Tietze syndrome is a rare inflammatory condition that causes swelling of the cartilage that attaches the upper ribs to the breastbone.
In this article, we outline the symptoms and causes of Tietze syndrome (TS) and provide information on how doctors diagnose and treat the condition. We also describe the outlook for people living with TS.
It is important to note that this condition is different than Tietz syndrome, the hallmarks of which include profound hearing loss, white hair, and very pale skin at birth.
TS symptoms are the result of inflammation and swelling in the cartilage that connects the upper four ribs to the sternum. Doctors refer to this area as the “costochondral joint.”
The main symptom of TS is a sharp, dull, or aching pain in the chest. As TS usually affects only one rib, the pain typically occurs on just one side of the chest. If the condition affects multiple ribs, a person may experience pain on both sides of the chest.
In some cases, chest pain may radiate to the neck, shoulders, and arms. These areas may appear red or discolored and feel warm to the touch.
TS pain may range from mild to severe, and it may come on gradually or suddenly. The pain may worsen during the following activities:
- breathing deeply
- coughing
- sneezing
- exercising
- performing quick movements, such as reaching across the chest or opening a door
TS symptoms may follow a relapsing-remitting pattern, meaning that a person will have alternating periods of experiencing symptoms and being symptom-free.
Symptoms typically appear before a person reaches the age of 40 years.
Scientists have yet to identify the exact cause of TS. However, some researchers believe that small injuries, or microtraumas, to the chest wall may play a role in the development of the condition.
Microtraumas within the chest wall may occur as a result of the following:
- a sports injury
- a car accident
- a fall
- viral or bacterial infections
- frequent coughing
- frequent vomiting
- surgery to the thoracic area, which is the area between the sternum and the bottom of the rib cage
The diagnostic procedure for TS involves ruling out other possible causes of chest pain.
A doctor will ask about a person’s symptoms and medical history before performing a thorough physical examination of the chest.
They may also order one of the following diagnostic tests to help rule out possible heart-related or lung-related causes of chest pain:
An MRI scan can be useful to confirm a diagnosis of TS. If TS is present, the scan should show thickening and enlargement of the affected rib cartilage.
TS pain sometimes resolves without the need for medical treatment. In other cases, a person with TS may experience persistent or relapsing pain.
If TS pain does not subside, a doctor may recommend the following:
- resting
- avoiding strenuous activities
- applying heat or ice to the affected area
- taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen
Some people may experience severe or persistent TS pain that does not respond to the above treatments. In such cases, a doctor may recommend injecting the affected area with corticosteroids and lidocaine to reduce the inflammation and numb the pain.
In some cases, doctors may recommend physical therapy. A physical therapist may suggest stretches and exercises that the person can do to help manage their TS symptoms.
However, some people may need to avoid exercise and physical activity during treatment. A person should ask their doctor for advice on which treatment approach will be best for them.
TS is not an autoimmune disease. Instead, it is likely to be due to the development of microtraumas inside the chest wall.
However, having an autoimmune condition could theoretically contribute to TS. An autoimmune condition could predispose a person to certain viral or bacterial infections. Some infections could increase the likelihood of persistent coughing or vomiting, both of which are known risk factors for TS.
TS shares similarities with other disorders of the ribs and chest, including costochondritis and intercostal neuralgia.
Costochondritis
Costochondritis is another condition that causes an aching pain in the cartilage that connects the ribs to the sternum. As with TS, the pain may radiate to surrounding areas.
The main difference between TS and costochondritis is that TS causes characteristic swelling and inflammation in the affected rib cartilage, whereas costochondritis does not.
Other differences between the two conditions include:
- Prevalence: Costochondritis is much more common than TS.
- Age group: Costochondritis tends to affect people over the age of 40 years, whereas TS tends to affect people younger than this.
- Costochondral joints: Costochondritis
typically affects the second, third, fourth, or fifth rib, whereas TS tends to affect only the second or third rib.
Intercostal neuralgia
Intercostal neuralgia is the medical term for nerve pain that originates in the spaces between the ribs.
Symptoms include a sharp, stabbing, or tingling pain around the ribs and possible left-sided back pain. Chest and back pain may worsen during the following activities:
- breathing deeply
- laughing
- coughing
Intercostal neuralgia may occur as a result of a viral infection or following an accident or surgery that damages the intercostal nerves.
The general outlook for people with TS is good. The condition itself is rare, and most people who have it experience mild or short-term symptoms. A 2018 study notes that with standard treatment, the symptoms of TS last an average of
People who experience severe or relapsing-remitting symptoms may require long-term treatment.
TS is benign, and the life expectancy for people with the condition is normal.
Tietze syndrome is a rare inflammatory condition that involves inflammation of the cartilage between the ribs and sternum. The characteristic symptom is chest pain, which may radiate to the neck, shoulders, and arms.
It can take time to receive a diagnosis of TS because doctors will need to rule out more serious causes of chest pain.
Most cases of TS are mild and go away on their own within a couple of weeks. However, a doctor may recommend medical treatments to alleviate severe or persistent TS pain. Overall, the outlook for people with TS is good.