Tietze syndrome is inflammation of rib cartilages causing localized pain. It is a severe form of costochondritis and can cause swelling and pain in the arms and shoulders. Treatment includes rest, ice/heat therapy, physical therapy, pain relievers, and anti-inflammatory medication. The cause is unknown, but it can be triggered by mechanical events. It is a benign condition that usually resolves within 12 weeks. Treatment involves avoiding activities that aggravate the condition and using ice/heat therapy and medication.
Tietze syndrome refers to inflammation of the rib cartilages, leading to localized pain between the ribs and the breastbone. Previously, Tietze syndrome was believed to be distinct from an entity called costochondritis, but it is now recognized as the severe form of the latter. The severity of this syndrome is characterized by swelling of the cartilage and pain extending to the arms and shoulders, both of which are not present in the milder forms of costochondritis. Like other inflammatory conditions, this syndrome is treated through rest, ice packs or heat therapy, physical therapy, pain relievers, and anti-inflammatory medications such as corticosteroids.
The underlying cause of the syndrome is not known, but the precedent is often a mechanical event that causes the rib cartilages to stretch. Examples of such events include repeated episodes of coughing, vomiting, sneezing, laughing, or physical impact on the chest. Excessive strain on the chest wall during exercise could also damage the rib cartilages. This syndrome was previously thought to occur after surgery, but this is not the case, mainly because most of those affected have not previously had surgery.
The cartilage injury causes inflammation, which is manifested by swelling of the affected cartilages and severe pain that is aggravated by breathing. Although pain from cartilage inflammation is sometimes debilitating, Tietze syndrome is a benign condition and should not be mistaken for a heart attack. This syndrome usually resolves within 12 weeks as the inflamed cartilages heal. It can, however, become a chronic condition.
In order for the doctor to determine whether a person has costochondritis or a more severe case of Tietze syndrome, questions may be asked about both the location and radiation of the pain, as well as the presence of swelling. In costochondritis, the third, fourth, and fifth costal cartilages are usually involved. Only one joint is usually affected in this syndrome. The pain frequently radiates to the arm or back, and the affected person is usually unable to pinpoint the origin of the pain. In terms of epidemiology, the majority of costochondritis cases occur among women aged 40 years and older, while cases of this syndrome affect men and women aged 20 to 40 equally.
Treatment of this syndrome involves healing the cartilages by avoiding or reducing activities such as coughing, strenuous exercise, pulling or pushing, straining, and lying down. Ice packs or heating pads can reduce inflammation and improve circulation to the inflamed area. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be used. Patients with severe pain often benefit from local anesthetics such as lidocaine injection. For chronic cases, steroid injections may be used.
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