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Condition/Disorder Synonym

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  • Tietze's disease

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ICD-9-CM Code

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  • 733.6 Tietze's disease

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ICD-10-CM Code

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  • M94.0 Chondrocostal junction syndrome [Tietze]

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Preferred Practice Pattern1

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Key Features

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Description

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  • Described in 1921 by Alexander Tietze, a German surgeon

  • Benign inflammation of the costal cartilage

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Essentials of Diagnosis

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  • Localized nonsuppurative nodule, usually located at the second or third costochondral junction1

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General Considerations

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  • Inflammation, tenderness, and swelling

  • Need to rule out a heart attack until proven otherwise, as symptoms are very similar and can cause anxiety attacks, hyperventilation

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Demographics

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  • More common in teens then adults

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Clinical Findings

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Signs and Symptoms

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  • Acute chest pain, anterior-upper

  • Pain radiating into the shoulder and arm

  • Pain increased with respiration (deep inspiration), coughing, sneezing

  • Tenderness and swelling along costal cartilage along the sternum (breast bone)

  • Redness and heat over cartilage

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Functional Implications

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  • Breathing limitations, hyperventilation

  • Pain with sleeping and lying on the ribs

  • Inability to carry bags of groceries by one's side

  • Inability to turn the steering wheel in a car

  • Inability to carry heavy items

  • Inability to dig in the garden

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Possible Contributing Causes

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  • Radiation to the chest region

  • Psychological stress

  • Physical strain

  • Repetitive coughing

  • Injury to chest and breast tissue

  • Excessive laughing

  • Impact from airbag/steering wheel in a car accident

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Differential Diagnosis

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  • Myocardial infarction (heart attack): identical symptoms with acute pain and pain into the shoulder and arm, different in terms of no electrical heart change and no damage to the organs

  • Costochondritis (different in that there is no swelling of the costal cartilage)

  • Bruised ribs

  • Broken ribs

  • Pleurisy

  • Pneumothorax

  • Shingles

  • Pneumonia

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • To rule out other diagnoses

  • Blood test for heart damage (cardiac enzymes and troponin levels), negative for inflammation

  • Sedimentation rate

  • C-reactive protein (CRP) test

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Imaging

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  • ECG

  • X-ray usually not helpful for cartilage, usefully for pneumonia

  • Rule out parenchymal lung disease and rib fracture

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Findings and Interpretation

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  • Tenderness and swelling, palpable coastal cartilage

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Treatment

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Medication

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  • Acetylsalicylic acid

  • Aspirin

  • Anti-inflammatory

  • Cortisone injection

  • Lidocaine patch

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Referrals/Admittance

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  • Rule out myocardial infarction

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Impairments

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  • Debilitating pain, limiting movement and exertion

  • Respiratory issues

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Intervention

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