Tietzes Syndrome

by Katya
(Western, WA)

When my 2 oldest children were small (& I still smoked occasionally) I suddenly one day sitting & laughing on the couch with 1 of them developed ingratiating, crushing upper chest pain; centered at & above my sternum (7-8 yrs ago). I lay on the floor in a fetal position, until the paramedics took me to the hospital. Each episode was sudden & with non-stop crushing horrifying pain. It generally brought me to my knees as the pain was so horrid that I was physically unable to stand or hold myself up, but no position was/is ever comfortable. At that 1st hops visit & several subsequent ones, the dr.s told me I had everything from heartburn (which I emphasized had never been a problem except when I was in late pregnancy, also I hadnt always eaten anything within hours of an attack), they told me I was having a panic/anxiety attack (though my pain was in no way psychosomatic, plus my life was relatively happy & many times these attacks started when playing or relaxing with family), they even suggested gall bladder problems or other stomach upsets though that clearly wasnt where the pain was. Generally they left me in a room for hours while I was too incapacitated to cry out for help, they refused to give me pain meds or any anti-inflammatories, & they tried everything from anxiety meds to anti-nausea or heartburn meds (which of course didnt work). Finally after nearly 2 yrs of these trips to the same ER, an intelligent Dr appeared one day & listened to me & said he though I had costrochondritis! He said the fact that the first episode happened after a serious cold with bronchitis, that I had immunological diseases in my family, that I did house-keeping & heavy landscaping for a living & that I smoked, plus being female (& that they had repeatedly ruled out heart or digestive problems with tests) - made Tietze most likely. I know enough now from what he told me to avoid having an attack but once or twice a year. I dont smoke which really aggravates my chest, I watch for any mild creeping upper chest pain. My biggest problem now is that a severe cold or flu with vomiting is likely to bring on an attack. Steroid inhalers lower my immunity & generally cause me to end up very sick later even if I only used them a few days to ward off an attack. The swelling is helped with ice-packs, but I often feel like I cant breath properly during an attack. I usually still end up in the ER for pain control & a shot of steroids tho.

Dear Katya,
A sad tale, good for the doctor who finally figured it out. Now to fix it!

Firstly, a violent movement, like a sneeze, coughing, and even a heavy midback manipulation, posterior to anterior, can set Tietzes syndrome off.

Obviously there are other causes of chest pain, and they need to be ruled out, which seems to have happened.

Congratulations on giving up smoking. The associated coughing was probably one of the causes.

Did you / do you have actually visible swelling, a nodule along the breastbone? If so, I'd appreciate a photograph.

If you press on the joints between your ribs and the breastbone, are one or more very tender? Does the pain radiate under the armpit and to your midback? Any tingling in the arm?

Use alternating ice and heat on your breastbone, then rub your fingers with oil along the ribs, moving away from the sternum.

A GENTLE Anterior- posterior chiropractic adjustment of the rib is often the key. Warn your chiro not to adjust your midback hard P to A. That will aggravate it.

Good luck, I hope this has contributed.

Dr B

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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.



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