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Feb 18, 2017
Going on 7 months with Tietze's syndrome
by: Anonymous

Lung and heart are clear on X-ray and I have follow up MRI in two weeks. I have quite a bit of short breath as soon as I go out in cold or exercise for long.
Can cold weather make Tietze worse? That's my question.


It's great that the tests are clear; are you still having chest pain, and that pec minor tendon?

As far as I know Tietze's syndrome is no more affected by the weather than any other joint.

Dr B

Dec 13, 2016
Another question
by: Anonymous


Another question if I may. When I was in Rome a few weeks ago, I pulled a suitcase around with my bad side. My joints hurt like mad for a few minutes. That was around end of October. Then a few days over that, my osteopath realised that I winced with pain every time he touched my minor pectoralis muscle. Could I have torn my minor pectoral muscle by dragging a suitcase over 100 meters on an already injured area?

Now, it's been about a month, the pain radiates to my arm and top of shoulder too.
Of course, this doesn't turn up on MRI....but if you touch the minor pec or I stretch it, I clearly wince with pain.

I'm guessing I have made things worse. Any practical suggestions on how I could recover from this? At least the minor pec muscle. Again, because of the breast op, the joint swelling, I'm guessing the whole area has gone crazy.
The check up MRI is in 2 months, but I need to do something NOW:

I don't see my osteopath before two weeks.

Many thanks in advance for your reply. Shame I'm not nearer, this is an interesting case!!

Lovely to have got to Rome in October; definitely not in midsummer. The most interesting city in Europe I've visited.

The sign of a pulled muscle is that it hurts when you contract it; in fact an "isometric" contraction where the joint doesn't move. It's very specific for the pec and difficult to describe; you might find something on google. Your osteopath will know.

Put some alternating ice and heat on the muscle, stretch it gently and start some simple shoulder exercises; they shouldn't hurt but you'll feel it.

True; it's not always nice to have an 'interesting' problem. Like the Chinese curse: may you live in interesting times.

Dr B

Dec 01, 2016
Mysterious tietze???
by: Anonymous


This is Alicki again - updating. We did a second MRI and firstCT that showed a small infiltration of the minor pectoral muscle which they believe is inflammation. I have to do another MRI in 3 months! Impossible to get a bone scan - the bones are ok on MRI and CT. I saw a thoracic surgeon who believes my sternous exercise provoked an inflammation of the articulation which doesn't show on MRI.
Arm is starting to ache too. Breast MRI cleared any breast involvement . Lymph nodes are up again in the area.

This is my theory: what do you think :

I had a butchered breast reduction in 2013, correction done in 2015 (June). Did strenuous exercise in August 2016. I have massive scarring in my breast (internal scars).

I think the breast reduction and scarring impaired the lymphtics of the area and the strenuous exercise over did the
joint that popped out. This would explain why the area is swollen in the evening and more or less ok in the morning.

I think this is a mixture of some sort of Tietze and lymphatic impairment and it's going to be a question of how to treat it.

Could you tell me about cases that you ve had/seen when Tietze appeared after some kind of Breast surgery? That might be helpful! Does Tietze flat up and then settle again?

I will keep updating because I think this is pretty unique condition. Meantime any feedback is welcome!

Warm regards

Hello Alicki,
I would your thoracic surgeon is close to the mark, especially as you said you could some sort of popping sound in the costosternal joint.

What doesn't fit with pure Tietze's syndrome is the swollen lymph nodes; that is probably more to do with what you call the botched breast reduction. Surgery like chiropractic is an art, and some have good hands, others not so good.

I'm sure blood tests have been done to rule out lymphomas.

It's not uncommon after breast surgery and because it's really not frequent in the general population I've never seen statistics; my experience is that it responds quite well to chiropractic, but tends to come back; maintenance rather than a cure is the order of the day.

You're not that unique, at least not in this regard, Alicki! But those swollen lymph nodes will keep your doctors guessing; thanks for the update and I hope you gradually improve.

