TIETZES SYNDROME (actually Tietze's)

Breastbone pain

Breastbone pain is a not uncommon complaint at the Chiropractic Coalface. In its severe form a swollen node appears at one of the breastbone joints: either with the rib, or the collar bone.

Tietze's-syndrome and costochondral syndrome were initially described as two separate conditions, the sole difference being the amount of swelling of the costal cartilages. Costo-sternal pain is commonly caused by this little understood, and generally poorly managed syndrome.

Tietzes syndrome was first named by a German physician early in the twentieth century.

It is now recognized that the presence or absence of swelling is only an indicator of the severity of this syndrome.

Swollen Sterno-Clavicular (SC) joint

"CAN YOU PLEASE ADVISE ME. I HAVE HAD PAIN FOR NEARLY 2 YEARS IN THE RIB, STERNUM, BREAST REGION, SOMETIMES RADIATING TO MY MID BACK, RIGHT UNDER THE SHOULDER BLADE.

ALSO I HAVE HAD PAIN IN MY ARM, WITH TINGLING IN MY FINGERS.

I CAN'T LIE IN CERTAIN WAYS, I DEFINITELY CAN'T LIE ON MY FRONT AND TWISTING IS A NO-NO.

I CAN'T LIFT THINGS FOR ANY LENTGH OF TIME.

IT'S SERIOUSLY AFFECTING MY LIFE THAT I'M SO DOWN EVERY DAY AND I HAVE 3 GORGEOUS GIRLS WHO ARE NOT SEEING THE BEST OF THEIR MUM AND I AM SUFFERING.

I'M OK IF I DON'T MOVE BUT I CAN'T GO ON EVERY DAY LIKE THIS, MY DAUGHTERS HAVE HEALTH PROBLEMS AND SEVERE SKIN CONDITIONS AND I THINK YEARS OF DOING THEIR SKIN ROUTINE HAS OVER WORKED MY MUSCLES BUT I'VE HAD SCANS XRAYS BLOOD TESTS AND NOTHING IS SHOWING UP I WOULD JUST LOVE A DIAGNOSIS OF SOMETHING AND A PROMISE IT WIL GET BETTER AS I CAN'T FACE LIFE LIKE THIS EVERY DAY.

PLEASE CAN YOU HELP

ANY ADVICE IS WELCOME AS I HAVE THE PAIN CLINIC AT THE HOSPITAL SOON AND NO ONE KNOWS WHAT TO DO WITH ME. THEY ARE SAYING I,M A HYPOCHONDRIAC SO I JUST SHUT UP AND PERSEVERE NOW."

TIETZES SYNDROME

Chest pain is commonly caused by a strain/sprain of the joint between the rib and the sternum or breast-bone. It is usually associated with pain along the course of the rib, and in the midback, but this is not necessarily the case.

You can easily test for Tietzes syndrome yourself: Press firmly on the breast bone, and then let your fingers slide right and left over the junction with the rib and between the ribs. It will be very tender over some of the joints if you have Tietze's syndrome, usually on one side only, more commonly the left, but it may be bilateral. It can also affect the breastbone- collarbone joint, called the Sterno-Clavicular joint in anatomical terms.

You are almost certainly not having a heart attack, though this should always be considered! It's name is: costo-sternal syndrome, or costosternal syndrome, or the costochondral syndrome of Tietze, or sterno-clavicular syndrome of Tietze and in its mild form is really quite common. Deep breathing may aggravate the pain, but does not usually, unless it is severe.

This is a common condition which responds well to the CORRECT chiropractic treatment. I stress 'correct', as it took me over twenty years to work out how to treat this nasty painful condition, and, like me, your chiropractor might not know about it. Whilst s/he should be aware of it, it may be worth repeating, that a heavy adjustment in the middle of the back may well aggravate this problem. In fact it may cause it! How do I know? Because I have caused it myself. It's known as iatrogenic or doctor-caused disease. There's not a doctor alive who hasn't aggravated or caused some condition, I regret to say, including myself. That's why we call it "a practice". Because that's where we practise the art of doctoring all day long, and you dear patient are the guinea pig. There is, I regret to say, no other way.

