costochondritis (Tietze syndrome)
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Introduction
Chronic inflammation affecting the costochondral joints.
Etiology
unknown
Clinical manifestations
- chest pain, accentuated by respiration, sneezing, coughing, twisting or reaching overhead
- onset of pain may be sudden or gradual in onset
- possible radiation of pain to arms, shoulders or entire chest
- tenderness & swelling at costochrondral joints, especially 2nd & 3rd ribs
- erythema of overlying skin may be present
- absence of visible swelling or crepitus
- most commonly involves left anterior chest wall
Laboratory
of little value
Radiology
- chest x-ray to rule out other diseases
- bone scan if infectious etiology suspected or history of intravenous drug abuse
- echocardiogram
Differential diagnosis
- ankylosing spondylitis
- bone metastases
- contusion
- cardiac angina (may coexist with costochondritis)
- costal cartilage separation
- Herpes zoster
- infection
- lipoma
- muscle spasm
- neoplasm
- rib fracture
- Reiter's syndrome
- rheumatoid arthritis
- septic arthritis
- slipping rib syndrome
- sternalgia
- xiphoidalgia
Management
- pharmacologic agents
- physical modalities
- local heat
- refrain from aggravating activities
- stretching exercises, especially pectoralis major continued for at least 3 weeks after improvement of symptoms
- surgical resection of involved cartilages in severe or refractory cases
- patient education
- generally self-limited with improvement within 3-6 months
- occasionally symptoms may last months or recur
- smoking cessation
- be aware that costochondritis may coexist with other disorders, especially coronary artery disease
More general terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 876
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 785-86
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012