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148: TIETZE SYNDROME

Eric Shamus, PhD, DPT, PT, CSCS; Colin Brooks, MBA, SPHR

CONDITION/DISORDER SYNONYM

  • Tietze disease

ICD-9-CM CODE

  • Tietze disease

ICD-10-CM CODE

  • M94.0 Chondrocostal junction syndrome [Tietze]

PREFERRED PRACTICE PATTERN

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

The patient is a 30-year-old man who presents with anterior rib pain. The patient states that his 3-year-old daughter jumped up and landed on his chest while he was lying on his back on the floor. He had pain along the anterior rib cage. The patient had a positive sedimentation rate and C-reactive protein test for inflammation. There is localized pain with palpation of the upper ribs at the rib cartilage. The patient said when he coughs or sneezes the pain increases.

KEY FEATURES

Description

  • Described in 1921 by Alexander Tietze, a German surgeon

  • Benign nonsuppurative inflammation of the costal cartilage

Essentials of Diagnosis

  • Unknown cause

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

General Considerations

  • Inflammation, tenderness, and swelling

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

Demographics

  • More common in teens than in adults

FIGURE 148-1

Deformities of the thorax. (A) Rachitic rosary. (B) Pigeon breast. (C) Harrison grooves. (D) Funnel breast. (E) Barrel chest. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

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

  • Acute chest pain, anterior-upper

  • Pain radiating into the shoulder and arm

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

Functional Implications

  • 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

Possible Contributing Causes

  • Excessive laughing

  • Impact from airbag/steering wheel in a car accident

  • Injury to chest and breast tissue

  • Physical strain

  • Psychological stress

  • Radiation to the chest region

  • Repetitive coughing

FIGURE 148-2

Components of the respiratory system. (Reproduced with permission from Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. New York, NY: McGraw-Hill, 2011.)

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