Your medical doctor too, I'm afraid, may have no clue. How do I know this? Because I treat so many people with it, and NSAIDs just don't work. Perhaps I am making an ass of myself by making such an assertion. I would be pleased to hear from any of you reading this who have been cured of Tietzes syndrome by anti-inflammatory medication, without having got an ulcer. ANTI INFLAMMATORY DRUGS ...

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How does it present?

There is tenderness and may be some swelling of the cartilages adjacent to the sternum, which is commonly palpable on examination.

Although many times it can be extremely painful, to the point of being debilitating, Tietze's Syndrome is considered to be a benign condition that may (like many conditions) resolve in 6-8 weeks.

Tietzes syndrome pain is sometimes exacerbated by deep breathing.

Costochondritis symptoms may be similar to and are often confused with the chest pain associated with a heart attack.

Sterno-Clavicular syndrome of Tietze

Indigestion, heartburn and regurgitation. Because the diaphragm attaches to the lower six ribs, Tietzes syndrome is sometimes association with abdominal discomfort of one sort or another.

Says chiropractor Emma Maria Nygren:

"I am looking forward to your third book, Dr Preston. I really enjoyed reading Frog and Bats! They make you think, laugh and relax just like a good book should!"

For more information, click here. Frog in my Throat ...

What causes it?

Costosternal syndrome of Tietze can also be caused by a heavy manipulation of the thoracic spine.

"I read your article on sternum pain and Tietzes syndrome this afternoon and would like to submit a question to CHIROPRACTIC HELP questions . I saw a chiropractor over the summer in June of 2008. I had pain in my neck and mid back. He gave me numerous adjustments over the course of several weeks, some with heavy force. After some of my appointments I noticed pain in my sternum, something I'd never felt before. He said it might just be muscle related. I stopped seeing him as I felt he was a lousy listener and kind of arrogant. It is now January and I still have the pain in my sternum. Should I see a chiropractor? And if so, what should I look for so as to avoid getting yet more pain?"

REFERRED PAIN

Rare conditions such as Mesothelioma, a nasty lung cancer usually caused by exposure to asbestos, and greatly aggravated by asbestos plus smoking, should also be kept in mind if there is weight loss, malaise...

Mesothelioma Prognosis - Information on mesothelioma and the treatment options available. PleuralMesothelioma ...

TREATMENT of Tietzes syndrome

This author acknowledges that he was unable to treat this condition successfully for 25 years. Accidently, he discovered a cure that almost always works, how quickly depending how much actual swelling there is of the joints.

Heavy posterior to anterior PA manipulation usually aggravates the condition.

My treatment?

* Alternating ice and heat (eg an ice cube in a hot shower)

* Gentle !!! PA chiropractic adjustments of the involved costo-vertebral joints.

* Examining the costo-sternal joint to determine the fixation with inhalation and exhalation.

* An adjustive technique which involves placing the doctor's hands along the rib, from the sternum to the spine, thrusting either cephalad or caudad depending on the fixation, counter to the breathing.

* An activator treatment may help.

* Soft tissue therapy of the muscles involved.

* As always, the pelvis and neck should be examined and if necessary treated.

Because of the proximity of the breast tissue in the female, the doctor discreetly removes his grip on the rib during the inactive phase of breathing. Asking the female patient to place her hand over the breast, and pulling the breast tissue out of the way gives her a modicum of decorum. I recommend that the anxious female patient should ask a family member to attend the treatment, certainly for the first consultation.

Usually there will be some improvement within a week or two, depending on how long the costosternal pain has been present. However it may take a month or more to resolve. Tietzes syndrome is definitely one of those conditions where patience may be needed. Like any chronic condition it may not resolve completely and require an occasional regular treatment from your chiropractor.

If your chiropractor has no clue, don't be irritable. I was such for 25 years. Suggest s/he contact me.

Click on this link for more information: Costosternal anatomy ...

TIETZES SYNDROME CaseFile

Have a question or story about Tietzes syndrome?

Something about breastbone pain to tell? Share it! If you suffer from indigestion and heartburn as well please tell us about that too.

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