Tietzes: Difference between revisions

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'''Original Editors ''' - [[User:Els Bernaers|Els Bernaers]]  
'''Original Editors ''' - [[User:Els Bernaers|Els Bernaers]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
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== Search Strategy  ==
== Search Strategy  ==


add text here related to databases searched, keywords, and search timeline <br>  
Pubmed: key words: Tietze, Tietze syndrome, costochondritis
 
1985-2015<br>  


== Definition/Description  ==
== Definition/Description  ==


[[Costochondritis|Costochondritis]] is a painfull chronical inflammation of the cartilago of one or more costae at <br>the transition between sternum and costae.<ref name="Fam 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="Thongnarm et al">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</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> Only when a swelling occurs underneath sternum and/or a reddening of the skin at the painfull spot, it's called Tietze's syndrome<ref name="Verdon et al">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</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><ref name="American academy of family physicians">American acadamy of family physicians, Costochondritis: What you need to know, Am Fam Physicians, Sept 2009, 15;75(10):1</ref><ref name="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref>. 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.<ref name="Verdon et al" /><ref name="Moin et al" /> Costochondritis<ref name="American academy of family physicians" /> and the Tietze's syndrome are often confused but in fact they are two different diseases. <ref name="Zryd et al" />
In 1921, Tietze syndrome is described for the first time by Alexander Tietze, a German Surgeon.<br>Tietze syndrome usually affects the third, fourth and fifth costochondral joint. The manubriumsternal and xiphisternal joints are less frequently affected. Joint swelling distinguishes the condition from costochondritis. Tietze’s syndrome is supported by an elevated erytocryryte rate and more morning stiffness. (Lawless, 2015, Jensen et al.,, 2010, LOE: 3A)<br>With Tietze syndrome a local swelling is visible of the involved costal cartilages and patients complain of chest wall pain. (Frontera,2015, Jensen et al.,, 2010, LOE: 3A)


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<ref>Anthony S. Fauci, Carol A. Langford. Harrison’s rheumatology. Second edition. 2010. McGraw-Hill Education</ref> . Both diseases can start either acute or progressively at any age<br><br>
[[Costochondritis|Costochondritis]] is a painful chronical inflammation of the cartilage of one or more costae at <br>the transition between sternum and costae.&nbsp;. (Fam et al, 1985, LOE: 2A; Thongngarm et al., 2001, LOE: 3B)Only when a swelling occurs underneath sternum and/or a reddening of the skin at the painfull spot, it's called Tietze's syndrome. (Verdon et al., 2010, LOE: 2B; Hoogendoorn et al., 2004, LOE: 3B; Hurst,2001) 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.&nbsp;(Verdon et al., 2010, LOE: 2B)&nbsp;Costochondritis&nbsp;and the Tietze's syndrome are often confused but in fact they are two different diseases. (Proulx et al.,2009,LOE:2A)<br><br>  


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==


add text here
The thorax is part of the human body and is located between the neck and the abdomen. Our thorax is composed of the clavicula, sternum and 24 ribs, 12 ribs at each side. Ten of the 12 ribs are connected to the sternum by cartilage. The purpose of the cartilage is to make the thorax flexible during the respiration. (Paulsen, 2011)<br> <br>The ribs articulate posteriorly with the proc. transversii of the thoracic vertebrae. These junctions are called the costotransverse joints. The ribs also articulate with the body of the vertebrae. These articulations are called the costovertebral joints. (Fam et al, 1985, LOE: 2A)<br>


== Epidemiology /Etiology  ==
== Epidemiology /Etiology  ==
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== Characteristics/Clinical Presentation<br>  ==
== Characteristics/Clinical Presentation<br>  ==


