Tietzes: Difference between revisions

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== Differential Diagnosis  ==
== Differential Diagnosis  ==


The symptoms and signs of Tietze’s syndrome may occur in all arthropathies involving the anterior chest wall, particularly in seronegative spondylarthropathy and rheumatoid arthritis luckily these are distinguished easily by their other clinical features. Other sometimes mistaken for tietze’s syndrome skeletal causes are xiphoidalgia and [http://www.physio-pedia.com/index.php5?title=Slipping_rib_syndrome#Slipping_rib_syndrome slipping rib syndrome]. Besides these pathologies, there are many other diseases to consider in the differential diagnosis, such as multiple myeloma, primitive neoplasms of the bone and soft tissues, chondrosarcoma of the chondrocostal joints, breast and lung tumors with extension to the costal cartilage, as well as metastases of breast, kidney, and prostate neoplasms<ref>Fioravanti, A., Tofi, C., Volterrani, L. and Marcolongo, R. (2002), Malignant lymphoma presenting as Tietze's syndrome. Arthritis Care &amp; Research, 47: 229–230. doi: 10.1002/art.10401</ref>. consequently malignancy should always be kept in mind in the differential diagnosis of tietze’s syndrome. The use of the appropriate other investigations such as electrocardiography[<ref>Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref><ref>Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm</ref>, CT-scan<ref>Hamburg C., Abdalwahab I.F., Reliability of computed tomography in the initial diagnosis and follow-up evaluation of Tietze's syndrome: a case report with review of the literature, J Comput Tomogr., 1987;11(1):83-87</ref><ref>Hoogendoorn R.J., Brinkman J.M., Visser O.J., Paul M.A., Wuisman P.I., Sternal pain: not always harmless, Ned Tijdschrift Geneeskd. 2004 Dec 11;148(50):2469-74</ref>, MRI<ref>Hoogendoorn R.J., Brinkman J.M., Visser O.J., Paul M.A., Wuisman P.I., Sternal pain: not always harmless, Ned Tijdschrift Geneeskd. 2004 Dec 11;148(50):2469-74</ref><ref>Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref><ref>Volterrani L., Mazzei M.A., Giordano N., Nuti R., Galeazzi M., Fioravanti A., Magnetic resonance imaging in Tietze's syndrome, Clin Exp Rheumatol., Sept-Oct 2008; 26(5):848-53</ref>,… is necessary.<br><br>
The symptoms and signs of Tietze’s syndrome may occur in all arthropathies involving the anterior chest wall, particularly in seronegative spondylarthropathy and rheumatoid arthritis luckily these are distinguished easily by their other clinical features. Other sometimes mistaken for tietze’s syndrome skeletal causes are xiphoidalgia and [http://www.physio-pedia.com/index.php5?title=Slipping_rib_syndrome#Slipping_rib_syndrome slipping rib syndrome]. Besides these pathologies, there are many other diseases to consider in the differential diagnosis, such as multiple myeloma, primitive neoplasms of the bone and soft tissues, chondrosarcoma of the chondrocostal joints, breast and lung tumors with extension to the costal cartilage, as well as metastases of breast, kidney, and prostate neoplasms<ref>Fioravanti, A., Tofi, C., Volterrani, L. and Marcolongo, R. (2002), Malignant lymphoma presenting as Tietze's syndrome. Arthritis Care &amp;amp; Research, 47: 229–230. doi: 10.1002/art.10401</ref>. consequently malignancy should always be kept in mind in the differential diagnosis of tietze’s syndrome. The use of the appropriate other investigations such as electrocardiography[<ref name="Smythe et al">Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref><ref name="Moin et al">Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm</ref>, CT-scan<ref name="Hamburg et al">Hamburg C., Abdalwahab I.F., Reliability of computed tomography in the initial diagnosis and follow-up evaluation of Tietze's syndrome: a case report with review of the literature, J Comput Tomogr., 1987;11(1):83-87</ref><ref name="Hoogendoorn et al">Hoogendoorn R.J., Brinkman J.M., Visser O.J., Paul M.A., Wuisman P.I., Sternal pain: not always harmless, Ned Tijdschrift Geneeskd. 2004 Dec 11;148(50):2469-74</ref>, MRI<ref name="Hoogendoorn et al">Hoogendoorn R.J., Brinkman J.M., Visser O.J., Paul M.A., Wuisman P.I., Sternal pain: not always harmless, Ned Tijdschrift Geneeskd. 2004 Dec 11;148(50):2469-74</ref><ref name="Smythe et al">Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref><ref name="Volterrani et al ">Volterrani L., Mazzei M.A., Giordano N., Nuti R., Galeazzi M., Fioravanti A., Magnetic resonance imaging in Tietze's syndrome, Clin Exp Rheumatol., Sept-Oct 2008; 26(5):848-53</ref>,… is necessary.<br><br>


