular symptoms, so that they may mimic Tietze's syndrome in the presentation. Tietze's syndrome is a benign, self-limiting entity with tender, non-suppurative swelling in the upper anterior chest wall, especially at the second and third costosternal junctions and the sternoclavicular joint. Therefore, distinguishing spondyloarthritis from Tietze's syndrome during an entire disease course is important, even after an initial tentative diagnosis. This article aims to re-evaluate the importance of Tietze's syndrome in the differential diagnosis of spondyloarthritis, while keeping in mind information about rheumatic diseases affecting the upper anterior chest wall.

Un dolore in sede parasternale: la sindrome di Tietze

The author describes two cases of costochondritis (Tietze syndrome) detected within a short period of time in two 13-year-old girls.

The Efficacy of Corticosteroids in the Management of Tietze Syndrome: A Randomized Controlled Trial

Abstract Background So far there are no clinical trials in the literature discussing the methods of treatment of Tietze‟s syndrome. Particularly, conservative methods of treatment are used, which include pain management using analgesics and nonsteroidal anti-inflammatory drugs. Oral corticosteroids offer a safe and effective treatment modality that is proven to be useful in a significant number of chest wall syndromes such as Sternoclavicular arthritis, Painful xiphoid syndrome, Costovertebral arthritis, and Slipping rib syndrome as well as conditions arising from ligament and tendon diathesis. Objective To use oral Corticosteroids in management of patients with Tietze syndrome at Ain shams university hospitals‟ cardiothoracic department and measuring the outcome randomly compared with the conventional NSAIDs to achieve the best outcome and quality of life. Methods This study included 40 patients who were diagnosed clinically as Tietze Syndrome at Ain Shams University Hospitals-cardiothoracic department in the duration between August 2020 till March 2022 with age ranging from 14 to 45 years and were sorted randomly. Two groups of patients were chosen and matched randomly as „Control arm‟ and „Interventional arm‟. The control group received the conventional NSAIDs (in the form of 50 mg of diclofenac potassium as „cataflam‟ twice daily) and the Interventional group received oral corticosteroids (in the form of 20 mg of prednisolone as „solupred‟ twice daily). Results Our study suggested that in patients with moderate to severe chondritis diagnosed clinically as Tietze syndrome, a 3 week course of oral 40 mg prednisolone is superior to the conventional oral NSAIDs in alleviating pain and improving the quality of life which is evidenced by the decline in EQ-5D total score of patients receiving oral steroids at the end of the treatment course as well as during each week throughout the trial timeframe. A highly significant reduction in pain score demonstrated via NRS was evident in the steroid-treated group compared to the NSAIDs-treated group at the same time point. Conclusion Oral corticosteroids are effective and safe in non-responding, obstinate Tietze syndrome. The results were unexpectedly good, obtaining significant relief and an outstanding refinement in quality of life reported by patients receiving oral steoids. There is no widely accepted protocol for oral steroid usage in Tietze syndrome and similar chest wall pain syndromes. Some other studies propose surgery in such patients. We think that surgery is a troublesome intervention for the patient and his doctor as well.

Post-COVID-19 Infection Tietze’s Syndrome in a Young Adult Patient

Tietze syndrome is a benign inflammation of one or more of the costal cartilages. The condition is characterized by tenderness and painful swelling of the anterior (front) chest wall at the costochondral (rib to cartilage), sternocostal (cartilage to sternum), or sternoclavicular (clavicle to sternum) junctions. We describe a previously healthy 35 years old gentleman with repeated presentations to the emergency department (ED) with left-sided chest and sternoclavicular pain on a background of recent asymptomatic COVID-19 infection. Labs and imaging subsequently confirmed the diagnosis of Tietze’s syndrome. Anti-inflammatory medications and colchicine eventually led to uneventful recovery. This case highlights how Tietze’s syndrome — a disorder that is potentially self-limiting, can cause recurrent hospital admission and should be a differential diagnosis of chest pain related to COVID-19. Bangladesh J Medicine 2023; 34(2): 155-159

