Tietze Syndrome

Tietze syndrome is a benign inflammatory painful swelling of one or more costal cartilages, typically the second and third.

• Uncommon; young adults under 40; men and women equally affected.

• Cause unknown; possible microtrauma, viral infection, coughing.

• Distinguished from costochondritis by swelling and localisation to upper ribs.

• Self-limited over weeks to months; may recur.

• Localised tender, firm, fusiform swelling of a costochondral or sternocostal junction (second or third rib), usually unilateral.

• Chest pain radiating to arm and shoulder, worse with deep breathing, coughing, movement.

• No fever or systemic features.

• Patient may fear a cardiac cause.

• Clinical diagnosis based on localised painful swelling on palpation.

• Exclude cardiac, pulmonary, and aortic causes (ECG, troponin, chest radiograph) if risk factors or atypical.

• Ultrasound shows cartilage thickening; MRI/CT or bone scan only for suspected infection, tumour, or SAPHO.

• ESR/CRP normal usually.

• Exclude sternoclavicular septic arthritis, rib fracture, malignancy, rheumatic disease, relapsing polychondritis.

• Reassurance and education on the benign course.

• Analgesia: paracetamol 1 g up to four times daily, NSAIDs (ibuprofen 400 mg three times daily or naproxen 500 mg twice daily) for 1 to 2 weeks.

• Local heat, avoid aggravating movements.

• Local injection of lidocaine 1% 2 mL with triamcinolone 20 to 40 mg or methylprednisolone 40 mg for persistent pain.

• Topical diclofenac 1% gel four times daily.

• Surgical excision of cartilage is rarely needed for refractory pain.

• Persistent or atypical presentation: investigate for infection, SAPHO, spondyloarthritis.