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TIETZES SYNDROME (actually Tietze's)Chest pain of the costosternal jointsTietzes syndromeand 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 costochondral syndrome.
Chest pain is commonly caused by a subluxation of the joint between the rib and the sternum or breast-bone. It may be 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, but it may be bilateral. 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 and is 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 disease, 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 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, but making such an assumption. I would be pleased to hear from any of you reading this who have been cured by anti-inflammatory medication, without having got
an ulcer.
How does it present?Costo-sternal pain syndrome presents with pain (which may be acute) in the chest, 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) resolves in 6-8 weeks. Tietzes syndrome pain is sometimes exacerbated by deep breathing. Costochondritis symptoms are similar to the chest pain associated with a heart attack.
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. 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. TREATMENTThe 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. 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. An anxious patient should ask a family member to attend the treatment. 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. If your chiropractor has no clue, don't be irritable. I was such for 25 years. Suggest s/he contact me.
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