Tietzes syndrome casefile

Tietzes syndrome casefile reveals a puzzling chest pain condition.

You're likely to find that doctor and chiropractor have never heard of it; I hadn't until I'd been in practice for over twenty years. However faced with patients with what we'll call non medical chest pain on a regular basis I became interested, and started looking up the literature; there's very little research on the subject.

Many ER consultations for left sided chest pain relate to this nasty condition. It does not respond to anti inflammatories.



This blog tells the story of a young woman with three years of unrelenting chest pain. Tietze's syndrome causes a costo sternal lump between the rib and the breastbone.

And sometimes a clavicular sternal lump at the collarbone joint, more frequently in women than men.

Patricia, a 33 year old woman, has had low thoracic pain that radiated up to the midback and between the ribs to her sternum where she had a constant aching pain. It began immediately during or soon after the birth of her first child.


Chest pain

Chest pain is the most common symptom of a Tietze's syndrome casefile, often thought to be a heart or breast condition.


Tietzes syndrome casefile

Tietzes syndrome casefile tells the story of a young woman with three years of unrelenting breastbone pain.

My apologies for the variable use of the apostrophe; is it Tietze's or Tietzes syndrome? The former of course, but search engines don't like it.

Her doctor made a diagnosis of Tietze's syndrome, the correct diagnosis in my opinion, but when his pills didn't help, he sent her to a physiotherapist. She didn't know the reason, but PT seemed to aggravate the condition. Hard manipulation in the midback certainly will worsen this condition, and is sometimes the primary cause of chest pain and Tietze's syndrome.

Treat any anecdote with a pinch of salt! It's not scientifically admissible, but behind this Tietzes Syndrome CaseFile you may find a gem of truth that could be helpful.

On examination a mild double scoliosis was evident with one apex in the upper lumbars, and the other apex in the mid-lower thoracic spine.

Right rotation of her midback was painful in the spine. Lateral compression of the chest caused pain in her back, along the ribs on the right, all the way to the breastbone.

Pressure over the joints between the 6&7th ribs, where they attach to the sternum was extremely sensitive. No oedema was evident.

On exhalation those two ribs did not move downwards in the normal manner.

All in all a difficult Tietzes Syndrome Case. What particularly irritated her was the fact that she couldn't lift her children onto her bicycle, as all Dutch women do.


Rib treatment

The rib treatment of this condition is highly specific. Heavy manipulation of the midback will often aggravate, and even cause this condition. So we use specific mobilisation techniques of the joints, where they meet with the spine, and at the attachment at the other end to the breastbone.


Happily, Patricia said this morning that, after only six treatments over a 5 week period that she is 70 percent better. It was nice to be called her hero and that I may never go on pension. We are now involved with a series of rehab exercises, and have made a start with two other conditions that often are associated with a scoliosis; tingling in her right arm associated with a thoracic outlet syndrome, and a numb feeling down her leg.

Frankly, in my experience, Tietze's syndrome casefiles never seem to resolve completely as in many medical conditions; they need ongoing management and care, much of it done by the patients themselves. I'm not sure why that bothers folk as they accept entirely that diabetes, or hypothyroidism or hypertension, for example, likewise need continued treatment.


Tietze's syndrome comes in four stages, only the fourth produces an angry red swollen nodule on the breastbone or SC joint.



Chiropractic help

At chiropractic help clinics every patient is unique and the treatment needs to be modified to fit the condition; it's what makes our work so interesting and challenging. And no where is this more true than with a Tietze's syndrome casefile like this. The presentation varies from person to person.


For example, is this Tietze's syndrome? Several orthopaedic surgeons and chiropractors don't know.


CAUSES OF TIETZE'S SYNDROME

Could a chiropractic mishap be one of the causes of Tietze's Syndrome? Why, certainly and so could a heavy midback chiropractic manipulation. I've done it myself.

Chiropractic Iatrogenic Illness is the name given to doctor caused disease.


Another TIETZE'S Case File


Another Tietze's case file, explained in somewhat more detail, and associated with extreme heartburn; the long and the short of it is that it's a complex syndrome with many different presentations and causes. It's not uncommon after a mastectomy or breast enlargement; in this case a young man with a chronic midback rib subluxation.


› Tietzes syndrome casefile


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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

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You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


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