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Tietze's syndrome

Definition

Tietze’s syndrome is inflammation of the cartilage (tough flexible tissue),  that joins your ribs to your breastbone.  This area of cartilage is known as the costochondral joint.

When the costochondral joint becomes inflamed, it results in pain, tenderness and (in the case of Tietze’s syndrome) swelling over the ribs and cartilage around the breastbone (see Tietze’s syndrome – symptoms for more information).

Inflammation is the body’s natural response to infection, irritation or injury. It is not known why the costochondral joint becomes inflamed, but in some cases it has been linked to respiratory infections and excessive coughing.

It is not known how many people are affected by Tietze’s syndrome in the UK, but the condition is believed to be rare. Tietze’s syndrome is more common in young adults.

Tietze’s syndrome vs costochondritis

Tietze’s syndrome is sometimes confused with another similar condition called costochondritis. Costochondritis is also an inflammation of the costchondrial joint, which causes pain and tenderness, but there is no swelling.

The rest of these pages refer to Tietze’s syndrome, but the advice is also applicable to costochondritis.

Outlook

Tietze's syndrome tends to improve on its own after a few weeks. However, you may still have some swelling after the pain and tenderness have gone.

Many people can relieve the symptoms of Tietze’s syndrome themselves with rest and by using non-steroidal anti-inflammatory drugs (NSAIDs) to control the pain and swelling (see Tietze’s syndrome – treatment for more information).

The symptoms of Tietze's syndrome can disappear very quickly or come and go for several years.

 

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Symptoms

The pain and tenderness associated with Tietze’s syndrome may happen gradually or suddenly. Symptoms include:

  • a sharp pain in your upper ribs
  • tenderness around the area of your upper ribs
  • swelling around the area of your upper ribs

Sudden movements of your ribs, during physical activity or when you cough or sneeze, may make the pain worse.

The pain of Tietze's syndrome may be confused with a heart attack. However, the pain of a heart attack is usually more widespread, while the pain of Tietze’s syndrome usually affects only a small area.

See the encyclopaedia A-Z page on symptoms of a heart attack for more information on the pain and symptoms associated with this.

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Causes

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
  • severe coughing, which strains your chest area
  • injury to your chest
  • physical strain from strenuous exercise
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Diagnosis

Your GP will carry out a physical examination by looking at and touching the upper chest area around your costochondral joint. They will ask you when and where your pain occurs, and look at your recent medical history.

Before diagnosing Tietze’s syndrome, some tests may need to be carried out to rule out other possible causes of your chest pain. This may include:

  • an ECG (electrocardiogram), which records the rhythms and electrical activity of your heart
  • a chest X-ray
  • other scans, such as an ultrasound scan and MRI (magnetic resonance imaging) scan, which produce pictures of the inside of your body

If no other condition is suspected or found, a diagnosis of Tietze’s syndrome may be given.

Many people worry that they could have a heart condition when they first feel the chest pain of Tietze’s syndrome. Therefore a diagnosis of Tietze’s syndrome can be very reassuring and more important than any treatment your GP can offer.

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Treatment

Treating Tietze's syndrome 

Tietze's syndrome tends to improve on its own after a few weeks, although you may still be left with some swelling after the pain and tenderness have gone.

Many people can relieve the symptoms of Tietze’s syndrome themselves with rest and by using non-steroidal anti-inflammatory drugs (NSAIDs) to control the pain and swelling. If pain is severe, your GP may prescribe a stronger painkiller, such as a corticosteroid injection.

Rest

Tietze’s syndrome can be aggravated by any activity that places stress on your chest area, such as racket sports, athletics or simply reaching up to a high cupboard.

Any activity that makes the pain in your chest area worse should be avoided until the inflammation in your ribs and cartilage has gone down.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The symptoms of Tietze's syndrome can be treated with non-steroidal anti-inflammatory painkillers (NSAIDs), which can help to relieve inflammation and pain.

NSAIDs include ibuprofen, naproxen and aspirin.
Do not use NSAIDs if you have asthma, high blood pressure, or kidney or heart problems. You should not take aspirin if you are under 16.

Corticosteroids

In severe cases of Tietze's syndrome, corticosteroid injections may also be used to treat the condition.

Corticosteroids are medicines that help to reduce swelling and pain, and can be injected into and around your costochondral joint. Before having a corticosteroid injection, you will be given a local anaesthetic to numb the area around the injection.

Having too many corticosteroid injections can damage your costochondral joint, so you may only be able to have this type of treatment once or twice.

 

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