The cartilage connects sternum with costae and clavicula, and makes the movement of the thorax possible while breathing.<ref name="Fam 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> 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.<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><ref name="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref>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.&nbsp;<ref name="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref><ref name="Zryd et al">Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20</ref><ref name="Verdon et al">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</ref><ref name="Fam et al">Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref> Pain occurring during the palpation of the painful spot suggests costochondritis but the pain could also have a cardiac origin<ref name="Zryd et al">Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20</ref><ref name="Verdon et al">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</ref> tumor<ref name="Verdon et al">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</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><ref name="Fam et al">Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref> . From the pain of inflammation, the normal movement in joints is disrupted, the movements of the shoulder crepitates and pain may occur.<ref name="Fam 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><ref name="Verdon et al">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</ref> Complaints occur gradually and can disappear spontaneously after some days but it may take years to disappear.<ref name="Fam 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="Gregory et al">Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.</ref> Even after a spontaneously healing, the complaints can return on the same place or another spot around the costae.<ref name="Fam 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="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref><br><br>
The cartilage connects sternum with costae and clavicula, and makes the movement of the thorax possible while breathing.<ref name="Fam 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> 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.<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><ref name="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref>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.&nbsp;<ref name="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref><ref name="Zryd et al">Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20</ref><ref name="Verdon et al">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</ref><ref name="Fam et al">Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref> Pain occurring during the palpation of the painful spot suggests costochondritis but the pain could also have a cardiac origin<ref name="Zryd et al">Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20</ref><ref name="Verdon et al">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</ref> tumor<ref name="Verdon et al">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</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><ref name="Fam et al">Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.</ref> . From the pain of inflammation, the normal movement in joints is disrupted, the movements of the shoulder crepitates and pain may occur.<ref name="Fam 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><ref name="Verdon et al">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</ref> Complaints occur gradually and can disappear spontaneously after some days but it may take years to disappear.<ref name="Fam 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="Gregory et al">Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.</ref> Even after a spontaneously healing, the complaints can return on the same place or another spot around the costae.<ref name="Fam 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="Hurst et al">Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29</ref><br><br>  


== 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 [[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;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>
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|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;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  ==
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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.<ref name="Gregory et al">Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.</ref><ref>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.</ref>  
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.<ref name="Gregory et al">Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.</ref><ref>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.</ref>  


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== Physical Therapy Management <br>  ==
== Physical Therapy Management <br>  ==


The treatment of Tietze’s syndrome is not yet perfect. It is not known weather the disease is dealt definitly or not.<ref name="Moin et al" /> For now, trustworthy clinical studies on the treatment of Tietze's syndrome are lacking&nbsp; <ref name="Zryd et al">Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20</ref><ref name="Verdon et al" /><ref name="American academy of family physicians" />. <br><br>The physiotherapist can:<br>- Reassure the patient by explaining the condition <ref name="Zryd et al" /><ref name="Verdon et al" /><br>- Instruct a good body position and give exercise advise. Patients need a good balance between exercise and rest.<ref name="Zryd et al" /><ref name="Gregory et al" /><ref name="Hurst et al" /><ref name="American academy of family physicians" /><br>- Use heat pads and massage to help against the overloading of muscles and to lessen the pain.<ref name="Zryd et al" /><ref name="Fam et al" /><ref name="American academy of family physicians" /><br>- Mobilize spine and ribs to avoid rigidity of the thorax and to reduce complaints.<ref name="Gregory et al" /><ref name="Moin et al" /><br>- Teach the patient breathing excercises<ref name="Moin et al" /> <br>- Learn the patient to cope with pain.<ref name="Zryd et al" /><ref name="American academy of family physicians" /><br>- Exercise for shoulder and back can be provocative, therefore only when the complaints have disappeared, they can be applied<br><ref name="Moin et al" />
The treatment of Tietze’s syndrome is not yet perfect. It is not known weather the disease is dealt definitly or not.<ref name="Moin et al" /> For now, trustworthy clinical studies on the treatment of Tietze's syndrome are lacking&nbsp; <ref name="Zryd et al">Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20</ref><ref name="Verdon et al" /><ref name="American academy of family physicians" />. <br><br>The physiotherapist can:<br>- Reassure the patient by explaining the condition <ref name="Zryd et al" /><ref name="Verdon et al" /><br>- Instruct a good body position and give exercise advise. Patients need a good balance between exercise and rest.<ref name="Zryd et al" /><ref name="Gregory et al" /><ref name="Hurst et al" /><ref name="American academy of family physicians" /><br>- Use heat pads and massage to help against the overloading of muscles and to lessen the pain.<ref name="Zryd et al" /><ref name="Fam et al" /><ref name="American academy of family physicians" /><br>- Mobilize spine and ribs to avoid rigidity of the thorax and to reduce complaints.<ref name="Gregory et al" /><ref name="Moin et al" /><br>- Teach the patient breathing excercises<ref name="Moin et al" /> <br>- Learn the patient to cope with pain.<ref name="Zryd et al" /><ref name="American academy of family physicians" /><br>- Exercise for shoulder and back can be provocative, therefore only when the complaints have disappeared, they can be applied<br><ref name="Moin et al" />  


== Key Research  ==
== Key Research  ==

Revision as of 21:35, 8 June 2015

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Els Bernaers

Top Contributors - Jeroen Verwichte, Els Bernaers, Laura Danhieux, Admin, Kim Jackson, Rachael Lowe, Evan Thomas, Simisola Ajeyalemi, Uchechukwu Chukwuemeka, 127.0.0.1, Nikie Peeters, WikiSysop and Claire Knott  

