Tietzes syndrome after a bad chest

by Linda

» Tietzes syndrome after a bad chest.

When my daughter was 14 she had a really bad chest; after her chest was better she said she had a pain in her back between a rib and would get quite breathless.

She was sent to see a consultant; by the time we had the appointment she was really ill she was sleeping all the time so much so she would fall asleep in school even in mid sentence, she had pain all over her body.

She had cramp like pains from her neck all the way down her spine and into her feet; she could not concentrate and her memory was affected.

She was diagnosed with ME and her life just changed within a couple of months. She had to be driven to school and could only go part time she went to hydrotherapy once a week for a year.

Eventually she felt slightly better but the pain between her ribs never went away she was sent to see a cardiologist who had an interest in ME who diagnosed Tietze's syndrome then gave her an injection of steroid and lignocaine.

I got my daughter back; she could function normally again but then he discharged her. After the injection wore off all the pain and chest infections returned she was eventually sent to see a Rheumatologist who started to give the injections again; she has been having these now for four years she has completed uni been travelling and now has a job she loves. We went for her injection which she has between her ribs at the back, not in her breast bone even though to touch there hurts.

It's the constant pain between the ribs that affects her, to be informed that after this one she needs to go for a bone density scan and that he is referring her to a surgeon to see about surgery to remove inflammation or to kill the nerve. I have been reading things about the two procedures and it's not good reading but then will her life go back to not being able to function again.

Hello Linda,
Your daughter obviously has a complex case and I think it's not appropriate to comment on the specifics of her case. I haven't had the opportunity to examine her.

But in general terms, what we see commonly in chiropractic practice is that a person develops a cough for whatever reason. Sometimes it's the coughing, but a good sneeze can do it to, but a rib head becomes subluxated.

There are three joints between each rib head and the spine, and one or more can be sprained by coughing or sneezing. It causes incredibly sharp pain in the midback, every breathe being a nightmare.

Untreated the sharp pain gradually subsides and sometimes no doubts heals itself. But in others a dull ache remains and, because the fixated joint affects the rhythm of the rib during breathing, it starts to affect the other end of the rib: the joint between the rib and the breastbone. At first just tenderness begins there, then it may become painful and eventually form a swollen nodule at the joint; that's the true Tietze's syndrome. Often there is indigestion along with it, as the diaphragm is attached to the underside of the ribs.

The chiropractic treatment of the initial "sprung rib" as it's called is usually very simple and dramatic; reducing the subluxation of the rib head is something chiropractors are faced with frequently and it's cured without drama; if treated within a few days or weeks.

Once it becomes chronic, deep seated inflammation begins and spreading pain along the rib under the armpit and towards the sternum it becomes more difficult. It still responds to chiropractic care, but a "cure" becomes less likely, as with many medical treatable, but not curable, conditions.

So where does this leave your daughter? Certainly before surgeons get their knives in, I'd recommend you have a consultation without treatment with a local chiropractor. Weigh what he or she has to say and make your decision. Take any xrays and scans with you, and perhaps print this out. The find a good chiropractor link below may be of help.

One caution: there are two chiropractic manoeuvres that are classically used. One is on the rib head, from posterior to anterior. If a heavy manipulation is done, it will probably aggravate her condition.

Better is a gentle posterior to anterior adjustment, as above, and then the second type which is called an anterior thoracic adjustment. This is what really helps with a condition like your daughter has. Plus some massage between the ribs, all the way from the spine to the sternum.

I hope this contributes; let me know how you get on.

Dr B.

» Tietzes syndrome after a bad chest.

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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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