How do I manage breastbone pain

by Rebecca
( Northern Michigan)

Tietze's Syndrome

Tietze's Syndrome

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 I was told it was Tietze's Syndrome.

In the last few months, I've had some back pain. It feels like the lump straight thru to the spot between my should

er blade and spine, directly behind the lump. History: Spina Biffida Occulta, child of a Vietnam Vet exposed to Agent Orange, SLE, Sjogrens, Raynauds, food and environmental allergies, RA, moderate OCD, Vitamin D deficiency, GAD, pyloric stenosis (as an adult diagnosed, I understand it doesn't really happen to adults, lucky me), ischemic colitis and I'm hypersensitive to sounds, touch, sight, smell and stress.

I currently take Tylenol arthritis, tramadol, protonix, chlorpheneramine, zofran or phenergan, dicyclomine, xanax, plaquenil, zinc, magnesium, cinnamon bark, b12 sublingually. I should mention that I am unable to take narcotic pain relief because it won't stay down.

My doctor told me to ice it and heat it and do some stretches and in a few weeks it would go away. I did what she said and it got worse so I went back. This time she said that with my rheumatic history, it probably won't ever go away. She tried pushing it back in. All that did was make it worse!

Is very painful now and I don't know what to do to get some relief!

PLEASE HELP! (I can feel the lump better than I can see it in the pic. I hope you can see it! )

Hello Rebecca,
Yes, I can see it, though it's never clear on a photo unless you get the light exactly right.

Wow, you take
a lot of medication. But I doubt that is causing your Tietze's syndrome.

It took me 25 years to realise that my chiropractic treatment, like your doctor's, actually aggravated this condition, and even caused it a few times.

It's a chicken and egg situation. It's no coincidence you feel it right though to the midback - it's a condition that affects the rib at both ends.

Important: a heavy PA (posterior to anterior) manipulation will aggravate the condition. The key is an "anterior thoracic" adjustment, and that you'll have to see a local chiro. Please stress to him/her that heavy PA adjustments will increase your pain.

What you can do:
1. Get an ice block, take it to the shower, and do alternating ice and heat right over the joint.

2. Get a little cream and, after your shower, rub your fingers, straddling the rib, away from the breastbone, and under your breast.

3. Lie on your side, and ask someone to massage along the offending rib all the way from under the armpit, in both directions, towards the spine and towards the breast and breastbone.

4. Find a good chiropractor may be your next step.

I have worked out a particular technique to fix this problem, Rebecca. It won't cure it, but it will get 80-90% better. Your chiro might want to Skype me and discuss it, no problem.

Good luck, Rebecca. This is a painful condition, but really, it's very treatable. Oddly, I had a case this morning in the clinic. It's not uncommon.

Often there is a associated gastric troubles because the diaghragm attaches to the underside of the ribcage. So, what you're experiencing is fairly typical.

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Barrie Lewis

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Oct 24, 2013
Update on Tietzes syndrome
by: Rebecca

After being seen by an Orthopaedic Surgeon, he had a bone scan, SPECT scan and aCT scan done as I was very worried it was a bone tumor. He agreed it is Tietze's Disease. I was given Voltaren cream and lidocaine patches and follow up in 6 weeks. Because of my autoimmune disease, he thinks I'm healing slower than normal. I think I'll check into a chiropractor here in town, are you able to recommend anyone?

Thank you for posting my issue!

Hello Rebecca,
Cold comfort, but rather Tietzes than cancer, Rebecca.

Goes to show, most of our anxieties are much ado about nothing, but very real nevertheless.

Frankly, this ALWAYS heals slowly. It's a difficult condition and took me 25 years to figure out how to treat it.

Remember: a heavy PA thoracic adjustment will aggravate it. Tell your chiro, maybe print and take these reports with you.

Did the bone scan show anything? Often will.

Ice massage in a hot shower, alternating hot and cold, will help.

Barrie Lewis

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Costo sternal pain

by Mark Hugo
(Excelsior, MN (Marty Chiro))


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 the TOP of all the parameters which I was tested for. (Chest Xray, various listenings, PSA, 34 other items in blood, urine, feces..) Pulse, BP PERFECT. Glucose PERFECT.

Anyway, I strained myself major on the Monday of the last week, had the physical on Wed., after going through a "chest ache" centered on my sternum to begin with, and becoming more generic as the days went on.

OF COURSE that brought up the EKG, which was IDENTICAL TO 2 OTHERS over the last 18 months! Considering the Xcountry skiing, the biking, the inline skating...if I had a "heart problem" it would have shown.

