Tietzes: Difference between revisions
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== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
The etiology of Tietze syndrome is unknown but Tietze syndrome is often ossociated in acute cases associated with viral respiratory tract infections. Also microtraumas to the costosternal joints underlie the Tietze syndrome.(Frontera, 2015, Wildman, 2011) | |||
Tietze syndrome occur in children, infants and adults. The ratio man and women is 1:1. Lesions are in more than 80% of the patients single and unilateral. (Frontera, 2015)<br><br> | |||
== Characteristics/Clinical Presentation<br> == | == Characteristics/Clinical Presentation<br> == | ||
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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]
The etiology of Tietze syndrome is unknown but Tietze syndrome is often ossociated in acute cases associated with viral respiratory tract infections. Also microtraumas to the costosternal joints underlie the Tietze syndrome.(Frontera, 2015, Wildman, 2011)
Tietze syndrome occur in children, infants and adults. The ratio man and women is 1:1. Lesions are in more than 80% of the patients single and unilateral. (Frontera, 2015)
Characteristics/Clinical Presentation
[edit | edit source]
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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Outcome Measures[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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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 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.
- ↑ 2.0 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
- ↑ 3.0 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
- ↑ 4.0 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
- ↑ 5.0 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
- ↑ 6.0 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.
- ↑ 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
- ↑ 8.0 8.1 Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389.
- ↑ 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
- ↑ 10.0 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
- ↑ 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
- ↑ 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.
- ↑ 13.0 13.1 13.2 13.3 Cite error: Invalid
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