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==

Revision as of 22:38, 25 May 2011

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Definition/Description[edit | edit source]

Costochondritis is a painfull chronical inflammation of the cartilago of one or more costae at
the transition between sternum and costae.[1][2][3] Only when a swelling occurs underneath sternum and/or a reddening of the skin at the painfull spot, it's called Tietze's syndrome[4][5][6][7]. This disease causes severe pain when coughing and deep breathing. The Tietze's syndrome is not life-threatening or contagious but it is a fastidious and painfull disease.[4][3] Costochondritis[6] and the Tietze's syndrome are often confused but in fact they are two different diseases. [8]

Costochondritis usually affects the third, fourth and fifth costochondral joint and occurs more often in women. whereas Tietze’s syndrome most commonly affects one joint, in particularly the second or third costal cartilage and both sexes are affected equally[9] . Both diseases can start either acute or progressively at any age

Clinically Relevant Anatomy[edit | edit source]

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Epidemiology /Etiology[edit | edit source]

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Characteristics/Clinical Presentation
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The cartilage connects sternum with costae and clavicula, and makes the movement of the thorax possible while breathing.[10][11] The inflammation of the cartilage of one or more costae causes a red, warm swelling of the cartilage. This will be both visible and palpable.[12][13]There is pain with a varying intensity in the chest wall and this pain aggravated by movements of the torso, deep breathing, coughing and exertion. [14][15][16][17] Pain occurring during the palpation of the painful spot suggests costochondritis but the pain could also have a cardiac origin[18][19] tumor[20][21][22] . From the pain of inflammation, the normal movement in joints is disrupted, the movements of the shoulder crepitates and pain may occur.[23][24][25] Complaints occur gradually and can disappear spontaneously after some days but it may take years to disappear.[26][27] Even after a spontaneously healing, the complaints can return on the same place or another spot around the costae.[28][29]

Differential Diagnosis[edit | edit source]

The symptoms and signs of Tietze’s syndrome may occur in all arthropathies involving the anterior chest wall, particularly in seronegative spondylarthropathy and rheumatoid arthritis luckily these are distinguished easily by their other clinical features. Other sometimes mistaken for tietze’s syndrome skeletal causes are xiphoidalgia and slipping rib syndrome. Besides these pathologies, there are many other diseases to consider in the differential diagnosis, such as multiple myeloma, primitive neoplasms of the bone and soft tissues, chondrosarcoma of the chondrocostal joints, breast and lung tumors with extension to the costal cartilage, as well as metastases of breast, kidney, and prostate neoplasms[30]. consequently malignancy should always be kept in mind in the differential diagnosis of tietze’s syndrome. The use of the appropriate other investigations such as electrocardiography[[31][3], CT-scan[32][5], MRI[5][31][33],… is necessary.

Diagnostic Procedures[edit | edit source]

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Examination[edit | edit source]

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Medical Management
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medical management generally consists of relative rest for 4–6 weeks, injections of anesthetic-corticosteroid, topical or oral analgesics, and prescription of other drugs including sulfasalazine or capsofungin combined with fluconazole.[34][35]



Physical Therapy Management
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The treatment of Tietze’s syndrome is not yet perfect. It is not known weather the disease is dealt definitly or not.[3] For now, trustworthy clinical studies on the treatment of Tietze's syndrome are lacking  [36][4][6].

