Titze syndrome

Tietze's syndrome (costochondritis, perichondritis) is a benign inflammation of one or more costal cartilages. It was first described in 1921 by the German surgeon Alexander Tietze.

The main feature of this disease is inflammation of the rib cartilage, which is located in the upper area of the sternum.

Epidemiology

Tietze syndrome usually affects older children and people under 40 years of age. Men and women are affected by this syndrome in equal numbers.

[ 1 ], [ 2 ]

Causes Titze syndrome

Surgeon Tietze claimed that this disease develops due to improper nutrition, which leads to metabolic disorders. In addition, he believed that it can sometimes be provoked by a strong cough.

Unfortunately, even today there is no exact data on why Tietze syndrome develops. In addition, costochondritis is an extremely rare disease.

[ 3 ], [ 4 ], [ 5 ]

Risk factors

Several main risk factors for its development can be identified:

1. Daily physical activity that affects the upper shoulder girdle.
2. Heavy physical stress on the chest.
3. Frequent bruises in this area, which lead to microtraumas.
4. Diseases related to the respiratory tract.
5. Infectious diseases.
6. Allergic reactions.
7. Collagenosis.
8. Autoimmune diseases.
9. Arthrosis.
10. Arthritis.

Typically, Tietze syndrome develops against the background of any disease that affects connective tissues and disrupts their metabolism.

[ 6 ], [ 7 ]

Pathogenesis

First, an inflammatory process develops in the connective tissue between the sternum and the rib cartilages. For a long time, the patient does not even know that he is developing Tietze syndrome, since there are practically no symptoms. Usually, the lesion is localized in the following places:

• In 60% of cases, the cartilaginous tissue in the area of the second rib is affected.
• In 30% of cases, the cartilage in the area of the third and fourth ribs is affected.
• In 10% of cases, the area of the first rib or between the fifth and sixth ribs becomes inflamed.

In four out of five cases, only one side of the sternum is affected. A small swelling appears, as well as quite severe pain, which quickly spreads to the arm.

[ 8 ], [ 9 ], [ 10 ], [ 11 ]

Symptoms Titze syndrome

Usually the pathological process is localized on one side. Tietze's syndrome goes away on its own and does not require any specific treatment, but chest pain often causes discomfort to the patient.

Since Tietze's syndrome has no obvious symptoms, it can be extremely difficult to identify. Despite this, doctors can identify several key signs of this disease:

1. Pain in the anterior chest area (often sharp).
2. If the patient moves, the pain intensifies.
3. The pain may move to the left side of the sternum and downwards.
4. Usually the pain is worst in the area of the fifth or sixth rib.
5. If a person breathes frequently and deeply, the pain may also become stronger.
6. A noticeable pain appears if you press where the ribs are attached.

The most obvious sign that it is Tietze's syndrome is the last symptom. If the patient does not feel pain during palpation by the doctor, he most likely has another disease.

In addition, some experts claim that the pathognomonic symptom of Tietze's syndrome is the appearance of a slight swelling in the area of the costal cartilage that was affected. Usually, the swelling is quite dense and about 4 cm in size. Touching it is painful.

First signs

As a rule, the first signs of Tietze's syndrome are: severe shortness of breath, decreased appetite, tachycardia, worsening sleep (even insomnia). Rarely, the first sign is an increase in body temperature.

[ 12 ], [ 13 ], [ 14 ]

Complications and consequences

The progression of Tietze's syndrome leads to the so-called excessive calcification of cartilage tissue. That is, cartilage tissue is replaced by bone tissue over time. Fibrous metaplasia develops. In the future, pain may increase. It becomes more difficult for a person to breathe. Even short and slow walks lead to severe shortness of breath. Dense swelling can also interfere quite strongly with the patient's normal and usual life activities.

[ 15 ], [ 16 ], [ 17 ], [ 18 ]

Diagnostics Titze syndrome

The diagnosis of this disease is primarily based on clinical symptoms. The results of a general blood test show signs of non-specific inflammation: an increase in ESR, a shift in the leukocyte formula to the left, and the appearance of C-reactive protein.

In some cases, an X-ray examination is performed, which helps to see a spindle-shaped thickening in the anterior region of the upper ribs. However, it does not have cavitary or infiltrative changes. Sometimes, magnetic resonance imaging is also performed. It helps to see all the changes that occur in the rib tissue.

[ 19 ], [ 20 ]

Tests

Sometimes the doctor may order a general blood test, but usually the results do not show any typical signs or serious changes. The results of the patient's blood biochemistry tests do not change either, so there is no need to conduct them.

[ 21 ]

Instrumental diagnostics

In some cases, X-ray examinations are performed, which help to see the seals in the rib area. But often the quality of the image is quite poor, so it is not possible to make an accurate diagnosis. This can be explained by the fact that the contours of the ribs are poorly visible against the background of the heart and lungs.

Magnetic resonance imaging is a more effective method of instrumental diagnostics of Tietze syndrome. With its help, it is possible to obtain layered images that allow one to see all the changes occurring in the rib tissue.

Differential diagnosis

Tietze's syndrome is differentiated from the following symptoms:

• rheumatism,
• traumatic injury to the chest or ribs,
• mastalgia in women,
• Bechterew's disease,
• tumor formations in this area,
• angina pectoris and acute myocardial infarction.

[ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ]

Treatment Titze syndrome

Most doctors believe that Tietze's syndrome can only be completely cured by surgery (subperiosteal resection), but it is performed in rare cases. If severe pain does not bother the patient for a long time, then therapy is reduced to conservative methods:

• Various creams and ointments that have anti-inflammatory effects.
• Compresses using dimexide.
• Reflexology and physiotherapy.
• Blockade of intercostal nerves using novocaine.
• Analgesics and nonsteroidal anti-inflammatory drugs.
• Injections of steroids and anesthetics into pain points.

Of course, the above-described methods of therapy do not help to get rid of the pathological formation that appeared in the rib area, but they reduce swelling, relieve inflammation, and improve the general condition.

Medicines

• Apizartron. Ointment based on the action of several active components: bee venom, allyl isothiocyanate and methyl salicylate. Thanks to the use of this drug, metabolism in tissues and muscles improves, muscle tone decreases.

To obtain an effective result, apply a small strip of ointment (approximately 5 cm) to the affected area and distribute it evenly over the entire surface. Wait until a feeling of warmth appears and then rub it into the skin with light movements. Usually used up to three times a day until the pain disappears.

Side effects include only allergic reactions (itching, rash, redness). Contraindications for use are: pregnancy and breastfeeding, skin diseases, liver disease, chronic renal failure, mental illness, arthritis, children under 12 years of age.

• Dimexide. The active ingredient of the drug is dimethyl sulfoxide. It has a pronounced anti-inflammatory effect. It also has a local anesthetic and antimicrobial effect.

It is used externally for compresses or bandages. To reduce pain, the compress is done every day (until the pain disappears). A 25% solution of dimexide is used.

The most common side effects from using the drug are: nausea, bronchospasm, allergy, itching, vomiting, redness. Contraindicated in acute and chronic liver and kidney diseases, atherosclerosis, angina, stroke, pregnancy, intolerance to the main components.

• Piroxicam. This is a non-steroidal anti-inflammatory drug that belongs to oxicams. It has a good anti-inflammatory, antipyretic and analgesic effect. The result is usually noticeable within 30 minutes after taking the pill.

Taken once a day. Sometimes after taking the drug, side effects may occur: poor appetite, nausea, bleeding gums, constipation or diarrhea, anemia, headaches, dizziness, depression, hallucinations, insomnia, allergies. The drug should not be taken in case of gastric ulcer and duodenal ulcer, in the first trimester of pregnancy, children under 14 years old, proctitis, liver or kidney diseases.

Physiotherapy

• Laser therapy – a laser beam acts on the affected areas. The course consists of ten sessions, which last about ten minutes.
• Electrophoresis with the use of drugs - various drugs with an anesthetic effect are introduced through the skin (using electric current). The course consists of ten sessions lasting no more than five minutes.
• Ultraviolet therapy – the affected area is treated with a high-frequency electric field. The course consists of 10-15 sessions, which last 5-10 minutes (depending on the patient's condition).
• Darsonvalization – weak currents with high voltage and frequency are used. The course consists of ten sessions of 5-10 minutes each.

Folk remedies

In some cases, folk medicine helps relieve the symptoms of Tietze's syndrome. Patients use:

1. Baths to improve your condition.
2. Herbal compresses.
3. Decoctions.
4. Various rubs into the skin.

To take a medicinal bath, you need to dilute 300 g of chamomile in warm water (5 liters). Let the decoction brew and then strain. Pour into the bath. It is recommended to take water procedures for no more than 20 minutes daily. You can replace chamomile with spruce branches or sage.

Compresses are usually made from the following herbs: steamed lemon balm leaves, sage, horseradish. A shawl should be tied on top of the compress to retain heat. Rubbing pork or bear fat into the sore spots has shown good results. Some patients use tinctures based on alcohol and birch buds or eucalyptus for rubbing.

[ 27 ], [ 28 ], [ 29 ]

Herbal treatment

Decoctions are used in the treatment of Tietze's syndrome, as a rule, to increase the body's immune defense and improve blood circulation. To prepare such decoctions, the following are used:

1. Sage.
2. Yarrow.
3. St. John's wort.
4. Nettle root.
5. Thyme.
6. Juniper (fruits).

The most popular recipes using herbs are:

1. Take three tablespoons of birch leaves and pour 600 ml of boiling water, leave for eight hours and strain. Drink 200 ml two or three times a day.
2. Take one tablespoon of lingonberry leaves and pour 200 ml of cold water. Bring to a boil over the fire, let it brew for ten minutes. Cool and strain. Drink one tablespoon three to four times a day. You can store it in a cool place for 24 hours.
3. Take 20 g of elder flowers and put them in a clay or porcelain vessel, pour 1 liter of boiling water, leave overnight. Divide the tincture into three equal parts and drink them in one day.

Surgical treatment

Subperiosteal resection is used to treat Tietze's syndrome. Surgical intervention is an extremely rare method. It is performed only if conservative treatment has been ineffective. The operation is performed in a hospital under local or general anesthesia.

Prevention

Often, experts recommend visiting mud spas at least once a year to prevent Tietze syndrome.

[ 30 ], [ 31 ], [ 32 ], [ 33 ]

Forecast

With properly selected conservative treatment, as well as timely referral to a doctor, treatment of Tietze syndrome is effective, so the prognosis is considered favorable.

[ 34 ]