When severe chest pain radiates to the left arm, many immediately think of a heart attack. But this discomfort can also have completely different causes. One of these is Tietze syndrome, first described in 1921 by Alexander Tietze (1864 to 1927) in his paper “Über eine peartige Häufung von Fällen mit Dystrophie der Rippenknorpel,” published in the “Berliner klassische Wochenschrift.”
What is Tietze syndrome?
Tietze syndrome, which is also known in medical parlance as chondropathia tuberosa, costochondritis, or Tietze disease, is a painful swelling of the cartilage attachments of the sternum or ribs. Often, the causes cannot be clearly identified. In some cases, the complaints disappear by themselves after some time. As a rule, those affected complain of unilateral, non-specific pain in the area of the chest and sternum, usually on the left side. The pain, which often intensifies on deep inhalation, is sometimes so severe that it may feign a heart attack. If the symptoms increase, the pain radiates to the arm or the side of the neck. Although this might be suspected at first glance, Tietze syndrome is usually not based on inflammation. Because the complaints are similar to those of other conditions such as heart disease, these should be ruled out by a comprehensive examination.
Causes
Often, the complaints of Tietze syndrome occur without an identifiable trigger. Medical examinations often remain without findings. The assumption is that certain factors may promote the occurrence of Tietze’s disease. These include, for example, microfractures of the affected bones, which can be caused by overloading or fatigue. A previous surgical procedure in which the thorax was opened can also be causative for the subsequent occurrence of Tietze syndrome. Those affected are often people between the ages of 30 and 40. The symptoms may become more severe with increasing age. The occurrence of Tietze’s disease is also not excluded in children. In women, according to statistics, this syndrome occurs significantly more often than men.
Symptoms, complaints, and signs
Tietze syndrome is characterized by severe chest pain that occurs suddenly, especially during exercise. Swelling of the upper rib bones may be present. It usually affects women between the ages of 20 and 40. The condition is harmless and heals on its own. However, since Tietze syndrome presents with symptoms similar to angina pectoris, it should be differentiated from the latter in a differential diagnosis. The pain is triggered by movements of the ribs. However, the ribs always move during breathing, general physical activity, coughing or sneezing. Sufferers perceive the pain as sudden, very intense attacks. Although the discomfort appears mainly for a short time, chronic pain may also exist on certain occasions. Chronic discomfort always occurs only in the area of inflammation. Sudden movements produced by coughing, sneezing or deep breathing contribute to the short-term aggravation of the discomfort. This results in occasional radiation of pain to the arms or shoulders. As a rule, not all ribs are affected. The changes usually occur only in the upper two ribs. A curative therapy of the harmless disease is not necessary, because it heals by itself. In individual cases, however, the healing process can take more than a year. Only pain treatment often becomes necessary.
Diagnosis and course
In many cases, the diagnosis of Tietze syndrome occurs after the affected person is admitted to a hospital. In many cases, the condition is initially mistaken for angina or myocardial infarction because of the similar symptoms. This confusability made a comprehensive medical examination essential to rule out other dangerous conditions. Tietze’s disease is not life-threatening despite the sometimes severe pain and distress experienced by the affected person. There are individual cases in which there are no symptoms other than the swelling. Other patients experience an accelerated pulse and an exaggerated sensation of heat accompanied by a painful burning sensation.Since many symptoms of Tietze syndrome are initially non-specific, a concrete diagnosis can only be made by a medical specialist. He or she can usually diagnose the disease after a regular examination of the patient, for example, by performing a pressure test on the affected areas. A detailed discussion can be helpful in making the diagnosis.
Complications
Tietze disease does not normally result in major complications. However, the typical symptoms – i.e., chest pain, problems breathing, and swelling in the rib area – may cause other symptoms under certain circumstances. For example, if the affected person suffers from chronic breathing problems, Tietze syndrome may result in shortness of breath. Accompanying panic attacks may occur, which usually also have an impact on the mental state of the affected person. The typical chest pain may also correlate with other ailments and cause severe discomfort. In individual cases, Tietze syndrome also causes blood-drunkness, usually associated with a painful burning sensation and a feeling of heat in the chest and right arm. The symptoms are usually treated with anti-inflammatory drugs and painkillers – drugs that are always accompanied by side effects. Alternative treatments such as acupuncture or heat and cold therapy also carry risks. In the case of acupuncture, infections, bruising and, rarely, circulatory problems can occur. Cryotherapy can cause minor frostbite and may permanently damage tissue. Allergic reactions to the agents and materials used also cannot be ruled out in principle in the treatment of Tietze’s disease.