The physiotherapist can:
- Reassure the patient by explaining the condition [8][4]
- Instruct a good body position and give exercise advise. Patients need a good balance between exercise and rest.[8][37][7][6]
- Use heat pads and massage to help against the overloading of muscles and to lessen the pain.[8][1][6]
- Mobilize spine and ribs to avoid rigidity of the thorax and to reduce complaints.[37][3]
- Teach the patient breathing excercises[3]
- Learn the patient to cope with pain.[8][6]
- Exercise for shoulder and back can be provocative, therefore only when the complaints have disappeared, they can be applied
[3]

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References[edit | edit source]

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  1. ↑ 1.0 1.1 Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  2. ↑ Thongngarm T., Lemos L.B., Lawhon N., Harisdangkul V., Malignant tumor with chest wall pain mimicking Tietze's syndrome, Clin Rheumatol., 2001; 20(4):276-8
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm
  4. ↑ 4.0 4.1 4.2 4.3 Verdon F., Burnand B., Herzig L., Junod M., Pécoud A., Bernard F., Chest wall syndrome among primary care patients: a cohort study, Fam Pract., 2010 Aug; 27(4):363-9
  5. ↑ 5.0 5.1 5.2 Hoogendoorn R.J., Brinkman J.M., Visser O.J., Paul M.A., Wuisman P.I., Sternal pain: not always harmless, Ned Tijdschrift Geneeskd. 2004 Dec 11;148(50):2469-74
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 American acadamy of family physicians, Costochondritis: What you need to know, Am Fam Physicians, Sept 2009, 15;75(10):1
  7. ↑ 7.0 7.1 Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Cite error: Invalid <ref> tag; no text was provided for refs named Proulx and Zryd
  9. ↑ Anthony S. Fauci, Carol A. Langford. Harrison’s rheumatology. Second edition. 2010. McGraw-Hill Education
  10. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  11. ↑ Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm
  12. ↑ Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm
  13. ↑ Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29
  14. ↑ Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29
  15. ↑ Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20
  16. ↑ Verdon F., Burnand B., Herzig L., Junod M., Pécoud A., Bernard F., Chest wall syndrome among primary care patients: a cohort study, Fam Pract., 2010 Aug; 27(4):363-9
  17. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  18. ↑ Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20
  19. ↑ Verdon F., Burnand B., Herzig L., Junod M., Pécoud A., Bernard F., Chest wall syndrome among primary care patients: a cohort study, Fam Pract., 2010 Aug; 27(4):363-9
  20. ↑ Verdon F., Burnand B., Herzig L., Junod M., Pécoud A., Bernard F., Chest wall syndrome among primary care patients: a cohort study, Fam Pract., 2010 Aug; 27(4):363-9
  21. ↑ Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm
  22. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  23. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  24. ↑ Moin P., Vergouw M., Imanuel N., Hulshof D., 2005, Syndroom van Tietze, geraadpleegd op 26/12/2010, http://www.fysiotherapie-enschede.nl/content/ziektenbeelden3upo/Syndroom%20van%20Tietze.htm
  25. ↑ Verdon F., Burnand B., Herzig L., Junod M., Pécoud A., Bernard F., Chest wall syndrome among primary care patients: a cohort study, Fam Pract., 2010 Aug; 27(4):363-9
  26. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  27. ↑ Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.
  28. ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  29. ↑ Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29
  30. ↑ Fioravanti, A., Tofi, C., Volterrani, L. and Marcolongo, R. (2002), Malignant lymphoma presenting as Tietze's syndrome. Arthritis Care &amp; Research, 47: 229–230. doi: 10.1002/art.10401
  31. ↑ 31.0 31.1 Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  32. ↑ Hamburg C., Abdalwahab I.F., Reliability of computed tomography in the initial diagnosis and follow-up evaluation of Tietze's syndrome: a case report with review of the literature, J Comput Tomogr., 1987;11(1):83-87
  33. ↑ Volterrani L., Mazzei M.A., Giordano N., Nuti R., Galeazzi M., Fioravanti A., Magnetic resonance imaging in Tietze's syndrome, Clin Exp Rheumatol., Sept-Oct 2008; 26(5):848-53
  34. ↑ Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.
  35. ↑ 14. Hudes K. Low-tech rehabilitation and management of a 64-year-old male patient with acute idiopathic onset of costochondritis. J Can Chiropr Assoc. 2008; 52(4):224–228.
  36. ↑ Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20
  37. ↑ 37.0 37.1 Cite error: Invalid <ref> tag; no text was provided for refs named Gregory et al
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