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Condition/Disorder Synonym

  • Tietze's disease

ICD-9-CM Code

  • 733.6 Tietze's disease

ICD-10-CM Code

  • M94.0 Chondrocostal junction syndrome [Tietze]

Preferred Practice Pattern1

Key Features

Description

  • Described in 1921 by Alexander Tietze, a German surgeon

  • Benign inflammation of the costal cartilage

Essentials of Diagnosis

  • 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 are very similar and can cause anxiety attacks, hyperventilation

Demographics

  • More common in teens then adults

Clinical Findings

Signs and Symptoms

  • 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

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

  • 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

Differential Diagnosis

  • 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

Means of Confirmation or Diagnosis

Laboratory Tests

  • 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

Imaging

  • ECG

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

  • Rule out parenchymal lung disease and rib fracture

Findings and Interpretation

  • Tenderness and swelling, palpable coastal cartilage

Treatment

Medication

  • Acetylsalicylic acid

  • Aspirin

  • Anti-inflammatory

  • Cortisone injection

  • Lidocaine patch

Referrals/Admittance

  • Rule out myocardial infarction

Impairments

  • Debilitating pain, limiting movement and exertion

  • Respiratory issues

Intervention

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