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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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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