Dr B

Sep 30, 2016
Tietze or what next?
by: Anonymous


We need an MRI (chest no dye) and it showed nothing. My ostheopath who is great read the scans (he knows how) and said that my right side is a little more protruding than my left.
There was no swelling in the joints, no odema in bone, NOTHING but the bulge can clearly be seen. The odema in the soft tissue has now completely subsided, or is very minimal. The back pain has gone.

I have asked several times about Tietze to be told that because I was not/am not in terrible pain, it can't be that BUT the joints are still sensitive.

Now something else, I went to a chiro to see if he had an idea. He used a weird machine to test my back (resistance?) and was able to tell me that my right side (affected side) is much weaker than my left. He's going to try and do some kind of treatment to strengthen right side. What? I don't know - still waiting to find out - have asked for the paperwork. Does this machine (which shows green and red results on a chart) remind you of anything?

I have to see another radiologist for an unrelated problem next week and will ask her opinion.

meanwhile, if this tietze or non tietze thing is getting better, and the only thing I have left is protrusion, swelling of joints - should I still be concerned?
How long will it take for it to go away?
Can we have only 'mild' pain with Tietze??

Hello Alicki,
You can have a mild dose of anything and it certainly sounds like a mild dose of Tietze's syndrome; it can be extremely painful and debilitating and there's no known cure.

I have worked out a protocol for it that relieves most of the pain but it tends to come back. If you chiro wants to skype me, we can arrange that.

Just remember, a heavy manipulating in the mid back will bring it back with a vengeance.

I don't have much faith in those muscle machines to be honest, but that's my own prejudice, so ignore my doubts.

Take it quietly for a bit; remember the 50% rule; they pain goes away much faster than it heals.

Great that you are getting better.

Dr B

» Tietze or what next?

Aug 22, 2016
by: Anonymous

Ok, the swollen nodes have gone down (phew!)and this leaves just two protruding cost sternal joints (the first two after SJC). I'm following up with doc on Friday. No swollen nodes in the back, but my ostheo said that he felt that the 3rd rib was swollen.

I'm seeing both oseothpath and doc this week and will discuss exams. This could be just a small injury further to intensive sports but it's always best to check for peace of mind!

Thanks for the support doc, really helps. I'll report back once I have had the appropriate exam.


It's no coincidence Alicki that he found the joint swollen at the back; it usually follows the whole rib.

Remember, a heavy P to A manipulation will aggravate it.

Yes, let me know.

Dr B

Aug 19, 2016
Tietzes syndrome and lymph nodes
by: Alicki

The front 2nd? and 3rd? joints are swollen (the one below the SCJ - second and third sterno costal joints) and so are swollen lymph nodes around them. I have tingling in hands anyway from some weird condition; nothing new there. The joints are tender, but not painful. When I put my left hand on my right joint and lift my right arm above my ahead, I can feel Something coming out of place and going back into place. It cracks a little but softly.

The pain is mainly in the back (shoulder and midback). My excellent ostheopath noticed some swelling in the 3rd right rib too, back and front; seeing him again next week. But we read everywhere that Tietze is rare, so we are both wondering if it's that.
Armpit nodes and clavicular nodes are totally normal but the lymh nodes around the swelling are swollen. I've put some anti-inflamatory cream on swellling and nodes and the swelling on the nodes seems to be going down very slowly. But bone swellling still there. No breathing problems.

Any advice is welcome. I am thinking of getting an MRI done just to be sure I've not cracked Something but meanwhile insights are good. And am also wondering whether my ostheopahth could contact you if it is Tietze.

To my knowledge Tietze's syndrome does not cause swollen lymph nodes, though I could be wrong. And especially seeing you are have swollen lymph nodes at the back, I'd continue to keep a foot in both the medical and osteopathic camps.

It sounds very much like what I'd describe as an atypical Tietze's syndrome; which means I too am not sure.

A bone scan might be more useful than an MRI. Keep in touch. Sure he can contact me.

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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