Costochondritis and Tietze Syndrome

Costochondritis is an inflammation of the area where the ribs join the cartilage that is attached to the sternum. Costochondritis causes chest pain, especially upon palpation of the area.

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 syndrome?

Tietze 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 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 syndrome, where swelling is characteristic.

Possible causes include heredity (genetic predisposition), viruses, and trauma (injury).

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 the risk factors for costochondritis?

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

The main symptom of costochondritis is chest pain that varies in intensity. The pain may be perceived as pressure, sharp, or aching.

• Costochondritis is distinguished from Tietze 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 syndrome, where swelling is characteristic.
• Tietze 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 syndrome feature symptoms such as localized chest pain and tenderness, Tietze 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 syndrome, whereas patients with costochondritis alone typically have normal tests for inflammation.

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 syndrome. If a patient goes to an emergency room with chest pain, he or she will see an emergency medicine doctor.

Doctors diagnose costochondritis and Tietze 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 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 to treat the inflammation and chest wall pain of both costochondritis and Tietze syndrome.

What are home remedies for costochondritis and Tietze 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.

The outlook for costochondritis and Tietze 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 syndrome?

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