Tietze's Syndrome

Tietze's syndrome causes pain and tenderness over the breastbone and ribs.

Chest 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, but the sole difference is the amount of swelling of the cartilage.

Breastbone pain is commonly caused by this little understood, and generally poorly managed condition.

It also affects the joint between the collarbone and the sternum; the SC 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 cannot lie in certain ways; I definitely could not sleep on my front and I cannot twist without severe discomfort. I am unable lift things for any length of time.

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

This page was last updated by Dr Barrie Lewis on 17th January, 2019.

Swollen Sterno Clavicular (SC) joint

A swollen sterno clavicular (SC) joint is typical of Tietze's syndrome.

Tietze 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.

  • Chiropractic Conditions is a central page at Chiropractic Help. It provides you simply and easily with the sorts of conditions that the average chiropractor would be treating.
  • Healthy Living Tips is another vital page at Chiropractic Help. Sparkling good health is not just about having your subluxations adjusted. Our healthy living tips page gives you some insights into different foods you could and perhaps should be eating.

Costo-sternal cartilage

Tietze's syndrome

Tietze's syndrome is one cause of chest pain; costosternal ache may often be confused with a heart attack.

Chest pain is commonly caused by a sprain of the joint between the rib and the sternum or breastbone. It is usually associated with discomfort  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 articulation in anatomical terms.

You are almost certainly not having a heart attack, though this should always be considered. It's name is the costosternal syndrome, or Tietze's; in its mild form it really 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 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 provoked 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

Tietze's syndrome 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.

Rib bucket handle

Chest pain

Chest pain at the costo sternal joint, which may be acute, where the ribs meet the breastbone is the most common presentation of Tietze's syndrome.

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.

Thoracic outlet syndrome

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

Frog in my Throat

If you love to read, you will probably enjoy my first Chiropractic book of anecdotes, funny and healthful, Frog in my Throat

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.

Google appears to frown on too many links, so phrases in bold, like that above, need to be put into the Site Search function in the navigation bar on your left if you want more information.

Costochondral joint

Costochondral joint pain is often a sign of Tietze's syndrome; it can also be caused by a heavy manipulation of the thoracic spine.

Tietze's 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.

"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?"


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.

Rib pain treatment

The usual chiropractic rib pain treatment must be modified in the management of Tietze's 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 may 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 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.

Tietze's 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 pleural mesothelioma in their practices.

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


  1. Chiropractic Help
  2. Thoracic Spine Pain
  3. Tietzes Syndrome

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.

[ ? ]

Upload 1-4 Pictures or Graphics (optional)[ ? ]


Click here to upload more images (optional)

Author Information (optional)

To receive credit as the author, enter your information below.

(first or full name)

(e.g., City, State, Country)

Submit Your Contribution

  •  submission guidelines.

(You can preview and edit on the next page)

What Other Visitors Have Said

Click below to see contributions from other visitors to this page...

Classic Tietze's syndrome and heartburn. 
Hello, I just stumbled across your page, searching for some type of relief. I'm a 29 year old male, fairly active and a father of two. I'll start by …

Swollen sterno clavicular joint 
A swollen sterno clavicular joint is usually Tietze's syndrome. I have had a hard lump on my collar bone near my throat, swollen collar bones & sternum …

Tietze or what? 
Tietze or what? Hello, I did an intensive workout (new résolution) to do sports, so lifted some weights (just a kilo). Nothing happened for 10 days, …

Hello, first I want to say that seeing the picture at the top of this page has put me somewhat at ease, as I too have swelling on the sternum. My pain …

Swollen around sc joint 
I was on vacation with my family and know I was pulling luggage and carrying my heavy laptop bag which I always do for work. On the second day of vacation …

2 Years of Pain in the left side.  
Hi I am a 36 year old male. It all started two years ago with a very slight sharp pain in the left center of the chest. Right in between the ribs. …

Tietzes syndrome costochondritis 
Hi Doc, I am 52 yr old, healthy,active (live on a farm and ride and train horse) slightly overweight, married female who routinely sees my awesome Chiro, …

Rib subluxation or contusion 
Rib subluxation or contusion as diagnosis from doctors The incident in question occurred early in the morning November 28, 2013, and it is now the …

How do I manage breastbone pain  
How do I manage breastbone pain I've had this bump on my chest for over a year. My rheumatologist was concerned so I had a breast exam. This is when …

tietzes syndrome mimic breast cancer 
Tietzes syndrome mimic breast cancer I have all the symptoms of teitzes syndrome. however, I have had cxr, two bx, ct's. my md says it is stage 4 brast …

abdominal strain with breastbone and rib pain 
Hello, Dr b, there's been a delay with scope appt. Should be soon. Blood work is fine at this time. Let you know. Thank you, Diane. Hello Diane, keep …

shoulder rib pain 
Had an MRI on shoulder results sai rotater cuff tear tendinitis and some fluid around AC joint.would this cause breast area tenderness? Hello Diane, …

