Tietzes Syndrome

by Brooklyn
(Illinois, United States)

I should first preface this by saying that I am currently a first year osteopathic medical student in the United States, so that automatically makes me a hypochondriac. But seriously, I have had many of the same health/pain problems for years that have gone unsolved and have led me on a hunt for answers and giving me the desire to help others like me.

I am a 33 years old female. I spent 11 years in the military, where I was constantly abusing my body with training. My pain began when I was about 22 year old as mild and irregular bouts of undiagnosable pain and has progressed over the years to more chronic pain. I have always had this idea that all of these small "mystery" ailments were somehow connected. First, I get miserable headaches in the back of my head (like tension headaches). I also have fairly consistent burning and tingling pain along the medial borders of both of my scapula. I occasionally get severe upper abdominal pain (epigastric and not necessarily more severe on one side or the other- with a negative Murphy's sign, no distinct location, and negative labs) that is always accompanied by severe back pain at the same level (about T6-7-ish). In fact sometimes I can't tell which hurts worse and which started first.

I also occasionally get severe carpal tunnel-like symptoms with pain and tingling in all but my pinky finger involved. The pain often feels like a deep aching-almost burning feeling from my fingers up my arm and occasionally almost to my shoulder with intense swelling in my hands. The most severe pain is at night, especially after heavy lifting the day before. I should also point out that I am a side sleeper and I curl up into the fetal position when I sleep.

But this is not all. I also get pretty severe bilateral chest pains (not usually at the same time as the stomach pains though). The chest pain is more like an intense pressure and I often find myself gently massaging the area below my clavicle and intercostally with very little relief. I also often find myself feeling like I cannot complete a full breath, like my chest will just not expand enough to make room for complete lung expansion. Almost every doctor that I have seen has diagnosed me with something different. The army docs diagnosed me with GERD, the veteran's association diagnosed me with depression and loaded me up with drugs and my school diagnosed me with anxiety.

I am a generally tense person, but overall healthy (non-smoker, vegetarian for most of my life, active life-style, but always loads of stress). This could all be true, but I have found no other evidence to support the GERD or the depression and no amount of medication has given me any relief from these symptoms. Does this sound like these could all be connected somehow?

You would think that going to an osteopathic medical school that one of these physicians would have made a connection by now, right. Or maybe I am just a depressed, anxious, acid refluxing hypochondriac? I know that med school can turn you into a hypochondriac, but I was actually doing some research because I am currently experiencing some of these symptoms, and I am a little more knowledgeable on the medical terminology now so I can do more intelligent searching. I feel like Tietzes syndrome might tie some of these symptoms together a little bit, or am I just conveniently forcing my symptoms to fit this syndrome?

I know this was a long letter, but I wanted to make sure that you had all of the facts so you can tell me what you are thinking.

Please let me know what you think. I would love to hear your thoughts.

Hello Brooklyn,
You're definitely not hypo, but then again you do have some real problems. What's good is that in the main it's musculoskeletal with no real neurological overtones; even that gastro stuff is probably either an incipient hiatus hernia, or directly related to the costo-sternal pain you're getting.

So, you worked your bod hard. Nothing wrong with that, the more serious problems in the main relate to the couch potatoes, and that you certainly aren't! Good! High blood pressure, diabetes, stroke, obese knee and foot arthritis... that's not on your horizon.

And I'm sure you've discovered by now that, if doctors have no idea what's wrong, they hide behind a virus, stress and depression.

Press reasonably firmly on the costo-sternal joints. They shouldn't be tender at all. Are some painful, more right or left? In the classical Tietzes the joints are actually swollen. However, in a grade 1-3 they are often just tender and sore. And often an associated gastric pain.

Virtually always, Tietzes has also middorsal pain. We can argue long into the night whether the middorsal > costosternal pain, or vice versa. Probably both occur.

Most likely in all your army antics you've taken a few blows to the head and neck. Motor accident, diving? fall off a horse? A suboccipital subluxation is the cause of most neck pain and headache, but don't forget the jaw joint, that too can cause neck pain and headache.

GERD? How often does your dinner end up in your mouth? Does drinking with, or after meals give you heartburn?

Obviously you're training in a related, but different field. See some osteopaths and see what they have to say. Don't be too quick to take meds, challenge them. On what do they base their diagnosis. And, if you're really find you're getting no where, perhaps time to see a chiro. I must say, I struggled with Tietzes for 25 years before I came up with a protocol that works. Hard, P to A manipulation of the midback will aggravate it.

Who knows? Perhaps a transfer to chiropractic!

Good luck, let me know how you get on, I hope this has contributed.

Dr B

PS. Oh, that sounds really like carpal tunnel. Check the pronator teres and first rib too.

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