Non-the-less, I still had the chest soreness. ACHE, strong... Thursday of the week (last night) I could really feel it. I did some research work and decided, maybe, Hiatel Hernia. BUT I decided to go into my Chiro.

We had a complete discussion, and he said: "No Mark, no H.H... but let me check some things."

You can imagine, he checked the various "weakness when stimulated" movements. ZEROED IN ON ONE RIB and worked to get that back into position.

IT SEEMS AS THOUGH I'M BETTER NOW. (Despite some minor, crawling, moving about aches...from the readjustment I believe.)

NOW WE'LL SEE what happens tonight. If the night/morning chest ache is can be assured, I will write a detailed letter to my Chiro.

THANKS FOR YOUR GOOD WORK! And trust me, having worked in medical devices for about 5 years, I'm well versed on all things "standard medical". The standard MD's have a "paradigm", and they ARE NOT WILLING TO ADMIT that there are skeletal/muscular things that can be "out of wack" and be put back in place by a "skilled practitioner".

Alas, the Chiro's don't have Latin, or a "medical dictionary" that they can "bally who" with, and really...sometimes use some rather vague terminology. I say the proof is in the RESULTS!

Hello Mark,
Many thanks for your telling contribution. Great.

Left untreated, that sternal pain can lead to Tietzes syndrome ... a VERY trying condition.

And actually sometimes IS associated with a hiatus hernia.

If your chiro fixed that in one visit, nominate him for the Guiness book of records. That's definitely worth a mention in despatches!

Remember the pain goes away faster than conditions heal. Be careful for a few weeks.

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I hope this has contributed.

Barrie Lewis

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Open Heart Surgery caused breastbone pain

by Ann Q
(Bennington VT )

Follow the blue lines with index and middle fingers

Follow the blue lines with index and middle fingers

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 scared

after years of diff drs it was found to be Costochondritis nothing any one will do

they say the only thing that helps is asprin, advil...
Well being on Warfarin (Coumadin) i can do that.
my cartilage or whatever it is sticks out
I am a stomach sleeper and that can be quite painful

Hello Ann,
Firstly being a stomach sleeper will stir up pain in your neck and your lower back. It takes about two weeks of cursing and gnashing of teeth to change to a side sleeper. Do it.

I'd start with using alternating ice, directly on the painful joints, and heat. In the shower is a good place. Cold, hot, cold...

Then after your shower, take some cream and gently with your index and middle fingers on either side of the painful ribs, starting at the sternum, massage deep in the groove between the ribs, under the breast towards the armpit. Follow the blue lines in the sketch above.

If you are having midback pain, and you probably are, then you need to see a chiropractor. A little warning; a heavy posterior to anterior manipulation in the midback may aggravate the pain. I use a socalled anterior thoracic technique.

See if you can find a chiro experienced with treating Tietzes syndrome. Whilst this isn't a true Tietze's syndrome, treatment of Tietzes may help.

Good luck, let me know how you get on.

Find a good chiropractor may be your next step.

Barrie Lewis

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62 year old female who has breathing issues when doing overhead activities or bending forward alot.

by Deborah
(San Marcos, Ca.)

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, dust and pollen. I have been to a chiropractor who adjusted my spine and neck but it made me feel sore so I bought a spa instead and sit in front of the jets daily to help tight upper back muscles.

I have been having this issue for the past several years after I retired. I notice breathing issues when lifting my arms overhead to do my hair or sometimes when bending forward a lot doing housework. Also if I sit for long periods of time in front of TV or computer. When I sleep on my back at night I do not have breathing problems. I also have sore left chest muscle along outer left side of breast area and if I press on it, I feel my breathing is affected. My allergist does not know why I would have breathing issues intermittently so I was wondering if my posture or some thoracic problem could be contributing to the feeling like I forgot to breathe for a second.

Hello Deborah,
Let's try again. Obviously there are a lot of possibilities, but I would presume that the obvious medical conditions have been ruled out. I'm assuming there is no enlarged liver, for example, or a lung condition that's causing this.

That painful patch on the rib cage by your breast almost certainly is the underlying problem. First, have you had a chest Xray to rule out a lesion of the rib?

Not uncommonly a fixated costo-transverse rib fixation in the midback may irritate and refer pain along the rib towards the breastbone. Do you have any mid back pain? If your turn right and left, or tilt to the side does it hurt? If you press on the joints between your ribs and the sternum is there any tenderness?

It took me personally a long time to learn that a forceful, posterior to anterior, chiropractic adjustment in the midback would aggravate a condition like this. Were you given a heavy adjustment in the midback? What fixes this pain is what we call an anterior thoracic adjustment.