Tietzes Syndrome - left chest and arm pain 
I went to the emergency room last week for pain in the left of my chest and my left arm panicked that I was going to have a heart attack (which would be …

sternum problem 
my rigth collar bone is bigger than the other i get this in exessive using of my arm. I had slight pain in the shoulder blade, arm and neck. I don't know …

Questions regarding tietzes syndrome 
Home > Tietzes syndrome > Questions regarding tietzes syndrome Two years ago was diagnosed with costocondritis by a medical …

Tietzes Syndrome  
Tietzes Syndrome Hi, I am a 21 year old male who has been an athlete and very active my whole life. For 2 years now I have been dealing with tense …

Pain on my chest Not rated yet
I notice I have a lump on my chest on the left side; some time it's very painful and I am thinking I have had a heart attacks. I am wanting to know what …

Tietze syndrome? Not rated yet
Hi! I am a 32 year old female runner. I have been dealing with chest pain on and off for about 3 years now. My doctor diagnosed me Costochondritis. …

Hard lump on right collarbone  Not rated yet
I have had a bump on my right collarbone for about 2 weeks. No trauma or injury but I am a workout fanatic. There was no pain whatsoever or any symptoms …

Tietzes syndrome Not rated yet
I have a small hard swelling between my breasts just as the picture shows. It is not painful. I noticed it when I suffered from a bad cough which lasted …

how to contact this doc Not rated yet
So much of what has been written is dead on with my own story. Still in the middle of acute /chronic pain, with CT scan today. PCP loss as she is with …

Ten Rib Subluxations! Help! Not rated yet
May 31, 2018 To Whom it May Concern: Without your amazing work and website, I would be lost. I have ten ribs in subluxations, and two lateral breaks …

Pain through the sternum Not rated yet
I have copd, my trigger point pain is behind my heart through to the sternum, I have given up on my GP, I feel as if I am wasting the time, they have no …

Tietze's syndrome for forty years Not rated yet
I have experienced this pain off and on for almost 40 years! Started as a teenager with several bouts of costochondritis. The attacks the past 10 years …

Click here to write your own.

Tietze's Syndrome after pleurisy Not rated yet
After a confusing round of misdiagnosis, we realized I had a rib that shifts in my back and tietze syndrome. 2 months of chiro have mostly resolved my …

Tietzes Syndrome after a double mastectomy Not rated yet
Tietze's Syndrome after a double mastectomy is not that uncommon; specific chiropractic treatment may be part of the solution. I recently had a double …

Tietze syndrome with over 20 years of pain Not rated yet
I have a large bump where the rib meets the sternum. By bump I mean that it is like the rib itself is displaced. I have been looking into costochondritis …

I've had Tietze's syndrome for about 6 months  Not rated yet
I'm just wondering how to get rid of the stiffness and how long the lumps stay. I need a lot more information, Marcus, if you want a useful reply. …

Swelling but very little pain at the costosternal joint  Not rated yet
Swelling but very little pain at the costosternal joint still need to be assessed, like any other condition, if it continues for any length of time. …

Breast pain during reconstruction then car accident Not rated yet
I had a double mastectomy and the doctor was starting reconstruction doing the flap surgeries using my back muscles and the expander; then I got into a …

Tietze's syndrome unresponsive to medicine and chiropractic Not rated yet
Tietze's syndrome unresponsive to medicine and chiropractic is probably the norm with th I am a 46 yr old female. For 2 years I have suffered from what …

Tietzes Syndrome looking like a huge tumor Not rated yet
Tietze's Syndrome looking like a huge tumor should have the diagnosis confirmed. I am having problems moving breathing sleeping nothing helps the pain …

Severe Tietze's syndrome Not rated yet
In my early 20s I experienced my first case of costo. Never having to really be treated for the condition but was always cautious of my movements and it …

Tietzes Syndrome ....help me please! Not rated yet
For some reason I always seem to get some type of illness that is rare or unknown to the average person and doctor. My story starts with pain in my jaw …

Right sided deep breast pain going through to scapula with burning and itching Not rated yet
Right sided deep breast pain going through to scapula with burning and itching after surgery is a diagnostic nightmare. Thank you for allowing me to …

breast bone/rib pain Not rated yet
I had my gallbladder removed a few months ago. Right before then I was having pain in the upper right quadrant under my breast and wrapping around to my …

Tietzes syndrome after a bad chest Not rated yet
Chiropractic Help homepage » Rib pain treatment » Tietzes syndrome after a bad chest. When my daughter was 14 she had a really bad chest; …

diagnosis of "cervical angina" from cardio doctor, but neuro disagrees Not rated yet
I have been battling a condition that mimics cardiac arrest now for over 3 years. After multiple hospitalizations and tests, I have been given an all clear …

