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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What are symptoms of costochondritis, and what is Tietze's syndrome?

Costochondritis is distinguished from Tietze's syndrome, a condition also involving 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. 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 localized pain and tenderness in the front of the chest, Tietze's syndrome also causes swelling over the ribs and cartilage near the breastbone (sternum). Redness, tenderness, and warmth can also be present, but a localized swelling is the distinguishing finding. The pain is variable, often sharp, can be confused with heart pain, 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.

How are costochondritis and Tietze's syndrome diagnosed?

Costochondritis and Tietze's syndrome are diagnosed based on the typical history of 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 drugs, physical therapy, and cortisone injections have been used as therapy for the inflamed, painful cartilage of both costochondritis and Tietze's syndrome. Ice packs applied to local swelling can sometimes help to reduce pain and inflammation. Local lidocaine analgesic patch (Lidoderm) application can reduce pain.

Medically Reviewed by a Doctor on 11/6/2015

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