Costochondritis and Tietze's Syndrome

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Costochondritis and Tietze's syndrome facts

  • Costochondritis is inflammation of the costochondral junctions, where ribs attach to the breast bone.
  • Genetics, viruses, and injury may play roles in causing costochondritis.
  • Costochondritis can be a medical condition by itself or be a feature of a more widespread disorder.
  • Costochondritis and Tietze's syndrome are diagnosed based on the patient's history of signs and symptoms, such as chest pain localized to the cartilage adjacent to the breastbone, as well as tenderness.

What is costochondritis?

Costochondritis is a common form of inflammation of the cartilage where ribs attach to the breastbone (the sternum). The inflammation can involve multiple cartilage areas on both sides of the sternum but usually is on one side only.

What is Tietze's syndrome?

Tietze's syndrome is an inflammation of the costochondral cartilages of the upper front of the chest that involves swelling of the joint. Costochondritis is distinguished from Tietze's syndrome, a condition also involving pain in the same area of the front of the chest, by the presence of swelling. Costochondritis is not associated with swelling, as opposed to Tietze's syndrome, where swelling is characteristic.

What causes costochondritis?

The causes of costochondritis are not known and may involve several factors. Possible causes include heredity (genetic predisposition), viruses, and trauma (injury).

Costochondritis can be an independent health condition by itself or sometimes can be a feature of a more widespread disorder. Examples of health conditions that can feature costochondritis include fibromyalgia, psoriatic arthritis, ankylosing spondylitis, reactive arthritis, rheumatoid arthritis, lupus, and inflammatory bowel disease (such as ulcerative colitis and Crohn's disease).

What are risk factors for costochondritis?

Risk factors for costochondritis include injury to the chest, virus infection, and rheumatic diseases.

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Costochondritis Symptom

The main symptom of costochondritis is chest wall pain that varies in intensity. The pain may be perceived as

  • pressure,
  • sharp, or
  • aching pain.

Movement, exertion, and breathing deeply tend to aggravate symptoms as the cartilage between the ribs and sternum flex.

What are signs and symptoms of costochondritis and Tietze's syndrome?

Costochondritis is distinguished from Tietze's syndrome, a condition also involving pain in the costosternal joint, by the presence of swelling. Costochondritis is not associated with swelling, as opposed to Tietze's syndrome, where swelling is characteristic. Tietze's syndrome is an inflammation of the costochondral cartilages of the upper front of the chest that involves swelling of the joint.

While both costochondritis and Tietze's syndrome feature symptoms such as localized chest pain and tenderness, Tietze's syndrome also causes swelling over the ribs and cartilage near the breastbone (sternum). Signs and symptoms such as redness, tenderness, and warmth can also be present, but a localized swelling is the distinguishing finding. The chest pain is variable, often sharp, can be confused with heart pain or heart attack, and can last from hours to weeks. It can cause difficulty with sleeping and even rolling over in bed is sometimes painful. Blood testing (sedimentation rate or C-reactive protein test) can show signs of inflammation in patients with Tietze's syndrome, whereas patients with costochondritis alone typically have normal tests for inflammation.

What health care specialists aid in the diagnosis and treatment of costochondritis and Tietze's syndrome?

Primary-care doctors, including family medicine doctors, general practitioners, and internists, as well as rheumatologists (medical specialists in musculoskeletal disease and systemic autoimmune conditions) and orthopedists (medical specialists in disorders of the musculoskeletal system) are all health care professionals who aid in the diagnosis and treatment of costochondritis and Tietze's syndrome. If a patient goes to an emergency room with chest pain, he or she will see an emergency medicine doctor.

What medical exams and tests do health care professionals use to make a diagnosis of costochondritis and Tietze's syndrome?

Doctors diagnose costochondritis and Tietze's syndrome based on the typical history of chest pain localized to the cartilage adjacent to the breastbone as well as the examination findings of tenderness. Swelling is also noted in patients with Tietze's syndrome.

What is the treatment for costochondritis and Tietze's syndrome?

Costochondritis can be aggravated by any activity that involves stressing the structures of the front of the chest cage. It is generally best to minimize these activities until the inflammation of the rib and cartilage areas has subsided.

Rest, anti-inflammatory medication, physical therapy, and cortisone injections have been used by doctors treating the inflammation and chest wall pain of both costochondritis and Tietze's syndrome.

What are home remedies for costochondritis and Tietze's syndrome?

Ice packs applied to local swelling can sometimes help to reduce chest pain and inflammation. Local lidocaine analgesic patch (Lidoderm) application can reduce pain.

What is the prognosis for costochondritis and Tietze's syndrome?

The outlook for costochondritis and Tietze's syndrome is generally very good. Most patients respond well to conservative treatments. Recurrences are more likely in those who also have underlying rheumatologic diseases as described above.

Is it possible to prevent costochondritis and Tietze's syndrome?

Costochondritis and Tietze's syndrome cannot be prevented. Although aggravating the symptoms can be minimized by avoiding injury to the chest wall.

REFERENCE:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, Ninth Edition. Philadelphia, PA: Saunders, 2013.

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Reviewed on 9/7/2016
References
REFERENCE:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, Ninth Edition. Philadelphia, PA: Saunders, 2013.

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