Tietzes Syndrome

by Katya
(Western, WA)

When my 2 oldest children were small (& I still smoked occasionally) I suddenly one day sitting & laughing on the couch with 1 of them developed ingratiating, crushing upper chest pain; centered at & above my sternum (7-8 yrs ago). I lay on the floor in a fetal position, until the paramedics took me to the hospital. Each episode was sudden & with non-stop crushing horrifying pain. It generally brought me to my knees as the pain was so horrid that I was physically unable to stand or hold myself up, but no position was/is ever comfortable. At that 1st hops visit & several subsequent ones, the dr.s told me I had everything from heartburn (which I emphasized had never been a problem except when I was in late pregnancy, also I hadnt always eaten anything within hours of an attack), they told me I was having a panic/anxiety attack (though my pain was in no way psychosomatic, plus my life was relatively happy & many times these attacks started when playing or relaxing with family), they even suggested gall bladder problems or other stomach upsets though that clearly wasnt where the pain was. Generally they left me in a room for hours while I was too incapacitated to cry out for help, they refused to give me pain meds or any anti-inflammatories, & they tried everything from anxiety meds to anti-nausea or heartburn meds (which of course didnt work). Finally after nearly 2 yrs of these trips to the same ER, an intelligent Dr appeared one day & listened to me & said he though I had costrochondritis! He said the fact that the first episode happened after a serious cold with bronchitis, that I had immunological diseases in my family, that I did house-keeping & heavy landscaping for a living & that I smoked, plus being female (& that they had repeatedly ruled out heart or digestive problems with tests) - made Tietze most likely. I know enough now from what he told me to avoid having an attack but once or twice a year. I dont smoke which really aggravates my chest, I watch for any mild creeping upper chest pain. My biggest problem now is that a severe cold or flu with vomiting is likely to bring on an attack. Steroid inhalers lower my immunity & generally cause me to end up very sick later even if I only used them a few days to ward off an attack. The swelling is helped with ice-packs, but I often feel like I cant breath properly during an attack. I usually still end up in the ER for pain control & a shot of steroids tho.

Dear Katya,
A sad tale, good for the doctor who finally figured it out. Now to fix it!

Firstly, a violent movement, like a sneeze, coughing, and even a heavy midback manipulation, posterior to anterior, can set Tietzes syndrome off.

Obviously there are other causes of chest pain, and they need to be ruled out, which seems to have happened.

Congratulations on giving up smoking. The associated coughing was probably one of the causes.

Did you / do you have actually visible swelling, a nodule along the breastbone? If so, I'd appreciate a photograph.

If you press on the joints between your ribs and the breastbone, are one or more very tender? Does the pain radiate under the armpit and to your midback? Any tingling in the arm?

Use alternating ice and heat on your breastbone, then rub your fingers with oil along the ribs, moving away from the sternum.

A GENTLE Anterior- posterior chiropractic adjustment of the rib is often the key. Warn your chiro not to adjust your midback hard P to A. That will aggravate it.

Good luck, I hope this has contributed.

Dr B

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