Tietzes syndrome Not rated yet
I was ice skating on December 1, 2014, and my toe pick caught on the ice throwing me forward and down. My arms were extended out and the brunt of it was …

tietzes syndrome Not rated yet
Tietzes syndrome I am a 22 year old girl living in Denmark; I have had extreme pains in my chest on and off for 6 years. I noticed a massive bubble, …

Tietzes syndrome Not rated yet
Tietzes syndrome I first noticed my collar bone was swollen 8 months ago, following a bout of tonsilitis; I had antibiotics for this which made me violently …

sternum pain Not rated yet
About a year ago I sneezed really hard and my chest was sore for 4 days; recently I aggravated it maybe in the gym. Now when I'm laying down, and go to …

Tietzes Syndrome Not rated yet
Hi I live in Johannesburg, South Africa. My 15 year old daughter has been in severe pain now for 11 weeks. After numerous tests and specialists, finally …

BONES IN CHEST  Not rated yet
Hello! On the left side of my chest under collar, I have a large bone ,swelling tissue protruding .Dr said it was an injury still healing (got hit with …

62 year old female who has breathing issues when doing overhead activities or bending forward alot. Not rated yet
I do have poor posture. I am slim build, do not smoke. I have been to an allergist and tests are normal for lung function but do have allergies to trees, …

Pain after anterior sternum/chest adjustment Not rated yet
Hello! First I need to mention that I had breast cancer 7 years ago at age 40 (BRCA1), and had a double mastectomy and implant reconstruction. From …

tietzes syndrome Not rated yet
I am a chiropractor in Georgia and recently a 55 yo female presented with acute onset sternal pain that occurred from a chiropractic adjustment that …

Open Heart Surgery caused breastbone pain Not rated yet
After surgery i had major pain in the middle botton of sternum actually had to go to the er the pain ws so bad and just having a valve replaced and me …

ache in arm with dull chest ache Not rated yet
I'm 18 and have had shoulder muscle tension chest aches near breast bone area and aching in my wrist under arm thumb and elbow for about three months. …

Click here to write your own.

Costo sternal pain Not rated yet
Costo sternal pain Doc: I just had a standard MD Physical. My standard MD told me that if he had 100 patients come in, my demographic, I'd be on …

sternum rib pain with stomach bloat too Not rated yet
Dr.b I've been sending comments but don't know if u received them. I meant in last writing a hernia. Does tieze syndome cause stomach to swell or a hernia? …

sternum rib pain Not rated yet
Dr. B, hello its Diane, I meant to print ahernia last time I made a comment. I apologize for that. Just wandering if a hernia can cause swelling in stomach …

sternum rib pain Not rated yet
Hello, Dr b, it's Diane, I apologize for the misprint. I mean to write a hernia. I was just wandering. tieze syndrome could also cause stomach to bloat? …

tietzes syndrome Not rated yet
Tietzes syndrome I am a 19 year old female. My whole second rib is swelling.I guess its the second rib cause its below the collar bone.This started …

Tietzes syndrome Not rated yet
Tietzes syndrome I have swelling over 2nd costo-sternal joint on the right side. I also have some pain over that area but the pain is more of "on-off" …

Tietzes Syndrome Not rated yet
Tietzes Syndrome The pain is on my right side. It travels slightly down my neck. The pain is radiating to the side of my right breast. I also had …

Tietzes syndrome Not rated yet
Can this also include mid back nerve pain; feeling like it's pinched with what I call rib frez pain that you can not touch that area under the breast bone. …

Tietzes syndrome? Not rated yet
For years I have felt that I needed to pop my sternum, like when your fingers need to pop, but the pressure would build up so much that I would press my …

Swelling in arm pit and under collar bone.  Not rated yet
Have swelling pain under arm rib cage and very swollen two lumps under collar bone and now it feels like thick ribs in breast too? Hello Diane, It's …

Fall down the stairs.. Not rated yet
This morning I fell down the stairs.. It happened pretty fast so I don't remember any of it but as soon as I realized what was happening I felt a sharp …

Tietzes Syndrome Not rated yet
I should first preface this by saying that I am currently a first year osteopathic medical student in the United States, so that automatically makes me …

painless swelling, intermittent, at the steroclavicular and sterno rib 1&2&3 Not rated yet
Hi Dr. Barrie, I have the above symptom but no pain and swelling goes and comes. The swelling is neutralized with deep breathing......may be thru …

Questions about tietzes syndrome answered by Dr Barrie Lewis Not rated yet
Home > Tietzes syndrome > Questions about tietzes syndrome answered by Dr Barrie Lewis My symptoms started ten yrs ago …

Pressure in my chest Not rated yet
I have been seeing a Chiropractor 3 days a week for over 3 months. He at first told me that I had lost the curve in my neck and that I had some arthritis …

Click here to write your own.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.