You have two options. Return to your original chiropractor, perhaps with a copy of this correspondence, and discuss it honestly before any other treatment. Doctors in general, and chiropractors are included, are often egoists who think we know it all, and don't or won't listen to our patients' legitimate concerns.

Or, consult someone else, discussing this in some detail before any treatment. A heavy PA adjustment will aggravate the problem.

Have a look at our Tietzes syndrome page. Use the site search function key in the navigation bar.

I hope this contributes.

Barrie Lewis

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Sternum problem

by BEN

Possible Tietze's syndrome

Possible Tietze's syndrome

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 to right has been 3 months already. 3 weeks that I feel the pain i consult to a doctor and he said that this is a muscle damage he give a oral medication for 2 weeks but until now I been feeling the pain.

Hello Ben,
The photo is very small, only 6kb, could you send me the big pic to CONTACT.
But this looks very like Tietze's syndrome to me. Is that lump warm and swollen? It looks it. Is the lump tender?
When Tietze affects the sterno-clavicular joint it often affects the brachial plexus, hence the radiation down your arm. Ask your doctor to do Adson's test on you.
It certainly doesn't look like a muscular problem, though the scalene muscles may be affected.
Start by icing the joint twice a day, and see if you can find a chiropractor who knows something about Tietze's syndrome. The treatment is very specific - it happens to be something I'm interested in, but you may have to look around to find a chiro who knows how to treat it. Medication is not likely to help.
I hope this has contributed.

NB. Send me the full size pic.

Barrie Lewis

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Feb 17, 2014
lump on clavicle
by: Anonymous

I have an identical lump. I am quite slim but have quite large breasts. 32gg. I carry quite a weight on my shoulders and have dents where my bra sits which can be painful at times; could this cause an injury and be the cause of the lump on my clavicle where it joins the sternum?

It's hard to be sure, but I think that your breast size is incidental.

Is that lump over the sterno clavicular joint tender? And do you have pain there? Then it's likely to be Tietzes syndrome.

I'm not crazy about plastic surgery, but a breast reduction sometimes can do wonders for you if you have neck and upper back pain.

One alternative is a bra that doesn't hook over your trapezius muscles.

Barrie Lewis

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Pressure in my chest

by Margie

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 in my neck. My neck was also to the right a bit from a car accident that happened over 4 years ago. He keeps telling me that my shoulder isn't where he wants it to be. He has never explained what he means by this. My right shoulder is a little forward and a little lower than my left but not noticibly lower.

I have an ache that is constant in my middle back on the right hand side-kind of right at my bra line. It seems to feel better when I get up in the morning however after being out of bed for a couple of hours, it gets worse and seems to travel around to the front of my chest and I either have pressure or it feels like a tight band squeezing me. The whole right side in the front above my breast feels like the muscles are being pulled. My shoulder aches and so does the right side of my neck. It feels like there is a muscle in my neck that just has to loosen up but won't. Hot showers seem to help and so does a heating pad.
I work on a computer during the day but even on my days off, I get the same pain/aches.

When I lay on the roller table at the Chiro's office, the roller really irritates the spot in my mid back.
This has taken over my life. I can deal with my neck aching however it's this pressure in my chest that hurts so bad. I've had every test imaginable from the medical doctors everything comes up clean.

Any advice or suggestions would surely be appreciated.
Thank you for your time.

Hello Margie,

The key features here seem to be pain in the midback radiating along the rib to the right breast area, and breastbone (sternum). Is that right?

Press on the ribs where they meet the breastbone between your breasts. Is there a naughty rib (or several) that are distinctly more tender than their cousins on the left?

It's difficult without examination to make a diagnosis, but ask your chiro if he has considered Tietze's syndrome.

Tietzes syndrome requires a very specific chiropractic treatment. It relates to the whole rib, from its origin in the midback, to the breastbone.

Tip: A heavy manipulation in the midback will often aggravate the condition, perhaps also that roller. But an "anterior thoracic" adjustment, and management of the rib and rib-sternal joint is the key.

You've had a lot of treatment, Margie. 36 in three months? Probably too much, and if you are not seeing light at the end of the tunnel, it's probably time to move on. Fresh eyes, a fresh look. Perhaps some X-rays seeing there has been little response.

Because Tietzes syndrome often affects either the first rib and/or the collarbone joints, it often causes pain in the neck and arm. Correction of the first rib and clavicular fixations, and the muscles attached to these bones (scalenes and SCM) is the key to progress.

Long shot: place a small table at your right elbow at your computer work station. Roughly level with the work-top. This could be a case of mouse-arm.

I hope this has contributed. Let me know how you get on in a few months.

Barrie Lewis

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