Tietze's syndrome unresponsive to medicine and chiropractic

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 I think could be Tietzes syndrome. I have had numerous CT/MRI/Xrays and the Doctors can not find what is causing my chronic pain.

My pain started when I had what I think was a rib head out. I couldn't bend my neck down and was having a lot of upper back pain (between shoulder blades). After being adjusted again, I was still having a lot of pain.

I then developed costochondritis about 8 mths ago and I'm thinking now I may have Tietzes syndrome. I have chronic pain in my mid back and sternum area (about the 3rd rib down). There has been a swollen hard lump there on the right side and my pain runs down through my breast area. My chest has popped several times. I cannot lay on my stomach at all because of the chest pain. It is still painful to laugh even though the costochondritis has improved.

I have mentioned Tietze's syndrome to my chiropractor but he brushes me off. I desperately need help with this chronic pain and I don't know what avenue to take at this point. Any advice would be greatly appreciated.

Hello Michelle,
I'm not sure how wide to open my mouth, and whether to stick both feet in!

I've walked the walk with Tietze's syndrome and it's been a long a difficult journey; I first encountered it as a young chiropractor, not knowing its name and it was quite painful to discover that my treatment actually worsened it, and may have actually caused it. That was the beginning of the journey; in medical terms I was faced with what's known in the jargon as iatrogenic illness; doctor caused disease.

There's a fine line between costochondritis and Tietze's syndrome; firstly the former may be due to inflammation, but Tietze's is apparently not, and hence doesn't respond to anti inflammatories and in fact responds to very little; it becomes a chronic and debilitating condition, as you are experiencing.

The second feature is the presence of a lump over either a rib-breastbone joint, or over the joint between the collarbone and the breastbone.

The third is that often there is associated indigestion, and if it affects the collarbone, tingling in the arm.

Both have associated midback pain, often thought to be the start of the whole problem.

What I eventually realised was two things. Firstly a heavy manipulation in the midback worsens the condition. And secondly that, whilst it's not curable, it's a very treatable condition with chiropractic, but is unlikely to go away completely, and well require an occasional but regular adjustment; but the midback adjustment must be skillfully and gently done, or it will worsen the condition.

The treatment of choice is the so-called 'anterior thoracic" adjustment, and mobilisation of the whole rib.

Doctors in general, when they are out of their depth, brush off and dismiss patients' complaints. I know because I did too until I started to get interested in Tietze's syndrome, and whether chiropractic had any contribution to make. Medicine generally seems to admit there's nothing much they can do.

Which brings me back to your own chiropractor. If he has an enquiring mind, and is ready to face up to his limitations, and would to help patients with Tietze's syndrome, then I suggest you ask him to contact me. It's a difficult condition, and I make no claims to being a guru, but I have worked out a protocol that brings relief somewhere between 50-80%. It makes it manageable instead of being a daily struggle as you are experiencing.

I'm sorry if I've thrown petrol on the fire, but it's the way you may make progress. I know of no other, and it seems your doctors don't either.

Start by icing the painful spot on the sternum every day in a hot shower; alternating hot and cold helps.

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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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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