Tietze Syndrome

Medically Reviewed by Zilpah Sheikh, MD on February 11, 2024
Written by Keri Wiginton
6 min read

Tietze syndrome is a rare musculoskeletal condition that causes inflammation. It can hurt a lot but is rarely serious. It happens when cartilage around the joints that connect your upper ribs to your breastbone (sternum) swells from some kind of irritation. Usually, the second or third ribs are most affected. Tietze syndrome was named after Alexander Tietze, a German surgeon who first wrote about it in 1921.

Tietze syndrome is different from Tietz syndrome, a condition that causes hearing loss. Tietz syndrome is congenital, or present from birth, and is also rare.

Tietze syndrome vs. costochondritis

Tietze syndrome and another condition called costochondritis are very similar, but they aren't the same. Both affect your costochondral joint (where your ribs connect to your sternum). Two big differences are location and swelling. Costochondritis usually affects the lower ribs. It can cause pain throughout your chest, and the pain may start on the left side and spread out. Unlike Tietze syndrome, it doesn’t cause any visible tissue swelling. Tietze syndrome and costochondritis aren’t usually serious and are often managed the same way.

Is Tietze syndrome dangerous?

Rarely. But you should still see your doctor about it. They’ll want to rule out other medical issues that may have similar symptoms but need different treatments, including broken ribs, acid reflux, lupus, and serious conditions such as chest wall tumors or heart attacks.

 

No one knows exactly what causes Tietze syndrome. Some experts think it’s the result of repetitive actions that stress the ribs. Over time, there may be enough damage, leading to pain and swelling.

Some things that might cause Tietze are:

  • Frequent coughing
  • Throwing up often
  • Getting hit in the chest a lot during sports or another activity

It can also be caused by a big trauma that affects your chest wall. That might include something like a car crash, bad fall, or sports injury.

Tietze syndrome risk factors

People of all ages can get Tietze syndrome, but it’s seen most often in people under 40. Costochondritis is more common in people older than 40.

You may be more likely to get Tietze syndrome if you:

  • Get respiratory infections a lot
  • Have had surgery on your chest area
  • Have conditions that affect your joints, such as psoriatic arthritis or rheumatoid arthritis
  • Have an autoimmune disease
  • Sneeze or cough a lot because you have a condition such as sinusitis or laryngitis

The most common symptoms of Tietze syndrome are chest tenderness and swelling. The pain can be mild or severe, dull or sharp.

Tietze syndrome may also cause:

  • Redness or a warm feeling where it hurts
  • Skin color changes
  • Pain that spreads to your neck, arms, or shoulders

Chest pain and swelling from Tietze syndrome may:

  • Come and go suddenly
  • Develop gradually
  • Stick around for weeks or months
  • Happen separately (swelling with no pain)

Your pain may get worse when you do anything that involves your chest, such as when you:

  • Cough or sneeze
  • Exercise
  • Throw up
  • Breathe deeply
  • Laugh
  • Wear a seatbelt
  • Hug someone
  • Lie down

You might mistake the pain from Tietze syndrome for a heart attack, but there are some key differences.

Tietze syndrome usually only affects a small area of the chest, while a heart attack can cause pain or tightness in a larger area of your chest. Heart attack also doesn't cause noticeable swelling like Tietze syndrome. You may be short of breath, nauseous, or sweaty during a heart attack. Call 911 or get medical help right away if this happens to you.

Tietze syndrome can mimic other health conditions that affect your heart and lungs besides a heart attack. That's why it's important to see your doctor so they can rule out any other conditions that might be more serious or need different treatment.

There’s no single test to diagnose Tietze syndrome. To figure out what’s going on, your doctor will ask you to describe your symptoms and give you a physical exam. They’ll probably feel or press on your chest and ribs to check for spots of pain and swelling.

You may also need other tests, such as:

  • Blood tests to check for infection or inflammation
  • Chest X-ray to look closely at your ribs
  • Other imaging tests such as ultrasound, CT scan, or MRI
  • Electrocardiogram (EKG) to see electrical activity in your heart

In many cases, Tietze syndrome gets better on its own with little to no medical treatment. But you should still talk to your doctor about what treatment plan is best for you.

Treatment for Tietze syndrome involves reducing swelling and pain. To do that, your doctor may suggest the following:

Rest. You need to give your chest and ribcage a break from exercise or certain kinds of physical activity.

Nonsteroidal anti-inflammatory drugs (NSAIDs). This includes drugs such as aspirin, ibuprofen, and naproxen. Talk to your pharmacist or doctor before you take any over-the-counter medication. They’ll let you know if certain drugs will interact with medication you're already taking or make other health conditions worse.

Heat or ice. Your doctor may want you to apply hot or cold compresses off and on for a certain amount of time.

Steroids. If your pain is really bad and doesn’t respond to other treatments, your doctor might give you corticosteroid pills or an injection right into the affected area. This can quickly reduce pain and swelling around your joints when other treatments don’t work.

Lidocaine injection. Your doctor might give you a numbing shot (anesthetic) to ease pain. Like the steroid shot, this is something you might get when over-the-counter pain relievers don’t work.

How long does Tietze syndrome last?

Most of the time, symptoms go away within a few weeks or months. But some people have swelling for several months or longer. Tell your doctor if your symptoms are hard to manage on your own. You may need to take extra steps to ease your pain and inflammation.

Tietze syndrome tends to go away with time and without medical treatment. But there are steps you can take to feel better during your recovery.

You can:

  • Take over-the-counter pain relievers.
  • Ask your doctor for stronger medication if your pain is severe.
  • Apply heat or ice where it hurts.
  • Talk to your doctor about what activities to avoid while you recover.
  • Find out when it’s safe to get back to exercises that use your chest.

See your doctor if your symptoms don’t get better within a few weeks or if you notice any new pain or swelling in your chest.

You can find out more about Tietze syndrome and other joint diseases and childhood disorders from these organizations:

  • The Genetic and Rare Diseases (GARD) Information Center, part of the National Institutes of Health
  • The National Institute of Arthritis and Musculoskeletal and Skin Diseases
  • The National Organization for Rare Disorders
  • The Arthritis Foundation
  • The American Academy of Pediatrics

Tietze syndrome is a rare inflammatory condition that causes chest pain and swelling. It’s hardly ever serious and usually goes away on its own within a few weeks. But talk to your doctor if you think you have it or your symptoms last a while. Rest, medication, or other treatments can help you feel better faster.

How do you know if you have Tietze syndrome?

You'll have to see your doctor to know for sure whether you have it. They’ll ask about your symptoms, give you a physical exam, and maybe run some other tests (MRI, EKG, X-ray) to rule out other causes of your chest pain.

How long does Tietze syndrome last?

Symptoms of pain and swelling typically get better within a few weeks. But Tietze syndrome can last a few months or longer for some people. And it may come back after you recover.

What is the difference between costochondritis and Tietze syndrome?

They both cause pain, but costochondritis doesn’t cause visible swelling and usually affects your lower ribs. Tietze syndrome causes inflammation in the top few ribs around your breastbone, and you can usually see and feel the inflammation.

Is Tietze syndrome an autoimmune disorder?

Tietze isn't an autoimmune disorder, but you may be more likely to get it if you have an autoimmune condition, especially one that affects your joints.