Tietzes Syndrome

by Janine
(Johannesburg, South Africa)

Hi I live in Johannesburg, South Africa. My 15 year old daughter has been in severe pain now for 11 weeks. After numerous tests and specialists, finally at 9 and a half weeks she was diagnosed with Costochondritis. She is extremely sporty and is frustrated and despondent beyond description, at not being able to participate as she did 3 months ago and before that. It really has been quite debilitating for her.

As you say we have tried numerous anti inflammatorys and pain killers, but nothing seems to bring her any relief. PLEASE HELP!

I have never been to a chiropractor before and honestly I am quite scared of them. At this stage I am desperate to help my daughter, but at the same time petrified to take her to someone who doesn't know what they are doing and will end up making it worse. Please can you advise me of any reputable chiropractors in Johannesburg or even how I should go about assessing / finding one that can help her.

Much appreciated


Hello Janine,
There's no need to be anxious and scared of consulting a chiropractor; mostly we are careful and thorough and well trained.

Having said that, Tietzes syndrome is something of an enigma, and it took me a long while to figure it out. Just as your medical doctors are taking a long time.

It's a good thing they have ruled out the medical
causes; they are rare but do occur.

Does she actually have a lump over the breastbone? If so, I'd like to have a photo please.

There are four grades of Tietzes syndrome, but only the last has a palpable, tender, visible lump over the joint between the breastbone and the rib. Mostly it just hurts a lot but there's little to be actually seen.

One small warning that it took me a long time to figure out; a heavy chiropractic adjustment, P to A, will aggravate the condition. An "anterior thoracic" adjustment, mobilisation of the whole rib, and soft tissue therapy along the intercostal muscles is what will help her.

You can start with alternating ice and heat, an ice cube in the shower works well, directly over the tender spot.

The right way to find a good chiropractor is exactly the same as finding a good engineer, accountant and medical doctor; talk to friends and family and even your GP. Someone close by is usually, but not always best. Type find a good chiropractor into the search engine at Chiropractic Help; that might give you some ideas.

Perhaps print this out and take it with you to the chiropractor you choose. If they would like to phone me, that's fine. Like I said, it took me the best part of twenty five years to work out how to treat Tietze's syndrome. They can find my number in the navigation bar on your left.

Let us know how you get on.

Dr. Barrie Lewis

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Tietzes syndrome?

by Amanda
(Upstate NY)

Thoracic outlet syndrome

Thoracic outlet syndrome

For years I have felt that I needed to pop my sternum, like when your fingers need to pop, but the pressure would build up so much that I would press my shoulders back and it would pop and the pressure would release. During physical therapy for a neck injury, my therapist did a sternum myofascial release and the following day, my sternum popped so hard that I was in intense pain. After 3 x-rays, a chest ultrasound and a CT scan, no one has been able to tell me what is wrong with me.

It has been 8 months! The pain isn't as intense but is constantly there. The sternum area swells up and hurts really badly. Only recently, in the area of my collarbone, it is swelling and very tender. The pain is spreading and nothing is relieving it.

My shoulder is aching and my hand/fingers are numb. Last week, the doctor decided it was a good idea to push roughly on my sternum and then pound (literally with a closed fist) twice on each side of my ribs. I just wish I had answers and better yet, relief! Could this be Tietzes Syndrome?

Hello Amanda,
Yes, this could certainly be Tietzes Syndrome but there are other conditions that mimic it, so do also stay close to the medical world. Especially if you start to get any lymph gland or lung symptoms.

As you've probably read in the Tietzes syndrome casefile it affects the rib-sternum joints and sometimes the collarbone-sternum joints. In the latter case it often goes down the arm because of the relationship of the collar bone to the nerves and artery to the arm in the Inter Scalene Triangle ... Any heartburn?

Could you attach a photo of the area to show the swelling for the benefit of other readers? You'll have to play with the correct light to bring out the oedema.

Firstly, a no-no and it's a big no-no. Don't let anyone pound hard on your midback. It will aggravate, and may have been the cause.

Ice massage, or better cold hot therapy is probably the most important thing you can do.

