Causes
The causes of the Tietze syndrome are not conclusively clarified. However, the various symptoms are often described in connection with unaccustomed activities and stress. For example, one reason could be overstraining of the respective rib attachments on the sternum, e.g.
when exercising a new activity in professional life or in leisure time (sports, unusual lifting movements, e.g. carrying crates). Overstressing the cartilage at the rib roots can also be caused by incorrect loading of the joint. If, for example, one or more vertebral or rib joints are blocked (restricted mobility of the respective joint), the resulting unphysiological (non-normal) posture and exercise of movement can lead to some joint areas being loaded in a way and to a degree that they are not otherwise exposed to.
This abnormal load can lead to inflammation and irritation of the corresponding rib cartilage. A possible cause of the Tietze syndrome lies in so-called micro fractures of the ribs. These are smaller fractures of the ribs that have not previously caused any symptoms, but in the long term cause irritation or inflammation due to the altered force applied to the rib cartilage.
A further reason for this course of disease may also be due to previous operations on the thorax (ribcage), where the original position of the ribs or joint surfaces was not completely restored during the healing process. However, since no complete mechanism for the development of Tietze syndrome is known, it must be assumed that other causes exist. Accordingly, if the problem is unclear, further possible causes should be looked for in the affected person.
Diagnosis
The diagnosis is made after questioning the patient. Depending on the type and strength of the symptoms, diseases of the heart (angina pectoris) and other organs must be excluded. Many patients are very concerned that the symptoms are due to cancer or the heart.
However, an experienced physician can exclude another disease by appropriate diagnostics and laboratory tests. The rib-chest joints affected by Tietze Syndrome are described by the doctor as painful or pressure-sensitive on palpation. The intensity of the pain can vary greatly from patient to patient.
In the majority of cases, X-ray imaging is not helpful, since in Tietze’s syndrome there are usually no injuries or significantly different positions of the bony structures that lead to the development of the symptoms. To exclude fractures of the bony structures involved, e.g. the respective rib, the preparation of an x-ray image may be helpful. For further clarification, an MRI of the sternum can be helpful.
In contrast to X-rays, soft tissue structures can be visualized in the MRI. It is therefore possible to see swellings and fluid accumulations (in the course of inflammation). If Tietze syndrome is present, the affected joints or cartilage appear swollen in the MRI.
