Titze Syndrome

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

The main feature of this disease is the inflammation of the cartilage of ribs, which are in the upper region of the sternum.

Epidemiology

Tietze syndrome usually affects older children and people under the age of 40. Men and women suffer this syndrome in equal amounts.

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Causes of the syndrome Titze

Surgeon Tietze claimed that the disease develops due to malnutrition, which leads to disruptions in metabolism. In addition, he believed that sometimes it can be a provoked strong cough.

Unfortunately, even today there is no precise data on why the Tietze syndrome develops. In addition, rib chondritis is an extremely rare disease.

[3], [4], [5]

Risk factors

There are several main risk factors for its development:

1. Daily exercise that affects the upper part of the shoulder girdle.
2. Strong physical activity on the chest.
3. Frequent bruises of this area, which lead to microtrauma.
4. Diseases associated with the respiratory tract.
5. Diseases of an infectious nature.
6. Allergic reactions.
7. Collagenosis.
8. Autoimmune diseases.
9. Osteoarthritis.
10.  Arthritis.

Typically, Tietz syndrome develops against the backdrop of any disease that affects connective tissue and disrupts the metabolism in them.

[6], [7]

Pathogenesis

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

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

In four cases out of five, only one side of the sternum is affected. There is a small swelling, as well as a fairly severe pain, which quickly spreads into the arm.

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

Symptoms of the syndrome Titze

Usually, the pathological process is localized on the one hand. Tietz syndrome passes by itself and does not require any specific treatment, but chest pains often bring discomfort to the patient.

Since the syndrome of Tietze has no pronounced symptoms, it can be extremely difficult to determine it. Despite this, doctors can identify several of the main signs of this disease:

1. Painful sensations in the anterior thoracic region (often acute).
2. If the patient moves, the pain intensifies.
3. Pain can move to the left side of the sternum and down.
4. Usually it hurts the most in the area of the fifth or sixth rib.
5. If a person breathes often and deeply, pain can also become stronger.
6. A tangible pain appears if you press where the ribs are attached.

The clearest sign that this Tietze syndrome is the last symptom. If during the palpation of the doctor the patient does not feel pain, most likely, he has another disease.

In addition, some experts argue that the pathognomonic symptom of the Tietze syndrome is the appearance of a slight swelling in the area of the costal cartilage that was affected. Usually, the swelling is rather dense with a size of about 4 cm. Touches to it are painful.

First signs

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

[12], [13], [14]

Complications and consequences

Progression of the Tietze syndrome leads to the so-called excessive calcification of the cartilaginous tissue. That is, the cartilage tissue is replaced with bone in time. Develops fibrotic metaplasia. In the future, pain may be worse. It becomes harder for a person to breathe. Even small and slow walks lead to severe dyspnea. Dense swelling can also quite strongly interfere with the normal and habitual life of the patient.

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

Diagnostics of the syndrome Titze

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

In some cases, an X-ray examination is performed, which helps to see a thickening in the form of a spindle 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 costal tissue.

[19], [20]

Analyzes

Sometimes a doctor can prescribe a general blood test, but usually his results do not show any typical signs or major changes. Do not change and the results of biochemical studies of the patient's blood, so there is no need to conduct them.

[21],

Instrumental diagnostics

In some cases, X-ray studies are carried out, which help to see seals in the rib area. But often the quality of the image is rather poor, so it is impossible to accurately diagnose it. 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 diagnosis of the Tietze syndrome. With its help you can get layered pictures that allow you to see all the changes taking place in the costal tissue.

Differential diagnosis

Differentiate Tietze syndrome with symptoms:

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

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

Treatment of the syndrome Titze

Most doctors believe that completely cure Titze syndrome is possible only with the help of surgical intervention (subperiosteal resection), but it is carried out in rare cases. If a strong pain for a long time does not bother the patient, then the therapy is reduced to conservative methods:

• A variety of creams and ointments that have an anti-inflammatory effect.
• Compresses using dimexide.
• Reflexotherapy and physiotherapy.
• Blockade of intercostal nerves with novocaine.
• Analgesics and non-steroidal anti-inflammatory drugs.
• Injection of steroids and anesthetics into painful points.

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

Medications

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

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

Among the side effects, only allergic reactions (sensation of itching, rashes, redness) are isolated. Contraindications for use are: pregnancy and breastfeeding, skin diseases, liver disease, chronic kidney failure, mental illness, arthritis, children under 12 years.

• Dimexide. Active active substance of the drug is dimethylsulfoxide. Has a pronounced anti-inflammatory effect. Also differs local anesthetic and antimicrobial effect.

Used externally for compresses or bandages. To reduce pain, compress is done every day (until the pain disappears). At the same time, 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 diseases of the liver and kidneys, atherosclerosis, stenocardia, stroke, pregnancy, intolerance of the main components.

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

It is taken once a day. Sometimes after taking, side effects may occur: poor appetite, nausea, gum blood, constipation or diarrhea, anemia, headaches, dizziness, depression, hallucinations, insomnia, allergies. The drug should not be taken with peptic ulcer of stomach and duodenum, in the first trimester of pregnancy, children under 14, proctitis, liver or kidney disease.

Physiotherapy

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

Alternative treatment

In some cases alternative medicine helps to relieve the symptoms of the Tietze syndrome. Patients apply:

1. Baths to improve the condition.
2. Compresses with herbs.
3. Decoctions.
4. Various rubbing in the skin.

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

Compresses, as a rule, are made from such grasses: steamed leaves of lemon balm, sage, horseradish. On top of the compress you need to tie a shawl to keep warm. A good result showed rubbing in sore spots with pork or bear fat. Some patients use for rubbing tinctures based on alcohol and birch buds or eucalyptus.

[27], [28], [29],

Herbal Treatment

Decoctions are used in the treatment of Tietze syndrome, usually in order to enhance the body's immune defenses and improve blood circulation. To prepare such broths are used:

1. Sage.
2. Yarrow.
3. St. John's Wort.
4. The root of the nettle.
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, insist eight hours and strain. Drink 200 ml two or three times a day.
2. Take one tablespoon of cranberry leaves and pour 200 ml of cold water. Bring to a boil on fire, let it brew for ten minutes. Cool and drain. Drink one tablespoon three to four times a day. You can store in a cool place for 24 hours.
3. Take 20 g of elderberry flowers and put in a bowl of clay or porcelain, pour 1 liter of boiling water, leave so overnight. Divide the tincture into three equal parts and drink them in one day.

Operative treatment

To treat the Tietze syndrome, subperiosteal resection is used. Operative intervention is an extremely rare method. It is carried out only if conservative treatment was unsuccessful. The operation is performed in a hospital under local or general anesthesia.

Prevention

Often, experts recommend that for the prevention of Tietze syndrome at least once a year visit mud resorts.

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

Forecast

With correctly selected conservative treatment, as well as timely access to a doctor, treatment of the Tietze syndrome is effective, therefore the prognosis is considered favorable.

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