I wish I could help because I've worked out myself after years of battling to treat the syndrome successfully how to manage to treat Tietzes syndrome, but it's not common knowledge in chiro or other professions.

Start looking for a conscientious, thorough Chiropractor in your area. Someone who will take the time to work with you. Remember, no heavy back treatment.

If you find someone, and they would like to Skype me, we could talk, and I could make some suggestions. Sadly however most doctors, chiros too are pretty arrogant, and that precludes learning, and asking others.

Because the treatment is in and around the breast tissue, if you go to a male, take a friend along.

Let me know.

Dr Barrie Lewis

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Tietzes Syndrome

by Alex Davies
(Sault Ste. Marie, Ontario, Canada)


I am a 21 year old male who has been an athlete and very active my whole life. For 2 years now I have been dealing with tense neck muscles and constant (and I mean they never go away, ever) headaches. It started with a dull ache at the back of my head where my spine reaches my head but has grown into a problem that is overwhelming me. Today I am so stiff it hurts to do stand, sit and do daily activities. The headaches are the same but now my ribs and chest ache and feel very tight. When I was 16 I had pain in the center of my chest (that I went to emerge about?) and they called it "chest wall pain" and gave me anti-inflammatory medication. I carried on and the chest pain was only really present when I sneezed sometimes or during certain stretches.

The severe pain in my ribs has only been present since seeing a chiropractor a couple months ago, and the pain I felt in my chest as a 16 year old is present all the time since then.

Tietze's syndrome, which I read about on your site describes my symptoms except the only thing that bothered me for the longest time was head and neck pain.

My physio therapist says I'm as stiff as anyone he's seen and believes a tight dura is the reason for my headaches but the stretches he gave me (standing rag doll, trying to touch my toes) have aggravated my ribs, chest, and back to the point where it hurts to breathe. No doctor has ever been able to help me and im feeling very helpless as my condition worsens.

Other symptoms I've experienced include a numb left arm where its obvious the circulation has been cut off to my arm in the sitting position with my arm elevated (mainly sitting at a desk or driving). I often have pressure in my ears which coincide with bad tension headaches.

I fear seeing a chiropractor again because I believe it made me worse, and no one else seems to have any answers.

Any advice would be greatly appreciated



Hello Alex,

It took me many years to work out that a heavy manipulation in the midback would aggravate this condition, so don't feel all alone.

It sounds like you have several different conditions that are overlapping. Just to be sure, I would suggest some blood tests to be sure that you don't have a medical condition such as Ankylosing spondylitis. Frankly, unlikely, but it does happen.

The numb feeling in your arm when you raise your arm is typical of a first rib fixation causing a "thoracic outlet syndrome". It also involves several muscles in the neck (the scalenes) which would explain the neck pain and headaches.

Tietze's is a nasty condition involving the whole rib, sometimes several, usually unilateral, but it can be both sides. Breastbone pain, and pain along the rib to the midback is the feature. Commonly aggravated by deep breathing.

The correct Chiropractic treatment is very specific, and carefully avoids any heavy midback manipulation. Oddly I had a new patient yesterday, a professional cyclist, with this exact problem.

Often there is associated indigestion and heartburn because the diaphragm is attached to the lower ribs.

I confess I too may have aggravated and even caused this problem until I worked out how to treat it. It's called Iatrogenic Illness, or doctor-caused disease!

If you had a good rapport with your present DC, despite the fact he aggravated this condition, then I would return to him, and carefully and very definitely point out that the treatment increased your pain. If he listens, and is prepared to think and adapt his treatment, well and good. If not, and you feel rushed brushed off, in and out, don't let him touch you, move on.

If he would like to Skype me, I'd be happy to outline the protocol I have developed. No charge.

Have you had X-rays taken? Neck and midback. Get those blood tests.

Shop around Alex. Before consulting another chiro, always first ask if he has heard of Tietze's. Heavy midback manipulation definitely aggravates and even causes the condition. It will only increase your problems even more.

