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  • Tietze's disease

  • 733.6 Tietze's disease

  • M94.0 Chondrocostal junction syndrome [Tietze]


  • 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


  • More common in teens then adults

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

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


  • Tenderness and swelling, palpable coastal cartilage


  • Rule out myocardial infarction

  • Debilitating pain, limiting movement and exertion
  • Respiratory issues

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

  • 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

  • Can last from hours to weeks
  • Generally resolves ...

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