Orthopedics - Oleksa A.P. 2006

Chest Wall Deformities
Tietze's Syndrome

Tietze's syndrome was first identified by this author in 1921 as a distinct nosological entity, clinically manifested by painful Swelling of the anterior ends of the first two Ribs (most commonly the first) near the Sternum, and occasionally the sternoclavicular joint region.

Patients typically seek medical attention due to pain and localized swelling.

Tietze's syndrome is most frequently left-sided, though sometimes bilateral, and affects men and women with equal frequency between the ages of 20 and 30.

The exact cause of the syndrome remains unknown, although Tietze associated its onset with malnutrition and hacking coughs accompanying Upper Respiratory Tract infections. While these assumptions are supported in clinical practice, the patient history often reveals significant shoulder girdle strain in athletes, manual laborers, and others, though sometimes no specific cause can be identified.

Additionally, Brzezińska B. (1969), as well as Pohl R. and Wiener K. (1957), indicate that the syndrome may be caused by strains of the joint capsules or ligament tears in the sternocostal or sternoclavicular joints resulting from physical overexertion.

Reinberg S.A. (1964) explains the onset of the syndrome as a pathological remodeling process following physical strain. Neither impairments in the Blood supply to the costal cartilages (Tietze, 1921) nor infectious factors capable of triggering the syndrome have been identified.

Histological examination sometimes reveals no Changes in the Cartilage and Bone Tissues, or alternatively shows calcification and fibrous proliferation within the cartilage, accompanied by fibroblast and giant Cell nodules, as well as cartilaginous overgrowth.

The disease may have an acute onset, with patients experiencing localized pain near the sternum during coughing or deep breathing, but it more commonly follows an indolent course lasting several weeks or months with mild discomfort.

Upon inspection, swelling is visible in the sternoclavicular joint area. The Skin is of normal color. Range of motion in the upper extremity joints is fully preserved, but the patient may experience increased pain in the sternoclavicular joint region when raising the arms overhead or coughing.

Palpation reveals slight coarsening of the sternal end of the clavicle and swelling in the sternoclavicular joint area. Local Temperature is within normal limits. Laboratory blood and urine tests are also normal.

Since the condition affects the costal cartilages, there are no characteristic radiographic signs, and pathological changes are not visible on standard X-rays. However, Reinberg suggests that serial imaging during dynamic follow-up may reveal impaired calcification of the affected costal cartilage, premature appearance of calcified bone islands along its margins, and thickening.

Over time, however, the radiographic appearance may change. Periosteal reactions appear on the anterior bony end of the rib, causing the rib to thicken and the intercostal spaces to narrow. Subsequently, the rib may fuse with the cartilage. The most precise assessment of these changes can be achieved using computed tomography or Magnetic Resonance imaging.

Following a thorough patient evaluation, Tietze's syndrome typically requires no Differential Diagnosis.

Treatment. Reinberg maintained that, like any bone remodeling process, Tietze's syndrome has a favorable course and prognosis.

Nevertheless, considering the underlying Etiology, the primary objective is to rest the affected area. To achieve this, the upper extremity and shoulder girdle are immobilized using a plaster splint on an abducting wedge pillow.

Dmochowski J. (1958) recommends performing an intercostal procaine (novocaine) blockade. Analgesics can also be beneficial, alongside Diprospan and Dialgan (chondroprotectors).

Occasionally, two to three local corticosteroid injections administered at intervals of 4–5 days prove helpful.

D'Agostino A. and Loria L. indicate that Radiation therapy to the affected area may also be beneficial.

However, assessing the true efficacy of any treatment is challenging because Tietze's syndrome has a strong tendency toward spontaneous resolution and remission.