Go from Tietzes Syndrome to Chiropractic Tips …

I hope this has contributed. If so, this is my latest book of chiropractic anecdotes, available on Amazon for $2.99! Shameless, self promotion! Stones in my Clog … Chiropractic anecdotes from the polders of Holland.

Dr Barrie Lewis

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Oct 24, 2013
I am so sorry
by: Phil Agosta

I thought you were local I do not know where to go or trust. That Heart Attack Syndrome is killing me. At most I can clean 90 minutes after that I suffer three days. I get Charlie Horses Vicious Cramps around my ribs and chest than I pass out I have several cuts on my forehead from whatever I hit. I really cried when I saw where you were in the world. How can I find who I can trust. I am on Medicare disability and can only afford a few treatment a year. My house is a mess I am doing hard time in a little room. My Diaphragm is affected like a belt around my chest. I can't live like this. Sorry I thought you were near.

Hello Phil,
Maybe you have a vacation in Alaska coming up. This is treatable, keep positive, careful not to become an emotional wreck on top of a real physical problem.

Good luck,

Dr. Barrie Lewis

Jul 06, 2011
Your protocol for Tietzes syndrome
by: Anonymous

Tietzes syndrome

Dr. B,

I am a chiropractor for the military up in Alaska. I just today had a soldier come in today who has been suffering from Tietze's Snydrome for two years. I would be interested in what is you do with your patients. Any assistance would be much appreciated. You can email me at mary.long3@us.army.mil

Hello Dr Long,
I'll email you privately.

Dr Barrie Lewis

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Rib subluxation or contusion

The incident in question occurred early in the morning November 28, 2013, and it is now the 31st of December. It is kind of an embarrassing situation, and believe me, it will not happen again. It was very stupid on my part to have let it happen to begin with, but I will not lie to you as far as what happened. All I'm gonna say is that I took a direct blow to the chest from a heavyset man laying against me. (We weren't doing what you might think, but he was kissing me.) It just sort of happened out of the blue, but I will regret it forever; I felt a "pop" on the left side of my ribcage in the front, which I found out to be mostly cartilage.

I could see a visual difference as far as a protrusion on the left side of my ribcage compared to the right, no visible bruises though. What happened was that within a few hours after this occurred, I became very nauseous and sick and finally decided to go to the emergency room. They gave me a shot for nausea and a shot for rib pain, which helped for the moment.

After having xrays done, they told me there were thankfully no breaks or fractures. Also, I was told you can't visually see anything out of the ordinary on the xrays; that everything looked normal. So why is there a very visible protrusion from my chest, and if I could see it right away after this happened, could inflammation occurred that quickly? Or what else could be going on? I understand that rib injuries take time to heal. It's just I want to understand thoroughly exactly what I'm in for. I did go to a chiropractor where he didn't do a whole lot for me, saying that with bone and cartilage joints, it just takes time to heal. He also told me that everything was where it was supposed to be. It's been over a month since it happened now, and the visible protrusion looks exactly the same as it did when it happened. At the moment I do not have a job, so I've been able to take it as easy as possible with plenty of rest, etc.

I'm also starting to cold compress the area for 20 minutes 3 times a day, taking painkillers twice a day. But what if this doesn't clear it up? Will I have that for the rest of my life? I'm so worried right now about this that I'm literally sick to my stomach. I just wish I knew where to go get real answers. I want to see for myself on xrays what the issue is, but if I can't see anything, does it mean it's the inflammation only and that it will heal, or not?

Throughout the past month, I've had episodes where it's been difficult to breathe, shooting pain in the rib area, and muscle aches, etc. In the beginning I had trouble sleeping, finding a good position to sleep in, I usually sit upright because I'd find it harder to breathe lying flat. I suffer less when I'm up and moving around as to being stationary and resting for long periods of time. I was prescribed to take pills, so I've taken a large amount of pills, which some have made me very, very sick. At the moment I'm taking 2 ibuprofen each day. I guess the main question I have is that if I keep icing the wounded area and taking painkillers will this protrusion heal and the swelling go away in time? I think it's the not knowing that is worrying me. If I knew kind of a time frame, I may be able to put my mind at rest. If this stays like it is, would surgery be something I should consider to fix the issue? I don't even want to consider that, but. Please, please help me and advise me on what to do to get this cleared up. I will do whatever it takes. Thank you for your help and anything else that you can recommend.

