TIetzes syndrome

(British Columbia Canada)

Dear Dr. Lewis

Is it possible to have this deep in the left sternum, not feeling it just chronically there like a knife in my chest at certain stretches over years. Only once difficulty breathing after another spinal adjustment. Was told to just lie down and breathe. Have been seeing chiros for 30 yrs. Is there an actual subluxation where the sternum and rib meet/attach? How would this be adjusted or cracked, moved?

Frankly, I don't quite understand your question. Like any other condition, it can be chronic, or recent and acute.
It's my own observation that I have in my early years in practice actually caused this problem through an over-robust mid thoracic adjustment.

And, like any other condition, be it a musculo skeletal condition like Tietze's syndrome, or diabetes, or ... it comes in severe forms, and mild forms.

Sometimes trauma (like an overly-robust thoracic adjustment) is the cause, other times a chronic midthoracic subluxation that has not been well cared for.

No, I don't think there is an actual subluxation. This joint is quite unique and unlike the synovial joints of the spine. I think of it more like a strain / sprain. Like sprained ankle ligaments or a pulled hamstring.

And just like a sprained ankle, where the ankle mortice or subtalar subluxation is not reduced, it can lead to a chronic pain syndrome.

Frustratingly, there is little research, medical or chiropractic about costo-chondral pain. In fact medicine has more on the subject, as the condition is so often confused with myocardial infarction, and because of the association with the diaphragm, Tietzes syndrome is often associated with indigestion and GERD.

Obviously, in severe trauma, the costo-chondral cartilage can be disrupted/ torn/ fractured. But in chiropractic practice the condition seems to be more of a "strain". And the treatment is not an adjustment in the normal chiropractic sense, but rather a mobilisation. Plus an adjustment of the costo-spinal joints.

Frankly, the patho-physiology seems to be poorly understood, and there is a dearth of information on the subject. But it does respond well to the protocol I have outlined.

And because of a host of tissues deep below the sternum per se, other "medical" conditions do need to be kept in mind. Medicine has established that occasionally an acute heart attack is associated with costo-sternal pain. Probably a distinct condition that existed prior to the MI but can be so early confused with a true MI.

I hope this answers your question.

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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