P15 Acupuncture treatment of Costochondritis, a case series

Introduction/BackgroundI had been practising acupuncture for 30 years and noticed while working in the rheumatology clinic that costochondritis had a particular response to acupuncture. As this condition is extremely debilitating and often misdiagnosed, a case series of 8 cases is presented, the majority of whom were seen in primary care.Description/MethodCostochondritis is characterised by anterior chest pain associated with painful tender costochondral (CC) joints felt on palpation. These mainly affect the 2nd to 5th costochondral junctions, either unilateral or bilateral. Other areas of the anterior and lateral chest wall can also be affected. The pain is often severe and nocturnal, of sudden onset and can be associated with shock, nausea and dyspnoea, causing patients to call for an ambulance. Tietze's syndrome is a rare variant of this, usually affecting younger patients.Patients with persistent chest wall pain were offered acupuncture. Details of age, duration of symptoms, number of treatments and VAS pain scores were recorded day and night, (Table 1) pre and post treatment Patients with thoracic pain were excluded.0.25*25mm and 0.25*30mm needles were used with silicon tips and a guide tube, to help prevent painful insertion. An infra-red lamp (Bio-lamp) was used + electro-acupuncture (EA) if insufficient improvement after two close treatments, sessions were continued weekly.Acupuncture points used were local tender/trigger points + distal Chinese points P6 and LI4. Other points used were CV 17, GB 34, SI6, GB39 or Sp 6 and St36. An average of 4.7 sessions were needed.Audit of Acupuncture Treatment Table 1P15 Table 1PATIENTAGEDURATION OFNUMBER OFVAS INITIAL (0-10)VAS FINALYEARSPROBLEMTREATMENTSDAYNIGHTDAYNIGHT1375 MTHS410100022618 MTHS8 (1 EA)5.57.5023653 WEEKS5 (+EA)79114584 DAYS4972256210 WEEKS7 (+EA)68026346 WEEKS447227289 MTHS314008255 YEARS38700Recurrence of pain3651 WEEK4 (+EA)88126345 WEEKS228227282 WEEKS11311Six patients took daily analgesia which was rapidly reduced to nil. All completed their treatment until their pain stabilised. There were no adverse events.Average improvement in the day was 89% and night 85%. Recurrences of pain improved by 11% in the day and 72% at night. The attacks of severe chest pain and dyspnoea stopped, abating anxiety.Discussion/ResultsCostochondritis is a highly debilitating condition and I had noticed that acupuncture could be a dramatic treatment for this[i]. It can affect up to a third of patients attending emergency departments with atypical chest pain[ii] and 1-3% of patients in primary care[iii].It seems to be a missed diagnosis by Accident and Emergency (A&E) doctors and GPs, perhaps because the chest wall was not carefully palpated. One patient had ankylosing spondylitis (AS) and another had systemic lupus erythematosus but attributed her pain to prolonged laughter. Five patients attended cardiology clinics including one who had a coronary angiogram. Another had tests for upper abdominal pain which also were normal.All the patients were female although quoted F:M ratio is 7:3Differential diagnoses include: acute coronary syndromes, lung problems, trauma, upper gastroenterology pathology or neoplasiaPathogenesis is unclear but the onset can be acute and follow:Respiratory tract infection Extreme sneezing, coughing or laughterChest wall trauma Micro trauma from costovertebral dysfunctionFibromyalgia Inflammation from inflammatory joint disease.[i] Alexander R; White A. Acupuncture in a Rheumatology Clinic. Acupuncture in Medicine; Dec 2000 vol.18 (no.2): 100-103[ii] Disla E; Rhim HR; Reddy A; Karten I; Taranta A. A prospective analysis in an emergency department setting. Arch Intern Med. 1994; 154(21):2466-2469[iii] Ayloo A; Cvengros T; Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care (Review) Dec 2013 40(4): 863-87Key learning points/ConclusionNormal management of costochondritis includes analgesia, physiotherapy, steroid injections and occasionally surgery[i]. 30% can have protracted pain. There are isolated reports of acupuncture for this condition, integrated with conventional medicine[ii] [iii]. Acupuncture also has been used for myofascial trigger points including costochondritis[iv].Acupuncture is now an accepted modality of pain management and in 2021 was recommended in NICE guidelines for the treatment of Chronic Primary Pain alongside exercise programmes and CBT ahead of analgesic medication[v]. It has also been recommended in the management of low back pain in patients aged 60 years and over as a non-drug treatment[vi].This paper highlights the fact that acupuncture appears to be a safe effective treatment for costochondritis, with further research and more access needed for this therapeutic modality.Increased awareness of this condition would make complex invasive investigations less necessary.[i] Gologorsky R; Hornik B; Velotta J. Surgical Management of Medically Refractory Tietze's Syndrome. Annals of Thoracic Surgery; Dec 2017; vol. 104 (no. 6)[ii] Jonkman FAM.; Jonkman-Buidin M.L; Stolwijk P.W.J. Surprise after successful treatment of a patient with noncardiac chest pain using acupuncture. Medical Acupuncture; Feb 2015; vol.27(no 1):83-90[iii] Lin, Katerina; Tung, Cynthia. Integrating Acupuncture for the Management of Costochondritis in Adolescents. Medical Acupuncture; Oct 2017; vol.29(no 5): 327-330[iv] Baldry P. Cardiac and non-cardiac chest wall pain. Acupuncture in Medicine;1997; vol.15(no.2): 42-45[v] NICE guideline; Chronic Pain (primary and secondary) in over 16s (NG 193 April 2021)[vi] Traeger A; Underwood M;Ivers R; Buchbinder R. Low back pain in people aged 60 years and over. BMJ 2022 vol. 376: e066928

