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  • Tietze's disease

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  • 733.6 Tietze's disease

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  • M94.0 Chondrocostal junction syndrome [Tietze]

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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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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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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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  • Tenderness and swelling, palpable coastal cartilage

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Medication

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  • Rule out myocardial infarction

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  • Debilitating pain, limiting movement and exertion
  • Respiratory issues

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  • Ice
  • Joint mobilization to the costovertebral articulations
  • Rib mobilization
  • Diaphragm mobilization
  • Breathing training
  • Trunk rotation exercises

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  • Patient should be able to:
    • Take a pain-free, full, deep breath
    • Carry bags of groceries by their side
    • Turn the steering wheel in a car
    • Carry heavy items
    • Dig in the garden

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  • Can last from hours to weeks
  • Generally resolves in 12 weeks

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