Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Tietze's disease ++ 733.6 Tietze's disease ++ M94.0 Chondrocostal junction syndrome [Tietze] ++ 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation +++ Description ++ Described in 1921 by Alexander Tietze, a German surgeonBenign 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 swellingNeed 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 +++ Signs and Symptoms ++ Acute chest pain, anterior-upperPain radiating into the shoulder and armPain increased with respiration (deep inspiration), coughing, sneezingTenderness and swelling along costal cartilage along the sternum (breast bone)Redness and heat over cartilage +++ Functional Implications ++ Breathing limitations, hyperventilationPain with sleeping and lying on the ribsInability 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 regionPsychological stressPhysical strainRepetitive coughingInjury to chest and breast tissueExcessive laughingImpact 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 organsCostochondritis (different in that there is no swelling of the costal cartilage)Bruised ribsBroken ribsPleurisyPneumothoraxShinglesPneumonia +++ Laboratory Tests ++ To rule out other diagnosesBlood test for heart damage (cardiac enzymes and troponin levels), negative for inflammationSedimentation rateC-reactive protein (CRP) test +++ Imaging ++ ECGX-ray usually not helpful for cartilage, usefully for pneumoniaRule out parenchymal lung disease and rib fracture ++ Tenderness and swelling, palpable coastal cartilage +++ Medication ++ Acetylsalicylic acidAspirinAnti-inflammatoryCortisone injectionLidocaine patch ++ Rule out myocardial infarction ++ Debilitating pain, limiting movement and exertionRespiratory issues ++ IceJoint mobilization to the costovertebral articulationsRib mobilizationDiaphragm mobilizationBreathing trainingTrunk rotation exercises ++ Patient should be able to:Take a pain-free, full, deep breathCarry bags of groceries by their sideTurn the steering wheel in a carCarry heavy itemsDig in the garden ++ Can last from hours to weeksGenerally resolves ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.