Tietze or what?

by Alicki
(Switzerland )

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, then I got this (see picture). I stupidly added two Hours of kayak because I didnt want to let a friend down.

The pain is not in front but radiates just under the shoulder blade. No warmth, just swelling of sternocostal joint and a little on joint just below that one.
Appointment with GP on 26.08 . Pain very achy!
Could this be Tietze? Am thinking of asking for MRI .
Im a woman so want to make sure this has nothing to do with breast. I'm 43 and have had a breast reduction in past.
Thanks for any advice.
Best wishes,

Hello Alicki,
Just to be sure I have it right, you have no pain around the sternum, is that correct? The pain is more in the midback. Does a deep inspiration hurt?

Certainly the swelling you describe is typical of Tietze's sydrome; are these joints tender on palpation, compared to the other side?

Women't who have a breast procedure are more at risk.

In the full blooded Tietzes syndrome, those swollen nodes also become painful, and there is sometimes tingling in the arm, and indigestion. There are lots of variables.

A breast exam just to be certain is never a bad idea.

Give me a few answers to the questions above; and attach the picture.

Dr B

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Sep 22, 2019
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Bruised dungeon a bad fall or Tietze?
by: Carolina

Hi there, I'm a fit, thin and highly active 71 year old. Last week while hiking at night I tripped and fell and braced the full with both hands to avoid head injuries. I immediately felt pain in my chest, have had painful breathing and soreness since then. The nurse at the local Urgent Care noticed a swelling to the right of my sternum and diagnosed me with Tietze. I saw another physician and he thinks it's simply a bruised rib or pulled muscle. The xrays were normal. The swelling is small and when I duplicate the position I fell in, it corresponds to the same spot. I also have a small bruise near the swelling.

I know Tietze is a disease of exclusion and I was alarmed at the diagnosis after a 2 second exam and inconclusive xray. Is getting an MRI the only way to get a definitive diagnosis and if so, should I see a thoracic specialist? Thx!





Hello Carolina,
I take it your chest never actually came into contact with a rock or any other obstacle; something to cause a bruise. You didn't fall on your hand or fist, or a waterbottle?

I presume the painful breathing and soreness is over the sternal area, not under the armpit, or in the midback; or is there discomfort there too when breathing?

There was no sign of any problem whatsoever before the fall?

Frankly it's a bit of semantics. Costochondritis and Tietze's syndrome are first cousins, and the treatment is much the same; just the latter is likely to be more obdurate to treatment and may not go away completely. Particularly if the only treatment is medication.

An MRI may contribute something, quitely not.

I would recommend starting to apply ice immediately over the painful joint in the shower or bath, alternating cold and hot, and then massaging in the groove between the ribs.

Often the whole rib is affected, from the three joints where it meets the spine to the costosternal area. Then a gentle chiropractic adjustment is needed, note, important, an 'anterior thoracic' adjustment. A heavy manipulation from P to A will worsen the condition.

See your local chiropractor if it doesn't settle in a week or two with home care.

Let me know how you get on.

Sep 22, 2019
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Bruised dungeon a bad fall or Tietze?
by: Carolina

Hi there, I'm a fit, thin and highly active 71 year old. Last week while hiking at night I tripped and fell and braced the full with both hands to avoid head injuries. I immediately felt pain in my chest, have had painful breathing and soreness since then. The nurse at the local Urgent Care noticed a swelling to the right of my sternum and diagnosed me with Tietze. I saw another physician and he thinks it's simply a bruised rib or pulled muscle. The xrays were normal. The swelling is small and when I duplicate the position I fell in, it corresponds to the same spot. I also have a small bruise near the swelling.

I know Tietze is a disease of exclusion and I was alarmed at the diagnosis after a 2 second exam and inconclusive xray. Is getting an MRI the only way to get a definitive diagnosis and if so, should I see a thoracic specialist? Thx!

Feb 18, 2017
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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.

Thanks
Aliicki

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
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Another question
by: Anonymous

Hello,

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
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Mysterious tietze???
by: Anonymous

Hello,

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
Alicki

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
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Tietze or what next?
by: Anonymous

Hello,

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



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Aug 22, 2016
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Next
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.

Best
Alicki

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
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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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