Search Strategy[edit | edit source]

Pubmed: key words: Tietze, Tietze syndrome, costochondritis

1985-2015

Definition/Description[edit | edit source]

In 1921, Tietze syndrome is described for the first time by Alexander Tietze, a German Surgeon.
Tietze syndrome usually affects the third, fourth and fifth costochondral joint. The manubriumsternal and xiphisternal joints are less frequently affected. Joint swelling distinguishes the condition from costochondritis. Tietze’s syndrome is supported by an elevated erytocryryte rate and more morning stiffness. (Lawless, 2015, Jensen et al.,, 2010, LOE: 3A)
With Tietze syndrome a local swelling is visible of the involved costal cartilages and patients complain of chest wall pain. (Frontera,2015, Jensen et al.,, 2010, LOE: 3A)

Costochondritis is a painful chronical inflammation of the cartilage of one or more costae at
the transition between sternum and costae. . (Fam et al, 1985, LOE: 2A; Thongngarm et al., 2001, LOE: 3B)Only when a swelling occurs underneath sternum and/or a reddening of the skin at the painfull spot, it's called Tietze's syndrome. (Verdon et al., 2010, LOE: 2B; Hoogendoorn et al., 2004, LOE: 3B; Hurst,2001) 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. (Verdon et al., 2010, LOE: 2B) Costochondritis and the Tietze's syndrome are often confused but in fact they are two different diseases. (Proulx et al.,2009,LOE:2A)

Clinically Relevant Anatomy[edit | edit source]

The thorax is part of the human body and is located between the neck and the abdomen. Our thorax is composed of the clavicula, sternum and 24 ribs, 12 ribs at each side. Ten of the 12 ribs are connected to the sternum by cartilage. The purpose of the cartilage is to make the thorax flexible during the respiration. (Paulsen, 2011)

The ribs articulate posteriorly with the proc. transversii of the thoracic vertebrae. These junctions are called the costotransverse joints. The ribs also articulate with the body of the vertebrae. These articulations are called the costovertebral joints. (Fam et al, 1985, LOE: 2A)

Epidemiology /Etiology[edit | edit source]

add text here

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.[1][2] 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.[2][3]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. [3][4][5][1] Pain occurring during the palpation of the painful spot suggests costochondritis but the pain could also have a cardiac origin[4][5] tumor[5][2][1] . From the pain of inflammation, the normal movement in joints is disrupted, the movements of the shoulder crepitates and pain may occur.[1][2][5] Complaints occur gradually and can disappear spontaneously after some days but it may take years to disappear.[1][6] Even after a spontaneously healing, the complaints can return on the same place or another spot around the costae.[1][3]

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[7]. 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[[8][2], CT-scan[9][10], MRI[10][8][11],… 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.[6][12]



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.[2] For now, trustworthy clinical studies on the treatment of Tietze's syndrome are lacking  [4][5][13].

The physiotherapist can:
- Reassure the patient by explaining the condition [4][5]
- Instruct a good body position and give exercise advise. Patients need a good balance between exercise and rest.[4][6][3][13]
- Use heat pads and massage to help against the overloading of muscles and to lessen the pain.[4][1][13]
- Mobilize spine and ribs to avoid rigidity of the thorax and to reduce complaints.[6][2]
- Teach the patient breathing excercises[2]
- Learn the patient to cope with pain.[4][13]
- Exercise for shoulder and back can be provocative, therefore only when the complaints have disappeared, they can be applied
[2]

Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

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References[edit | edit source]

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  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 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
  3. ↑ 3.0 3.1 3.2 3.3 Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze's syndrome, Wiley-Blackwell, 2001, p23-29
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Proulx A.M., Zryd T.W., Costochondritis; Diagnosis and Treatment, Am Fam Physician, 2009 Sep 15;80(6):617-20
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 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
  6. ↑ 6.0 6.1 6.2 6.3 Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.
  7. ↑ Fioravanti, A., Tofi, C., Volterrani, L. and Marcolongo, R. (2002), Malignant lymphoma presenting as Tietze's syndrome. Arthritis Care &amp;amp;amp; Research, 47: 229–230. doi: 10.1002/art.10401
  8. ↑ 8.0 8.1 Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
  9. ↑ 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
  10. ↑ 10.0 10.1 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
  11. ↑ 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
  12. ↑ 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.
  13. ↑ 13.0 13.1 13.2 13.3 Cite error: Invalid <ref> tag; no text was provided for refs named American academy of family physicians
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