Management of Tietze Syndrome: Acupuncture and Cupping as an Effective Treatment Approach: A Case Study

Tietze syndrome is a rare inflammatory disorder characterized by chest pain at costochondral junction with an idiopathic etiology. A patient came to the Central Ayurved Hospital Nardevi with an excruciating pain since 5 months. Patient stated that the several medications were tried without any success. Patient was further assessed via radiologically and laboratory. Results were within normal limits. Hence, patient was given 12 sessions of acupuncture along with cupping as the means for pain management. Patient was initially assessed via VAS (Visual Analogue Scale) before the commencement of the treatment session. This case demonstrates that the acupuncture can be an effective treatment approach for the management of Tietze syndrome.

Tietze syndrome - a case report of 20 year old male patient with steroid induced tinea incognito

Tietze syndrome is a self-limiting, rare and benign condition that might be mistaken with potentially fatal chest diseases and misdiagnosed mostly as costochondritis. This disease is most often diagnosed in young individuals under the age of 40, with painful, localized inflammation.Tinea incognito is a ringworm infection that has been altered by corticosteroids and other immunosuppressive medications. Corticosteroids are administered for pre-existing illness or are used incorrectly for the treatment of tinea. We report a case of 20years old male patient admitted in emergency department with complaints of chest pain and SOB with normal ECG while neutrophils, ESR, CRP have found to be abnormal. Patient has been using steroids and itraconazole for maculopapular rashes in lower limb since 1year. Other diagnostic methods such as CT, MRI should be performed to avoid misdiagnosis. He was prescribed with NSAIDS, antifungals, antihistamines and other supportive measures which helped him to relieve from pain. Proper diagnostic criteria and early diagnosis remain challenging tasks, resulting in undue treatment costs for patients. Before confirming a diagnosis, other underlying diseases should be ruled out.

Tietze Sendromu: Bir Olgu Sunumu

Tietze’s Syndrome: A Case Report Tietze syndrome (TS) is a rare inflammatory arthropathy characterized by tenderness, pain, and non-purulent swelling of the costosternal, costochondral and sternoclavicular joints. It often involves the costosternal joints and sternoclavicular jointinvolvement is rare. In this case report, we present a 72-year-old female patient suffering from pain and swelling in the right upper chest wall fo rabout 2 years. Physical examination revealed tenderness in the right sternoclavicular joint and an approximately 2x2 cm moderate swelling. Ultrasonic imaging of the swelling area revealed increased echogenicity and edema in the right sternoclavicular joint area. Laboratory findings were normal. The patient was diagnosed with TS and a local injection of a corticosteroid and local anesthetic mixture was administered. The patient’s complaints decreased significantly after the infiltration. In this case report, we present a TS case with sternoclavicular joint involvement that we treated with local injection. Keywords: Tietze’s syndrome, sternoclavicularjoint, costochondritis