When should you see a doctor?
Tietze syndrome is a harmless but painful condition that should be promptly evaluated by a physician. When the typical chest pain occurs, it is best to consult a physician immediately. Other warning signs that need to be clarified are red spots and swelling in the chest area as well as shortness of breath and palpitations. The pain may radiate to the back and arms. If these warning signs occur repeatedly, a specialist must be consulted. The physician can determine the condition by means of an MRI and prescribe appropriate medication. Accompanying physiotherapy may be useful. Blockages in the rib area are treated by an osteopath. In consultation with the family doctor, homeopathic treatment is also conceivable. Mild discomfort can be reduced with postural and breathing exercises. However, Tietze syndrome can occur repeatedly and therefore requires medical monitoring in any case. Affected persons should see their doctor regularly, especially if the complaints become more severe or new symptoms appear. Chronic conditions require surgical treatment.
Treatment and therapy
In the best case, Tietze syndrome with all its symptoms disappears on its own after a few months. The sometimes severe pain that occurs during the disease is usually treated by appropriate pain therapy (tablets, topically acting ointments). Which agents are administered in individual cases depends on the severity of the pain that occurs. For some patients, the administration of mild painkillers or anti-inflammatory drugs is sufficient. In very severe cases, the symptoms can only be alleviated by injecting the active substance into the spinal cord. Muscle-relaxing medications can also be used in Tietze syndrome to curb the symptoms. In some cases, antidepressants are also used, as the ongoing pain can have a negative impact on the sufferer’s emotional state. Alternative treatment methods such as acupuncture can also be used for Tietze’s disease. Physiotherapy is also often prescribed to loosen the muscles and maintain the patient’s mobility. Depending on the individual case, heat or cold therapies may also be used in a supportive manner.
Prevention
Preventive measures against Tietze syndrome can hardly be taken, since the complaints often occur quite spontaneously without a known trigger. However, when symptoms suggestive of Tietze disease occur, a physician should be consulted as soon as possible. Here, as with most diseases, the earlier appropriate therapy is initiated, the greater the chance of containing the disease.
Aftercare
During the aftercare of Tietze syndrome, affected individuals need adequate rest and sparing. Pain must be managed by the affected person carefully performing his or her physiotherapy prescribed by the physician at home. Particular symptoms should be noted and reported to the physician immediately. If the pain is excessive, sufferers should undergo strict bed rest. The pain will adjust on its own with regular use of the medication prescribed by the physician and sufficient rest. Sufferers should definitely consider undergoing psychological therapy. Occurring inflammations require a visit to the doctor. It is recommended to take medication against them. Sufferers are also advised to expand social contact with family and relatives, as it is very likely that their help in coping with everyday life will have to be sought more often. The quality of life is significantly reduced due to the disease. For this reason, the affected person should perform activities with their relatives.
What you can do yourself
Tietze syndrome requires pain treatment by a physician. Accompanying this, sufferers should take various self-help measures to ensure that the syndrome subsides quickly. In the case of mild symptoms, such as those that occur after breast surgery, rest and relaxation are sufficient. Accompanying this, the pain-triggering functional disorders must be treated by the patient performing the recommended physiotherapy at home. In addition, the symptoms should be observed and changes should be reported to the doctor. In the event of severe pain attacks, bed rest applies. The pain should subside quickly, provided the pain reliever prescribed by the physician is taken and otherwise care is taken to take it easy. After taking antidepressants, which serve to erase the pain memory, accompanying therapeutic treatment may be necessary. The patient should monitor his mood and take the necessary countermeasures in case of emotional fluctuations. Corticoids may have to be taken, which can cause side effects. Here, too, rest and recuperation are recommended after use. If symptoms persist, a visit to the doctor is recommended. The inflammations can also be treated by homeopathic remedies. However, they are only a supplement to conservative therapy. The intake must be approved and controlled by the responsible physician.