Indeed a very unfortunate incident. I take you were either squeezed very hard, or punched or assaulted in some way. If so, you should lay charges. It's the only way men learn.

You have almost certainly had a cracked rib or rib cartilage. Perhaps actually fractured, difficult to see on plain xray. A ct scan or bone scan would show it up.

Seeing that there's a visible change in the contour of the rib, I'd assume it was fractured, so manipulation of any sort before the end of January would be unwise. An activator treatment might be okay.

And then, very important, an anterior to posterior chiropractic adjustment should only be done very gently. It could well worsen the costo chondral joint injury. Hyperextension adjustments are safer.

How well will it heal? It's impossible to be sure, but you can expect to be sore for at least six weeks. If there was any injury to the joints between the rib in question and the spine, it must be adjusted, just not until the bone has headed.

What will help is lying on the side, painful side up. Ask someone to massage gently between the ribs, right from the spine to the breastbone.

Go on with the ice, but limit anti inflammatories; they actually inhibit healing.

Of concern is whether this turns into a Tietze's syndrome. Use the search this site at chiropractic help to find it.

Let us know in a month or two how you are getting on.

Dr Barrie Lewis

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Feb 06, 2015
Slipped Rib.
by: Salem

This sounds exactly like a slipped rib. If you have a protrusion at the sternochondrral intersection at the anteriomedial aspect of the rib you can suspect 3 things, broken rib, slipped rib, dislocated rib. If your x-ray is clear, assuming your internist has seen a few spine x-rays and isnt missing anthing, as stated above by Dr. B, hyperextension adjustments will be the least painful. If it works, you will notice immediate neurogenic relief accompanied by soreness local to the capsule and general muscular soreness. Keep in mind........if this rib has been subluxed for longer than a few days, you can almost expect a hypermobility issue and will become great friends with your chiropractor. 2 things of point, you can effectively mobilize and adjust your ribs by laying supine over a firm 6" diameter foam roll positioning the foam roll just below the area of back pain, hands clasped behind head or across chest and gently extend over the foam roll. Also of note, this is a way better idea after a good back strengthening workout when you are nice and warm. 6am as soon as you wake up when you have extremely tight muscles from prolonged static positioning is going to be the most ineffective time to attempt to adjust your rib as it would likely take that big man jumping on top of you to get enough force. With that said, after the adjustment or repetitive adjustments, postural back stabilization exercises are indicated to improve posture and to use tone to make up for ligamentous laxity to stabilize your ribs.

Thanks for this Dr Salem.

Dr. Barrie Lewis

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Tietzes syndrome

by Sharon ojha

I have swelling over 2nd costo-sternal joint on the right side. I also have some pain over that area but the pain is more of "on-off" type...pain is not severe or terrible but it feels like a dull ache...i have had this for a month and my doc said its chostochondritis..but the swelling is not going away and i'm an 18 year old girl..what is this?

Hello Sharon,
Beautiful English, congratulations, you write better than many English speaking people.

Your doctor is almost certain right. It's old-fashioned name is Tietzes syndrome.

It's a complex condition, often related to a problem in the upper middle back where the rib attaches to the spine. Any upper back / lower neck pain? Any radiation down the arm.

I know of no chiropractors in Nepal so I'd recommend ice on the swollen joint, massage it with an ice block, followed by heat, and then on the upper back. Massage along the whole rib would be helpful but it goes very deep in the shoulder.

Cold hot therapy ...

Could you please attach a digital photograph of the lump. You'll have to move the camera around to get the light just right, not easy to photograph.

I hope this contributes.

Go from Tietzes syndrome to other Chiropractic Conditions often treated…

Dr Barrie Lewis

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Tietzes Syndrome - left chest and arm pain

this doesn't show it too well :/

this doesn't show it too well :/

I went to the emergency room last week for pain in the left of my chest and my left arm panicked that I was going to have a heart attack (which would be highly unlikely because I'm a healthy 19-year-old girl). After many tests, I went home still clueless as to what I had. I then had a follow up appointment with my regular doctor, who told me it was costochondritis.

