Tietze Syndrome

What happens in Tietze syndrome

The upper ribs connect to the breastbone (sternum) through flexible cartilage at the costochondral and costosternal junctions. In Tietze syndrome, one or more of these cartilage joints becomes inflamed and thickened. The cause is unknown. It often follows repeated strain on the chest wall, such as:

• Heavy or persistent coughing, or vomiting
• Upper respiratory infections
• Minor chest injury or strenuous upper body exercise

Symptoms

• Swelling: a firm, tender lump at the junction of the rib and breastbone, often about the size of a grape or larger
• Pain: sharp or aching, sometimes spreading to the shoulder or arm on the same side
• Worse with movement: deep breaths, coughing, sneezing, twisting, lifting or lying on that side
• Local tenderness: pressing on the swelling reproduces the pain
• Sometimes warmth or slight redness over the swelling

Pain can start suddenly or gradually. It often eases over weeks, though the swelling may last longer than the pain.

Tietze syndrome vs costochondritis

Both are diagnosed by finding chest wall tenderness after more serious causes are excluded. Other causes of chest wall pain include slipping rib syndrome, precordial catch syndrome in young people, and intercostal neuralgia.

Diagnosis

The doctor will ask about the pain and recent coughing, exercise or injury, then press on the chest wall to find the tender spot and look for swelling. Tietze syndrome is a diagnosis of exclusion, which means other causes must be ruled out first, especially in anyone with heart risk factors or worrying symptoms.

Tests may include:

• ECG and sometimes blood tests (troponin) to rule out heart problems
• Chest X-ray to look at the lungs and bones
• Ultrasound or MRI of the chest wall to confirm cartilage thickening and exclude a tumor or infection
• Blood tests for inflammation if an inflammatory arthritis is suspected

Conditions that can cause a swelling in the same area include infection of the joint, inflammatory arthritis (such as rheumatoid arthritis or spondyloarthritis), and rarely a cartilage or bone tumor. These are why a growing or hard lump needs imaging.

Treatment

• Anti-inflammatory painkillers such as ibuprofen or naproxen at the label dose. Avoid them with kidney problems, stomach ulcers or if you take blood thinners; acetaminophen (paracetamol) is an alternative.
• Heat or ice: warm packs or cold packs for 15 to 20 minutes several times a day.
• Rest the chest wall: avoid heavy lifting, push-ups and other movements that provoke pain until it settles.
• Treat the trigger: for example, control a persistent cough.
• Topical NSAID gels can help some people.
• Injection: a local anesthetic and steroid injection into the tender joint for persistent pain.
• Surgery to remove the affected cartilage is very rarely needed, only for severe, long-lasting cases.

Outlook

Tietze syndrome is benign and does not damage the heart or lungs. Pain usually improves within a few weeks to a few months. The swelling may persist for months after the pain has gone. It can return, often after another bout of coughing or strain.

Frequently asked questions

What is the difference between Tietze syndrome and costochondritis?

Both cause tender chest wall pain where the ribs meet the breastbone. Tietze syndrome includes a visible or palpable swelling, usually at one spot on the 2nd or 3rd rib in someone under 40. Costochondritis has no swelling, often involves several ribs and is more common in people over 40.

How long does Tietze syndrome last?

Pain usually settles over several weeks to a few months with rest and anti-inflammatory painkillers. The swelling can take longer to go down, sometimes many months. Episodes can recur, especially after heavy coughing or strenuous upper-body activity.

Can Tietze syndrome cause shortness of breath?

It can make deep breathing painful, so you may take shallow breaths and feel short of breath. It does not affect the lungs themselves. True shortness of breath, especially with chest pressure, sweating or dizziness, needs urgent medical assessment to rule out heart or lung causes.

Is Tietze syndrome serious?

No. It is a benign condition that does not harm the heart or lungs and usually resolves on its own. The main importance is making sure chest pain is not from something serious such as a heart attack, and that a chest wall lump is not caused by infection or a tumor.

What does Tietze syndrome feel like?

It feels like a sore, tender lump next to the breastbone, with sharp or aching pain that worsens with deep breaths, coughing, twisting or pressing on the spot. Some people feel the pain spread into the shoulder or arm on the same side.