A Retrospective, Single-Center Study Investigating the Effects of a Novel Miniature Wireless Spinal Cord Stimulation System for the Treatment of Chronic Back and Leg Pain

BACKGROUND: Tietze syndrome is believed to be a result of recurrent microtrauma and characterized by painful localized inflammation and swelling of the chest wall. Chronic inflammatory changes may infiltrate surrounding tissues, leading to nerve root irritation and subsequent neuralgia. Resultant chronic neuropathy has been historically treated with conservative therapies and local nerve blocks, but the role of implantable neurostimulators have not been well described. CASE REPORT: A 73-year-old woman presented with chronic pain in the left paracentral chest area with episodes of burning and tingling, which radiated to the left shoulder, left arm, and left upper side of the jaw and face. Following the implantation of a permanent neurostimulator, the patient reported a near complete resolution of her pain symptoms. CONCLUSION: The role of implantable neurostimulators in the treatment of chronic neuropathy in the setting of Tietze syndrome is promising and their use may become a mainstay option in the future. KEY WORDS: Tietze Syndrome, neuromodulation, spinal cord nerve stimulation, pain management, neuralgia, implantable spinal cord stimulator

Local treatment of pain in Tietze syndrome: A single-center experience.

Background In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome. Methods Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination. Results At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection. Conclusion Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.

Trunk Injuries in Athletes.

Trunk pain is a common cause of performance limitation and time away from sport in athletes. However, atraumatic trunk injuries are underrepresented in medical literature and underrecognized clinically. Delays in diagnosis and initiation of appropriate treatment can increase injury morbidity and return-to-play time. Currently, evidence-based guidelines for diagnosis and treatment of trunk pain in athletes are limited. Thus, we provide an overview of atraumatic sport-related injuries to the thoracic spine (disc herniation, scoliosis, kyphosis), ribcage (bone stress injury, costochondritis, Tietze syndrome, slipping rib syndrome, costovertebral or costotransverse joint dysfunction), and chest and abdominal wall musculature (intercostal, serratus anterior, oblique strains, regional myofascial pain), highlighting sport-specific biomechanical considerations. We aim to increase awareness of these causes of trunk pain among sports medicine providers in an effort to guide diagnostic and treatment recommendations that will ultimately improve overall musculoskeletal health in athletes.

Tietze syndrome

Tietze syndrome, first described in 1921 by Prof. Alexander TIETZE, is characterized with tender nonsuppurative swelling, pain, and tissue edema in the second or third costosternal cartilage. Differential diagnosis of Tietze syndrome includes diverse diseases, and its diagnosis relies on clinical examination, not the use of additional diagnostic techniques. The treatment of Tietze syndrome includes the use of anti-inflammatory medication and implementation of lifestyle modifications during the attacks. Surgical treatment is reserved for refractory cases and often is not necessary. Tietze syndrome can easily be diagnosed and treated in primary care medicine practice due to its benign nature.

