Introduction 

Tietze syndrome is a rare, benign inflammatory condition that causes pain and swelling in the chest, more specifically in the 2nd or 3rd costal cartilages (rib cartilage) unilaterally. Costal cartilages are connective tissues that are flexible and connect the ribs to the sternum. The cartilages, sternum, and ribs collectively make up the concave part of the chest. The condition is often mistaken for costochondritis, but unlike costochondritis, Tietze involves visible swelling in the affected area. Neither of the aforementioned conditions is life-threatening; however, the symptoms can mimic those of a more serious heart disease, which can cause more distress to the patient. The exact cause (aetiology) of Tietze is unknown; however, factors such as physical exertion, heavy manual work, severe coughing, or vomiting may factor into its development. It was one of the complications of COVID-19.⁵ Treatment typically focuses on relieving pain and inflammation through rest, medications and physical therapy.  The condition may affect both women and children with a 1:1 ratio and can typically be seen in the second and third decades of life (10-30 years).⁶ This article will provide an in-depth overview of Tietze syndrome, including its causes, symptoms, treatment options, and long-term outlook. 

Causes and risk factors 

As previously mentioned, Tietze is a rare inflammatory condition affecting the costal cartilages in the sternum. The exact cause of this condition is unclear, and like costochondritis, it is considered to be an idiopathic condition, meaning that it develops without a known trigger. 

However, despite it being an idiopathic condition, there are several potential risk factors and causes, such as:

• Repetitive microtrauma: This occurs when an individual repeatedly stresses the affected area from picking up objects or through exercise
• Acute trauma: This condition can also be caused by direct injuries to the chest, including falls, car accidents, or surgical procedures to the thoracic area¹
• Infections: Viral or bacterial: In certain circumstances, the inflammation is preceded by a respiratory infection, suggesting that there may be a link between the two. In fact, there were certain instances where Tietze occurred alongside coronavirus (Covid-19)
• Inflammatory conditions: Individuals with previously diagnosed autoimmune conditions, such as rheumatoid arthritis, may have an increased susceptibility to Tietze syndrome due to their predisposition to joint and cartilage inflammation

While the above four causes have been identified in patients, it’s important to note that the condition can also arise without an identifiable cause. There is currently a scarce amount of research, and more is needed to understand the underlying mechanisms and risk factors associated with Tietze syndrome. If you do have any of the symptoms mentioned in the next section, then please discuss this with a medical professional.

Symptoms and diagnosis 

The common symptoms of Tietze syndrome are as follows:¹

• Acute chest pain 
• Dull pain and aching at rest 
• Sharp pain radiating to the neck and arms with movements 

Please be aware that these are just of the symptoms and you may only experience one or multiple of these. The condition often presents itself in young people who otherwise lead a healthy lifestyle.¹

 In terms of the physical presentation at diagnosis, there is often a stabbing pain felt directly at the swollen area by the patient.¹ A medical professional may also be able to feel a spindle-shaped inflammation over the affected rib when doing an examination, sometimes feeling warm to the touch.¹ It should be noted that the condition may start suddenly and develop gradually, with it becoming worse when coughing, twisting the arm, sneezing and deep breathing.¹ An ECG ( electrocardiogram) may be performed to see the heart’s function, and an ultrasound to look at the extent of the inflammation in the soft tissue.¹ A biopsy of the costal cartilage may be performed, or nuclear magnetic resonance to identify inflammation alterations in neighbouring fat tissues.¹ The most common diagnostic tool for the condition is a physical exam performed by a medical professional, an ECG, and an ultrasound. 

Treatment and management 

First and foremost, it is important that a medical professional reassures you that with proper treatment, the condition should resolve within a few weeks or a few months.¹

The first line of treatment usually offered is non-steroidal medications alongside rest.¹ If the first line of treatment doesn’t relieve any pain, then a medical professional may do a steroid injection into the affected area, or putting warm pads/hot water bottle may reduce the swelling and pain simultaneously.¹ It is not a chronic condition; however, if symptoms persist, despite treatment, or there are any issues, it is recommended to then contact the medical professional you initially spoke to in order to follow up on this. 

Coping strategies 

Activity modification, such as avoiding heavy lifting, repetitive upper body movements, and excessive strain on the chest, can help prevent the symptoms from worsening. Ergonomic adjustments can be implemented, such as the use of an ergonomic chair, to reduce the stress on the rib cage whilst maintaining a good posture. In one study, it was concluded that respiratory path (how you are breathing) changes with your posture on different types of chairs, with there being a difference between the genders. This is not to say that you need to go out and buy a new chair, but potentially learn through YouTube from a chiropractor the correct posture in order to breathe properly and prevent other inflammatory conditions, such as arthritis. 

Breathing exercises, most notably meditation, may help in managing discomfort whilst reducing the tension in the inflamed chest muscles. Mindfulness meditation is a tool/intervention that can be used via apps or by going to classes to control the breathing pattern and reduce stress in the body. However, this is just one option, and it is totally understandable if the meditation practice causes you to stress more than relax. This is a holistic approach and may not suit everyone. 

In terms of long-term management, maintaining a healthy diet rich in anti-inflammatory foods could be beneficial in avoiding further complications and staying healthy. All foods should be consumed in moderation, and typically, anti-inflammatory foods should be consumed instead of inflammatory foods. Foods that can cause inflammation are: refined carbohydrates ( white bread ), fried foods, processed meats, sugary beverages and margarine.¹³ anti-inflammatory Foods are: tomatoes, olive oil, nuts, fatty fish and green leaves.¹³ A healthy diet consists of a mixture of a reduced amount of inflammatory foods and a higher amount of anti-inflammatory foods.¹³

Conclusion

Tietze syndrome is a rare inflammatory condition that, while not life-threatening, can cause significant discomfort due to chest pain and swelling. The exact cause remains unknown, but potential triggers include repetitive strain, infections, or underlying inflammatory conditions. The positive aspect is that this is not a chronic condition, and with the right treatment, typically rest, pain management, and in some cases, steroid injections, symptoms usually resolve within a few weeks to months.

Long-term management can involve lifestyle changes such as avoiding heavy lifting, maintaining proper posture, and incorporating more anti-inflammatory foods into your diet. If symptoms persist or worsen, following up with a medical professional is essential. Increased awareness and further research into Tietze syndrome will help improve treatment approaches and ensure better outcomes for those affected.