Tietzes Syndrome

Keywords: Tietzes syndrome, chest pain, costochondral syndrome, rib pain treatment

Breastbone pain is a not uncommon complaint at the chiropractic coalface. In its severe form a swollen node appears at one of the sternal joints; either with a rib, or the collar bone.


This condition and costochondral syndrome were initially described as two separate diseases, the sole difference being the amount of swelling of the costal cartilages. Breastbone pain is commonly caused by this little understood, and generally poorly managed syndrome. It also affects the joint between the collarbone and the sternum; the sternoclavicular joint.

It 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 the condition.

This is what one writer asks. Can you please advise me. I have had pain for nearly two years in the rib, sternum and breast region; sometimes it radiates 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 I cannot twist without severe discomfort. I cannot lift things for any length of time.

It's seriously affecting my life; I'm so down every day and I have three gorgeous girls who are not seeing the best of their mum and I am suffering.


Swollen Sterno Clavicular (SC) joint

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.

I've had scans and xrays, blood tests and nothing is showing up. I would just love a dianosis of something and a promise it will 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.



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Tietze's Syndrome

Chest pain is commonly caused by a strain sprain of the joint between the rib and the sternum or breastbone. 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 it, 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 the 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 she 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 non steroidal anti inflammatory drugs like brufin just don't work. Usually they have unsuccessfully done the medical rounds.

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.

Bone scan

The increased uptake in the right sterno clavicular joint is immediately apparently. Of concern, also in the left shoulder and neck, however the radiologist assures me that those are the features of osteoarthritis.

Happily, within three weeks of chiropractic help the oedema and pain were gone. Worryingly, two weeks after discharge, she went to the gym, did weights and immediately developed acute radiating arm pain, but that's another story. The Tietzes syndrome is healed to all intents and purposes, and she is weighing prayerfully whether to go for neck surgery, or give chiropractic help a chance with the much more serious neck condition.

My worry; did my treatment of the Tietzes syndrome set off the severe neck and arm pain? She had had tingling in arm and hand for over two years, a failed carpal tunnel syndrome operation... She assures me not, as for two and a half weeks she had almost no pain in the neck, arm, shoulder or sterno-clavicular joint. Until she went to the gym and decided to become the next Miss World.

Honestly, I have my doubts. Chiropractic Iatrogenic Illness is a concern for every Chiropractor too. Doctor caused disease, the third most common disease on planet Earth.

 How does it present?

Costo sternal pain syndrome presents with chest pain, which may be acute, where the ribs meet the breastbone.

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 to 8 weeks.

Tietzes syndrome pain is sometimes exacerbated by deep breathing, the pain radiating from the midback along the ribs to the sternum.

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


Sterno Clavicular syndrome of Tietze

Secondly, Tietzes syndrome may affect the first rib and/or collarbone, causing pain in the collarbone joints and, because the artery and nerves to the arm pass between the collar bone and the first rib, it may cause pain in the neck and tingling in arms and hands.

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


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What causes it?

Tietzes syndrome is often caused by a physical strain or minor injury, such as repeated coughing from a chronic chest infection, vomiting or a blow to the chest. I recently had a case where a young man was violently turned over on a water-slide, falling heavily on his fist whilst it was tightly clenched against his chest.

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

Many conditions of course can cause chest pain. Heart, lung, midback, stomach, pancreas, gall bladder and liver, and no doubt others... it's a definitely a team job, but once the others have been excluded, a Tietzes syndrome certainly responds to the correct Chiropractic care.

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

The treatment of Tietzes syndrome remains something of an enigma. It is does not respond well to NSAIDs, and ultrasound doesn't help either. Massage of the muscles between the ribs may help.

This author acknowledges that he was unable to treat this condition successfully for 25 years. After many years of struggling with the treatment of rib conditions, he worked out a cure that almost always works, how quickly depending how much actual swelling there is of the joints. The pain go not go away completely, particularly if you've had it for months.


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 posterior to anterior 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. Sexual advances chiropractor or medical doctor for that matter happens.

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 she he contact me.

Click on this link for more information. Costosternal anatomy.


Tietzes syndrome casefile

Anecdotes from a casefile have no scientific clout but they often reveal gems of truth. Also Costochondral syndrome aka Tietzes syndrome is a condition I see almost daily at the Chiropractic Coalface. It can be mild, and it can be extremely disabling if allowed to become chronic. Tietzes syndrome casefile.

Pleural Mesothelioma

Most of us know that exposure to asbestos is extremely dangerous. Because this disease is really quite rare (less than 1% of lung cancers) it is usually diagnosed late and the prognosis is poor. Few doctors ever see this disease.

Common symptoms are:

  • Shortness of breath (due to fluid around the lungs)
  • Chest pain (and hence on this page that concerns the chest)
  • Chronic cough
  • Weight loss

For more info go to PleuralMesothelioma.com ...

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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

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. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

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?


Letters

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
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.

Your own unresolved problem. Pose a question

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.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.