Chest Wall Pain In A Marathon Runner

HISTORY: A 39-year old male marathon runner presented with 1 year of left-sided anterolateral chest wall pain at ribs 10 and 11. Pain started insidiously, without trauma or other inciting incident. Pain primarily occurred with running, and typically worsened as his pace increased. Lifting weights, deep breathing, and prolonged sitting did not exacerbate pain. He denied cough, dyspnea, or wheezing. PHYSICAL EXAMINATION: Normal chest wall expansion. No visual deformity along the ribs or costal cartilage. Tenderness to palpation was noted along the left 10th and 11th ribs and intercostal muscle anterior to the mid-axillary line. No tenderness at adjacent segments or at the same segment on the contralateral chest wall. Mild left-sided chest wall pain with leftward thoracic rotation. DIFFERENTIAL DIAGNOSIS: 1. Costochondritis 2. Tietze syndrome 3. Slipping rib syndrome 4. Thoracic radiculitis 5. Pleurisy TESTS AND RESULTS: MRI Chest Wall: Focal thickening and edema along left lower ribs at region of pain, with surrounding soft tissue swelling. No pleural or pericardial effusion. No bone marrow edema within visualized osseous structures. Ultrasound Chest Wall: Significant signal impedance and focal thickening noted along the intercostal muscle of the left 10th and 11th ribs at the area of maximal tenderness along the anterolateral chest wall. No comparable signal changes are observed at adjacent segment levels or the same segment on the contralateral chest wall. FINAL/WORKING DIAGNOSIS: 1. Tietze syndrome TREATMENT AND OUTCOMES: 1. Performed corticosteroid/lidocaine injection to left 10th-11th rib intercostal muscle under ultrasound guidance 2. Pain diary for 6 hours immediately following injection 3. Routine marathon training as tolerated 4. Ice as needed after running 5. Pain resolved following injection. Inflammation and intercostal muscle hypertrophy resolved on repeat ultrasound 2 months later. 6. Patient completed Berlin and Chicago Marathons in 2019

Dynamic Contrast-Enhanced MR Imaging of Tietze's Syndrome: a Case Report

Dynamic Contrast-Enhanced MR Imaging of Tietze's Syndrome: a Case Report

Effectiveness of costochondral joint mobilization with deep breathing in Tietze syndrome: A case study

Effectiveness of costochondral joint mobilization with deep breathing in Tietze syndrome: A case study

Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies.

The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton.Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints.This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome.The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions.Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078

OP-238 - Idiopathic Costochondritis and Tietze Syndrome: Atypical Chest Pain Syndromes–Recurrence Rates, Treatment Modalities, Seasonality

Background: Patients with chest pain frequently apply to the cardiology clinics or emergency departments with fear of heart disease, after exclusion of life threatening diseases that may remain undiagnosed for a long time. Idiopathic costochondritis (IC), also known as atypical chest pain or anterior chest wall syndrome, is a poorly understood disease characterized by chest pain and tenderness over the chondrosternal or costochondral joints. Tietze syndrome (TS) resembles IC but differs by exhibiting a characteristic non-suppurative painful swelling over the rib cartilages. We aimed to compare IC and TS, to investigate recurrence rates of diseases and seasonality of the diagnosis consider unclear etiology of these issues

What do we know about Tietze's syndrome?

Tietze’s syndrome is a benign, self-limiting arthropathy, without purulent character. The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints. The characteristic symptoms are tenderness, pain and edema involving one of the aforementioned joints on one side. Diagnosis of Tietze’s syndrome is based on physical examination (increase of palpation tenderness in the affected joint), laboratory tests (increase of inflammatory parameters) and imaging studies (USG, MRI). Differential diagnosis of Tietze’s syndrome is based on exclusion of costal cartilage inflammation, coronary syndrome and inflammatory changes in the lung and pleura. Most commonly the treatment is conservative, in resistant cases surgical.

Patient with Thoracic (Spinal) Pain

Although less common than cervical or lumbar pain, thoracic pain is not an uncommon presentation in pain clinics. Thoracic pain may be nociceptive, neuropathic, mixed, or idiopathic. It can originate from bony structures, facet joints, intervertebral disks, or muscles and fascia. In addition, pain from the diaphragm, cervical spine, chest, and abdominal viscera may be referred to the thoracic region. Some of the conditions that should be kept in the differential include ankylosing spondylitis, Tietze syndrome, costochondritis, diffuse idiopathic skeletal hyperostosis, Scheuermann kyphosis, thoracolumbar junction syndrome, osteoarthritis, rheumatoid arthritis, vertebral compression fractures, facet arthropathy, and primary cancer and metastatic disease of the spine. This review focuses on thoracic pain of spinal and musculoskeletal origin. However, it is imperative not to overlook visceral pain because it may be associated with a life-threatening condition. Key words: ankylosing spondylitis, costochondritis, diffuse idiopathic skeletal hyperostosis, Maigne syndrome, sacroiliitis, Scheuermann kyphosis, slipping rib syndrome, thoracolumbar junction syndrome, Tietze syndrome