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Tietze Syndrome

What Is It, Causes, Treatment, and More

Author:Anna Hernández, MD

Editors:Alyssa Haag,Ian Mannarino, MD, MBA,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW


What is Tietze syndrome?

Tietze syndrome is a rare condition characterized by pain and swelling of a single costal cartilage of the upper ribs, usually the second or third rib, that often affects individuals under the age of 40. Although it is considered a benign and self-limited condition, it is important to distinguish it from other, more serious causes of chest pain, such as a heart attack

Costal cartilage with pain and swelling.

What causes Tietze syndrome?

Tietze syndrome is caused by the inflammation of the cartilage of the costochondral joints, which connect the sternal ends of the ribs with their respective costal cartilages. The costal cartilages are segments of hyaline cartilage that connect the sternum to the ribs and contribute to the elasticity of the thorax by helping to extend the ribs forward. The exact cause of Tietze syndrome is unknown; however, research suggests repetitive trauma to the chest wall may be a predisposing factor for its development. In some cases, the onset of Tietze syndrome is preceded by prolonged coughing or vomiting, trauma to the chest, or surgery to the thoracic area. In other cases, there may not be any relevant history. 

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What are the signs and symptoms of Tietze syndrome?

Signs and symptoms of Tietze syndrome include pain and swelling of the costochondral joints of the upper ribs, typically the second or third rib. In most cases, only the cartilage of one rib is affected, causing a firm spindle-shaped lump on one side of the chest. Tietze syndrome can cause mild to severe chest pain that radiates to the shoulder and arm and is generally made worse by sneezing or coughing, deep breathing, and torsional body movements. 

Although local cartilage swelling is considered a hallmark of Tietze syndrome, it may be absent in mild cases. In such cases, Tietze syndrome may be confused with costochondritis, a more common cause of chest wall pain characterized by diffuse inflammation of the costal cartilage that is generally not associated with any swelling or induration of the costochondral joints. 

How is Tietze syndrome diagnosed?

Diagnosis of Tietze syndrome relies on the findings of the individual’s clinical history and physical exam, as well as the exclusion of potentially life-threatening causes of chest pain, such as a heart attack, pneumonia, or malignancies. Depending on the clinical suspicion, additional tests may involve an electrocardiogram (EKG), chest x-ray, and laboratory investigations (e.g., cardiac biomarkers, serum electrolytes, complete blood count, renal and liver function tests). In cases where the diagnosis of Tietze syndrome is uncertain, an ultrasound or magnetic resonance imaging (MRI) of the affected area may be conducted to rule out other causes of chest wall pain that can mimic Tietze syndrome, including spondyloarthropathies, septic arthritis, and malignant tumors.

How is Tietze syndrome treated?

Treatment of Tietze syndrome focuses on relieving the pain. Common measures include non-steroidal anti-inflammatory steroids (NSAIDs) or analgesic medications such as acetaminophen and applying heat with heating pads or warm compresses to the affected area. In addition, individuals may be advised to minimize physical activity involving the upper body and use cough suppressants to minimize coughing. Once movement becomes pain-free, physical therapy and strengthening or stretching exercises may be beneficial for early recovery. Most cases of Tietze syndrome self-resolve within a few weeks, though it may occasionally last longer or relapse over time. 

In cases where pain persists despite these measures, treatment may involve local injections of anesthetic (e.g., lidocaine) and corticosteroids into the affected joint to decrease the inflammation. In refractory cases, blockage of the regional intercostal nerves may be performed for pain control. 

What are the most important facts to know about Tietze syndrome?

Tietze syndrome is a rare condition characterized by chest pain and swelling of a single costal cartilage that most commonly affects the second or third rib. The swelling differentiates it from costochondritis. It is typically seen in young individuals under the age of 40. Diagnosis of Tietze syndrome relies on the findings of the clinical history and physical exam, as well as the exclusion of potentially life-threatening causes of chest pain. Treatment is focused on pain-relief medications and minimizing physical activity until inflammation resolves. 

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Related links

Anatomy clinical correlates: Thoracic wall
Bones and joints of the thoracic wall
Non-steroidal anti-inflammatory drugs

Resources for research and reference

Grodin, L., & Farina, G. (2013). Tietze’s Syndrome in the emergency department: A rare etiology of atraumatic chest pain. Case Reports in Clinical Medicine, 02(03), 208–210. https://doi.org/10.4236/crcm.2013.23056

Major causes of musculoskeletal chest pain in adults. (n.d.). Uptodate.com. Retrieved November 23, 2022, from https://www.uptodate.com/contents/major-causes-of-musculoskeletal-chest-pain-in-adults

Rokicki, W., Rokicki, M., & Rydel, M. (2018). What do we know about Tietze’s syndrome? Kardiochirurgia i Torakochirurgia Polska [Polish Journal of Cardio-Thoracic Surgery], 15(3), 180–182. https://doi.org/10.5114/kitp.2018.78443

Tietze syndrome - NORD (national organization for Rare disorders). (2015, February 11). NORD (National Organization for Rare Disorders); NORD - National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/tietze-syndrome/