Tietze Syndrome

Overview

Tietze syndrome is a rare, benign, and self-limiting inflammatory condition that affects the costochondral, costosternal, or sternoclavicular joints: locations where the ribs attach to the sternum. It is characterized by localized pain, swelling, and tenderness in the upper chest area, most often affecting the second or third rib. First described by German surgeon Alexander Tietze in 1921, the condition is often confused with costochondritis; however, unlike costochondritis, Tietze syndrome is distinguished by the presence of visible or palpable swelling at the affected site.

Causes

The exact cause of Tietze syndrome is unknown, and it is considered idiopathic in most cases. However, several potential contributing factors have been proposed, including:

• Repetitive trauma or strain – Activities that involve excessive coughing, heavy lifting, or repetitive upper-body motion may provoke inflammation.

• Viral or bacterial infections – Upper respiratory infections or recent viral illnesses have been linked in some cases.

• Mechanical stress – Following surgery, chest injury, or sudden changes in physical activity.

• Posture-related stress – Prolonged poor posture may contribute to strain on chest wall structures.

Although it can affect individuals of any age, Tietze syndrome is more commonly seen in young adults under 40 years of age, with no significant gender preference.

Symptoms

The primary symptom of Tietze syndrome is localized chest wall pain accompanied by swelling. Key symptoms include:

• Localized pain – Sharp, aching, or pressure-like pain in the upper chest, often on one side.

• Tenderness to touch – Pain is reproducible when pressing on the affected rib or joint area.

• Swelling over the joint – Firm, non-purulent, and visible swelling at the costochondral or sternoclavicular junction, differentiating it from costochondritis.

• Pain worsens with movement or deep breathing – Activities like coughing, sneezing, or lifting may exacerbate symptoms.

• No systemic symptoms – Unlike infections or more serious conditions, there is typically no fever, malaise, or weight loss.

The symptoms may last for several weeks or months but often resolve spontaneously over time.

Diagnosis

Tietze syndrome is a clinical diagnosis based on history and physical examination. There is no definitive test for the condition, but investigations may be done to rule out more serious causes of chest pain. The diagnostic approach includes:

• Physical examination – Reveals localized tenderness and swelling over the affected costal cartilage without redness or signs of infection.

• Chest X-ray – Usually normal; helps exclude rib fractures or pulmonary pathology.

• Ultrasound or MRI – May be used to confirm joint inflammation or soft tissue swelling when clinical findings are unclear.

• Electrocardiogram (ECG) – Performed to rule out cardiac causes of chest pain, especially in older adults or when pain is atypical.

• Blood tests – Typically normal in Tietze syndrome but may be ordered to exclude infection, autoimmune disease, or other inflammatory conditions.

It is important to distinguish Tietze syndrome from costochondritis, myocardial infarction, pulmonary embolism, pleuritis, or musculoskeletal injuries.

Treatment

There is no specific cure for Tietze syndrome, but treatment focuses on symptom relief and inflammation control. Most patients recover without the need for invasive interventions. Management includes:

1. Conservative Treatment:

• Non-steroidal anti-inflammatory drugs (NSAIDs) – Such as ibuprofen or naproxen to reduce pain and swelling.

• Cold or warm compresses – Applied to the affected area to alleviate discomfort.

• Activity modification – Avoiding activities that exacerbate the pain, including strenuous lifting or repetitive upper-body movement.

2. Physical Therapy:

• Gentle stretching exercises and posture correction may be recommended for long-term symptom management and to prevent recurrence.

3. Injections (in refractory cases):

• Corticosteroid injections – For patients who do not respond to oral medications or experience persistent pain and swelling.

4. Rarely Surgery:

• Surgical resection of the affected cartilage – Considered in very rare, chronic, and debilitating cases that do not improve with medical management.

Prognosis

The prognosis for Tietze syndrome is excellent. Most individuals recover fully with conservative treatment within a few weeks to several months. Important prognostic factors include:

• Self-limited course – The condition often resolves spontaneously without long-term consequences.

• Recurrence is rare – Though symptoms may occasionally return, chronic or recurrent Tietze syndrome is uncommon.

• No long-term disability – With appropriate management, patients can resume normal activities without lasting impact.

Because of its benign nature, reassurance and patient education are essential components of care, especially when ruling out more serious causes of chest pain.