Tietze's Syndrome

Tietze's syndrome causes pain and tenderness over the breastbone and ribs.

Chest pain is a not uncommon complaint at the chiropractic coalface. In its severe form a swollen node appears at one of the sternal joints; either with a rib, or the collar bone.

This condition and costochondral syndrome were initially described as two separate diseases, but the sole difference is the amount of swelling of the cartilage.

Breastbone pain is commonly caused by this little understood, and generally poorly managed condition.

It also affects the joint between the collarbone and the sternum; the SC joint.

It was first named by a German physician early in the twentieth century.

It is now recognized that the presence or absence of swelling is only an indicator of the severity of the condition.

This is what one writer asks. Can you please advise me? I have had pain for nearly two years in the rib, sternum and breast region; sometimes it radiates to my mid back, right under the shoulder blade.

Also, I have had pain in my arm, with tingling in my fingers.

I cannot lie in certain ways; I definitely could not sleep on my front and I cannot twist without severe discomfort. I am unable lift things for any length of time.

It is seriously affecting my life; I am so down every day and I have three gorgeous girls who are not seeing the best of their mum and we are suffering.

This page was last updated by Dr Barrie Lewis on 17th January, 2019.

Swollen Sterno Clavicular (SC) joint

A swollen sterno clavicular (SC) joint is typical of Tietze's syndrome.

It's seriously affecting my life that I'm so down every day and I have 3 gorgeous girls who are not seeing the best of their mum and I am suffering.

I'm ok if I don't move but I can't go on every day like this, my daughters have health problems and severe skin conditions and I think years of doing their skin routine has over worked my muscles.

I've had scans and xrays, blood tests and nothing is showing up. I would just love a dianosis of something and a promise it will get better as I can't face life like this every day. Please can you help.

Any advice is welcome as I have the pain clinic at the hospital soon, and no one knows what to do with me. They are saying I'm a hypochondriac so I just shut up and persevere now.

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Tietze's syndrome

Tietze's syndrome is one cause of chest pain; costosternal ache may often be confused with a heart attack.

Chest pain is commonly caused by a sprain of the joint between the rib and the sternum or breastbone. It is usually associated with discomfort  along the course of the rib, and in the midback, but this is not necessarily the case.

You can easily test for Tietzes syndrome yourself; press firmly on the breast bone, and then let your fingers slide right and left over the junction with the rib and between the ribs. It will be very tender over some of the joints if you have it, usually on one side only, more commonly the left, but it may be bilateral. It can also affect the breastbone collarbone joint, called the sterno clavicular articulation in anatomical terms.

You are almost certainly not having a heart attack, though this should always be considered. It's name is the costosternal syndrome, or Tietze's; in its mild form it really is quite common. Deep breathing may aggravate the pain, but does not usually, unless it is severe.

This is a common condition which responds well to the correct chiropractic treatment. I stress correct, as it took me over twenty years to work out how to treat this nasty painful condition, and, like me, your chiropractor might not know about it.

Whilst she he should be aware of it, it may be worth repeating, that a heavy adjustment in the middle of the back may well aggravate this problem. In fact it may cause it.

How do I know? Because I have provoked it myself. It's known as iatrogenic or doctor caused disease.

There's not a doctor alive who hasn't aggravated or caused some condition; I regret to say, including myself. That's why we call it a practice.

Because that's where we practise the art of doctoring all day long, and you dear patient are the guinea pig. There is, I regret to say, no other way.

Your medical doctor too, I'm afraid, may have no clue. How do I know this? Because I treat so many people with it, and non steroidal anti inflammatory drugs like brufin just don't work. Usually they have unsuccessfully done the medical rounds.

Perhaps I am making an ass of myself by making such an assertion. I would be pleased to hear from any of you reading this who have been cured of Tietzes syndrome by anti inflammatory medication, without having got an ulcer.

• Anti inflammatory drugs
• Iatrogenic illness
  
  

Bone scan

The increased uptake in the right sterno clavicular joint is immediately apparently. Of concern, also in the left shoulder and neck, however the radiologist assures me that those are the features of osteoarthritis.

Happily, within three weeks of chiropractic help the oedema and pain were gone. Worryingly, two weeks after discharge, she went to the gym, did weights and immediately developed acute radiating arm pain, but that's another story. The Tietzes syndrome is healed to all intents and purposes, and she is weighing prayerfully whether to go for neck surgery, or give chiropractic help a chance with the much more serious neck condition.

My worry; did my treatment of the Tietzes syndrome set off the severe neck and arm pain? She had had tingling in arm and hand for over two years, a failed carpal tunnel syndrome operation... She assures me not, as for two and a half weeks she had almost no pain in the neck, arm, shoulder or sterno-clavicular joint. Until she went to the gym and decided to become the next Miss World.

Honestly, I have my doubts. Chiropractic Iatrogenic Illness is a concern for every Chiropractor too. Doctor caused disease, the third most common disease on planet Earth.

Chest pain

Chest pain at the costo sternal joint, which may be acute, where the ribs meet the breastbone is the most common presentation of Tietze's syndrome.

There is tenderness and may be some swelling of the cartilages adjacent to the sternum, which is commonly palpable on examination.

Although many times it can be extremely painful, to the point of being debilitating, Tietze's Syndrome is considered to be a benign condition that may, like many conditions, resolve in 6 to 8 weeks.

