Tietze Syndrome is a rare disease which refers to the inflammation of the cartilage found in the upper half of the ribcage, which connects the ribs to the sternum. The disease cannot be cured and, in some cases, can lead to functional limitations (preventing essential tasks to be performed), disability, and mental health conditions (such as anxiety or depression). Tailored treatment can help manage symptoms and reduce its negative impact on pain levels, quality of life, and mental health. 

Overview of Tietze Syndrome

Tietze (t-EE-t-z-ee) syndrome refers to the inflammation of the upper costal cartilages (the cartilage that is found on the upper ribs or on the sternum).¹ It is estimated that it occurs in around 10% of the general population, making it a fairly rare condition.² The reasons behind the development of Tietze syndrome are known, but it appears to be mostly found in adults under the age of 40 years old.^3,4 

Symptoms

Tietze syndrome is a benign (not life-threatening) condition and in most cases (80%) it only affects one side of the chest.¹ However, it does cause symptoms which can noticeably affect patients' lives, and which can be amplified by common actions such as sneezing, coughing, breathing, and stretching.¹ The symptoms of Tietze syndrome include:^1,3,4

• Chest pain
• Swelling of the area affected
• Tenderness
• Radiating pain

Causes and risk factors

The origin of Tietze syndrome is unknown.¹ However, some factors have been identified as being potential triggers or risk factors. They include:^1,5

• Repeated microtrauma to the ribcage, through actions such as severe coughing, heavy manual work or sudden movements
• Poor nutrition
• Sprain of the ligament that connects the costal cartilage to the body of the sternum
• Respiratory tract infections, including COVID-19⁶

Diagnosis

Considering the relative rare incidence of Tietze syndrome and the fact that its symptoms are shared by other conditions (for example, costochondritis or lung inflammation), it can be difficult to diagnose.⁴ The physical examination usually involves identifying swollen areas and applying pressure on the front, lateral and posterior chest wall to assess the level and exact location of the discomfort experienced by the patient.^1,4 A patient is diagnosed with Tietze syndrome if they only experience the symptoms listed above.⁴ Indeed, if they experienced additional symptoms, they would likely be suffering from another condition (for instance, heart disease or muscle strain). To confirm the diagnosis, performing imaging tests, such as ultrasound or magnetic resonance imaging (MRI), is highly recommended to confirm inflammation of the cartilage.^1,4,5

Chronic pain and functional limitations due to Tietze Syndrome

Tietze syndrome is not life-threatening, but it can cause a great deal of discomfort. Although the condition usually resolves itself after some time, it does not have a cure. Instead, treatment aims to manage the long-term or recurring (also known as chronic) pain.¹

The chronic pain associated with Tietze syndrome is usually limited to the chest. It can be worsened by some positions (for example, sleeping on one’s front) or daily actions, such as breathing, sneezing or coughing.^1,2 Similarly to most chronic diseases, the pain is not necessarily sustained, it often appears in episodes lasting weeks or months (also known as flare-ups).¹

During a flare-up, a patients’ ability to perform activities might be greatly limited. Indeed, as the pain radiates from the chest to the neck and arms, it causes great difficulty with movements that require lifting and arm extension (for example, reaching overhead), making them both painful and dangerous.⁴ It will also reduce, or prevent, someone’s ability to exercise, which leads to lower general levels of health and increases the potential development of other health concerns, including muscle weakness, joint issues, cardiovascular diseases.^7,8 Therefore, Tietze syndrome can significantly affect someone’s life by limiting or preventing them from performing work tasks or household chores as well as impacting their sleep and general comfort. Long-term, this condition can lead to potential disability or general reduction of quality of life.⁹

Consequently, Tietze syndrome does not only impact people’s functional abilities, but also their mental health. Indeed, chronic pain has been linked to:⁸

• Absenteeism 
• Social isolation
• Anxiety
• Depression

Treatment and management of complications

Medical treatments

Medical treatments cannot fully cure Tietze syndrome because the reasons behind its development are unknown, but they aim to reduce its negative impact on people’s lives by addressing its symptoms.¹ In order to address the pain, patients are often given simple oral analgesics (such as acetaminophen), or nonsteroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen).^1–3 Administering corticosteroids or local anesthetics may be recommended in more severe cases.^1,2 Recent studies on corticosteroids suggest that using them short-term alongside NSAIDs leads to efficient pain relief.¹⁰

In addition, a range of pain and mobility management strategies have shown to be effective, including:¹ 

• Repeated exposure to heat or cold (depending on patient preference) through the day¹
• Transcutaneous electrical nerve stimulation¹
• Electroacupuncture^1,11
• Cupping¹¹
• Avoiding poor posture while working¹
• Stretching exercises¹
• Gentle exercise (which does not cause pain), when possible¹
• Physical therapy¹
• Prolotherapy (injecting an irritant solution into the affected tissue), particularly recommended for patients who struggle to tolerate drug treatment¹

Mental health

Mental health appears to have strong impact on the symptoms of Tietze syndrome, with reassuring patients on the benign nature of the disease leading to a fast reduction in their pain.¹ Therefore, building a support system through family, friends, therapy or counseling or support groups is likely to greatly help with the symptoms of the syndrome itself but also with the mental toll of chronic pain in more severe cases (including anxiety, social isolation and depression).

FAQs

Can Tietze syndrome be transmitted from one person to another?

No, Tietze syndrome is an inflammatory condition and cannot be transmitted. However, the causes for the disease are unknown but it has been linked to repeated microtrauma to the chest, poor nutrition and some respiratory infections.^1,5

Is there a cure for Tietze syndrome?

No, there is no medical cure for Tietze syndrome because the causes for its development are known.¹ Often, the condition will resolve by itself after some time.¹ Treatments for Tietze syndrome aim to manage symptoms, reduce flare-ups and improve overall quality of life.

What are the complications of Tietze syndrome?

The main complications of Tietze syndrome are chronic pain and its associated consequences such as:^7,8

• Functional limitations
• Disability (in severe cases)
• Comorbidity (including join issues, cardiovascular diseases, obesity)
• Poor mental health

Is Tietze syndrome treated with surgery?

No, surgical intervention for Tietze syndrome has not shown to be beneficial and is not a recommended treatment for the condition.²

Summary

Tietze syndrome is a rare condition which refers to the inflammation of the cartilage located on the ribcage. The processes that cause the disease are unknown but medical treatment can help manage its symptoms. Most cases will be resolved after a few weeks, but some are more severe and lead to complications including chronic pain and functional limitations, which impact both physical and emotional wellbeing. A large range of medical treatments (from medications to physical therapy and mental health support) have shown to greatly improve people’s quality of life.