Then, later that day, I realized that the area beneath my collarbone, more on the left side, was swollen and appeared to be a shallow, though rather large-in-area lump. The lump is a little tender to touch. I called my doctor and he said it could be due to the costochondritis. I then did some research of my own about costochondritis which took me to Tietzes syndrome.

This must be what I have, even though I don't remember having any trauma to my chest. I've been using a heating pack and ibuprofen for the pain, but I'm finding it extremely hard to avoid lifting things and twisting my body too much (which my doctor would worsen it.)

How do I get rid of this? Can I exercise without making it worse? In addition to the pain in my chest and arm, there is now pain in my neck and back. I also have some indigestion (constant rumbling stomach that feels empty even though it's not.) Please help!

You're right, the pic isn't too clear. Could you send the full file, without reduction to me brlewis@mweb.co.za This website may reduce it automatically and I'd like to see the full graphic.

When Tietzes syndrome affects either the first rib, or the collarbone, it may affect the "brachial plexus of nerves" and hence the pain down the arm. Inter scalene triangle ...

And, because the diaphragm attaches to the underside of the (lower) ribs, it may also cause indigestion.

I presume a chest X-ray was taken. If not, I would recommend. What's vital is that the correct diagnosis is made, as there are other conditions that can mimic Tietzes syndrome. Keep in touch with your doctor and if concerned, ask to see a physician specialist. Were blood tests taken?

There is no proven treatment for Tietzes syndrome. Because it's something that kept arriving periodically in the clinic, I developed an interest and came up with a protocol that managed the condition quite well. I can't promise that the average chiropractor, or any doctor for that matter, will have any idea about the treatment of it.

If you decide to see a chiropractor and s/he would like to skype me, I would be very happy to discuss the chiropractic management of your condition with him/her.

Keep active, but I wouldn't exercise at present. But likewise, keep moving, otherwise everything is likely to stiffen up.

Meantime ice is good for pain relief and to reduce the swelling.

What does concern me a little is that the mass seems to be central rather than unilateral. Send me the full digi pic.

The pain often travels along the whole length of the rib, back to its attachment to the spine, hence your back and lower neck pain.

I wish I could be more helpful...

Dr Barrie Lewis

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Sep 30, 2015
Years of pain
by: Misty

I have had my pain for nearly ten years. I've been to dr after dr that never found anything. I've had MRI of my shoulder, chest X-ray, even an ultrasound. I went to a pain clinic that said he thought I had thoracic outlet syndrome and tried to send me to a dr out of state. I have learned to live with the pain because I thought I had too. It feels better when I apply pressure on it for some reason. I recently had a ct scan of my neck for a different reason and you can see the muscle in my left in that area is bigger almost inflamed looking. I'm completely miserable with this pain. It has my arm feeling so weak. I would travel to where u are just to fix it. I'm gonna call some chiropractors Tomm to see if they know about this. Thank you for helping me diagnose my problem.

I'm glad it was helpful, Misty. Now to see if there's someone to help you.

Contact me again if need be with more details of your particular problem.

Barrie Lewis

Dec 25, 2014
by: Anonymous

Tietzes syndrome

This might as well be written by me, it's exactly what I've been experiencing for almost 3 years. I'm 23, and my doctor says I will likely outgrow it in my 40s or 50s. I'm honestly not sure I can live with the pain that long.

Please help

Hello Casey,
Mm, thirty years is a long time to wait, if there's a reasonable alternative.

I say reasonable, as what I have is unresearched; really nothing more than a chiropractic anecdote.

I have struggled to find a treatment for this nasty syndrome for over twenty five years, and now have perhaps fifty cases under the belt. Few are cured, most are 50 to 80 percent better. Would you be satisfied with that?

Casey, start looking for a conscientious local chiroprator, and ask him to email or skype me; I'll happily go over my protocol with him or her.

One little warning; a heavy manipulation in the middle of the back will aggravate this condition. Don't let anyone do it.

Barrie Lewis

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