Tietzes syndrome pain is sometimes exacerbated by deep breathing, the pain radiating from the midback along the ribs to the sternum.

Costochondritis symptoms may be similar to and are often confused with the chest pain associated with a heart attack.

Sterno Clavicular syndrome of Tietze

Secondly, Tietzes syndrome may affect the first rib and/or collarbone, causing pain in the collarbone joints and, because the artery and nerves to the arm pass between the collar bone and the first rib, it may cause pain in the neck and tingling in arms and hands.

• Thoracic Outlet Syndrome.
  

Because the diaphragm attaches to the lower six ribs, Tietzes syndrome is sometimes association with abdominal discomfort of one sort or another.

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Costochondral joint

Costochondral joint pain is often a sign of Tietze's syndrome; it can also be caused by a heavy manipulation of the thoracic spine.

Tietze's syndrome is often caused by a physical strain or minor injury, such as repeated coughing from a chronic chest infection, vomiting or a blow to the chest. I recently had a case where a young man was violently turned over on a water-slide, falling heavily on his fist whilst it was tightly clenched against his chest.

"I read your article on sternum pain and Tietzes syndrome this afternoon and would like to submit a question to CHIROPRACTIC HELP questions . I saw a chiropractor over the summer in June of 2008. I had pain in my neck and mid back. He gave me numerous adjustments over the course of several weeks, some with heavy force.

After some of my appointments I noticed pain in my sternum, something I'd never felt before. He said it might just be muscle related. I stopped seeing him as I felt he was a lousy listener and kind of arrogant. It is now January and I still have the pain in my sternum. Should I see a chiropractor? And if so, what should I look for so as to avoid getting yet more pain?"

REFERRED PAIN

Many conditions of course can cause chest pain. Heart, lung, midback, stomach, pancreas, gall bladder and liver, and no doubt others... it's a definitely a team job, but once the others have been excluded, a Tietzes syndrome certainly responds to the correct Chiropractic care.

Rare conditions such as Mesothelioma, a nasty lung cancer usually caused by exposure to asbestos, and greatly aggravated by asbestos plus smoking, should also be kept in mind if there is weight loss, malaise...

Mesothelioma Prognosis - Information on mesothelioma and the treatment options available. PleuralMesothelioma.

Rib pain treatment

The usual chiropractic rib pain treatment must be modified in the management of Tietze's syndrome.

• Rib pain treatment

The treatment of Tietzes syndrome remains something of an enigma. It is does not respond well to NSAIDs, and ultrasound doesn't help either. Massage of the muscles between the ribs may help.

This author acknowledges that he was unable to treat this condition successfully for 25 years. After many years of struggling with the treatment of rib conditions, he worked out a cure that almost always works, how quickly depending how much actual swelling there is of the joints. The pain may not go away completely, particularly if you've had it for months.

Heavy posterior to anterior PA manipulation usually aggravates the condition.

My treatment?

• Alternating ice and heat (eg an ice cube in a hot shower)
  
• Gentle posterior to anterior chiropractic adjustments of the involved costo vertebral joints.
  
• Examining the costo sternal joint to determine the fixation with inhalation and exhalation.

• An adjustive technique which involves placing the doctor's hands along the rib, from the sternum to the spine, thrusting either cephalad or caudad depending on the fixation, counter to the breathing.
• An activator treatment may help.
• Soft tissue therapy of the muscles involved.
• As always, the pelvis and neck should be examined and if necessary treated.

Because of the proximity of the breast tissue in the female, the doctor

discreetly removes his grip on the rib during the inactive phase of breathing. Asking the female patient to place her hand over the breast, and pulling the tissue out of the way gives her a modicum of decorum.

I recommend that the anxious female patient should ask a family member to attend the treatment; certainly for the first consultation. Sexual advances chiropractor or medical doctor for that matter happens.

Usually there will be some improvement within a week or two, depending on how long the costosternal pain has been present. However it may take a month or more to resolve. Tietzes syndrome is definitely one of those conditions where patience may be needed. Like any chronic condition it may not resolve completely and require an occasional regular treatment from your chiropractor.

If your chiropractor has no clue, don't be irritable. I was such for 25 years. Suggest she he contact me.

Click on this link for more information. Costosternal anatomy.

Tietze's syndrome casefile

Anecdotes from a casefile have no scientific clout but they often reveal gems of truth. Also Costochondral syndrome aka Tietzes syndrome is a condition I see almost daily at the Chiropractic Coalface. It can be mild, and it can be extremely disabling if allowed to become chronic. Tietzes syndrome casefile.

Pleural Mesothelioma

Most of us know that exposure to asbestos is extremely dangerous. Because this disease is really quite rare (less than 1% of lung cancers) it is usually diagnosed late and the prognosis is poor. Few doctors ever see this pleural mesothelioma in their practices.

Common symptoms are:

• Shortness of breath (due to fluid around the lungs)
  
• Chest pain (and hence on this page that concerns the chest)
• Chronic cough
• Weight loss

USEFUL LINKS

• CHIROPRACTIC RESEARCH ...
• CHEST PAIN page.
• Go from Chest pain to Rib pain causes ...

1. Chiropractic Help
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2. Thoracic Spine Pain
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3. Tietzes Syndrome