Frequently Asked Questions

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Although most patients with Tietze Syndrome are 35 years or older, there are cases known from people as young as 15 years. The Tietze syndrome and Costochondritis Association has members in their early twenties.

From experience, regretfully, the attention that a certain disorder gets from the medical world is determined by the number of patients with a certain disorder and not by the seriousness of the disorder. In short a serious disorder like Tietze, but with relatively few patients is a reason for doctors to ignore it. Quantity above quality? Unfortunately a fact. It is about money and not about care for the patient. Not very nice but that is the reality.

According to TNO, Rheumafonds and Ieder(in)- the central organization for patient support groups- and medical practitioners, Tietze is a so called rare disorder. To this date, no formal research has been done on Tietze as the disorder is rarely diagnosed. Prof. Dr. Rini Geenen from the UMC Utrecht did research the mental disadvantages from Tietze and made suggestions for treatment therapies. In medical publications you will find little about Tietze Syndrome. Definition for rare diseases or disorders: A disease or disorder is defined as rare in Europe when it affects fewer than 1 in 2000 Rare diseases are serious, often chronic and progressive, diseases. For many rare diseases, signs may be observed at birth or in childhood. However, over 50% of rare diseases appear during adulthood. They can be genetic, hereditary or chromosomal by nature, but can also brought on by external factors.

There are situations known where this is indeed the case. As with so many other Tietze questions, this is not yet scientifically researched or proven to be true. We therefore welcome any feedback on this matter from Tietze patients.

Fybromyalgia is a group of medical conditions of which one of the characteristics is chronic widespread pain in muscle tissue and other weak tissues without a clear indication of an infection and also comes with extreme tiredness. When the pain in felt in the chest area, the symptoms are very similar to Tietze Syndrome, however extensive examination will rule out Tietze to be the cause. X-rays and blood test will not show any thing abnormal. Patients very often end up at a Rheumatologist or a department for chronic pain treatment. The cause for this disorder is unknown. A possible explanation is that it is a reaction of the body on unprocessed psychological trauma. This disorder has, because of its character a profound negative effect on the patient’s life. Some patients have benefited from Chakra Therapy. The idea behind this is that this therapy will (re)open the blocked energy fields (chakra’s).

A hypochondriac is a person, with an excessive pre-occupation with his/her health or body functions. For the wrong reason some medical practitioners consider Tietze and/or costochondritis patients hypochondriacs. By doing this, they actually show that they are too lazy or don’t care to further investigate. They trivialize the problem, with the result that the patient is left with many questions and no treatment. Such medical practitioners can better be avoided. Employers, friends and sometimes even close family members can be guilty of this behaviour as well.

There are no results known from medical research whether Tietze and Costochondritis are hereditary. However, the many reactions we receive from patients show that Tietze does occur often within the same family. Although there are many factors that could play a role in causing this disorder, there is some reason to presume that there may be a factor of hereditary in play, however this has to be proven yet.

There is not a clear answer for this question. Everyone reacts in their own way on different therapies. Some get little result from injections, physiotherapeutic treatments or medication and are send to special centres for treatment of chronic pains. Without giving any judgement you can read some more on a number of therapies where other patients had more or less results. Below are a few tips to keep in mind in daily life. Much exercise will result in less calcium deposit on your bones. Daily exercise and paying attention to your posture will reduce the pain. Much strenuous exertion will make the condition worse. Therefore don’t exert too much and don’t lift heavy objects. Identifying stress factors and trying to reduce them can help to lessen the pain. A peaceful and quiet life will have a positive effect in reducing the frequency of the Tietze attacks. Physio therapy, Chinese acupuncture, Manual extraction therapy, Reiki treatment, yoga to get a better posture and breathing technique are all kind of therapies that have been working for some Tietze patients.

Antibiotics are only working in cases of bacterial infections. With Tietze there is no bacterial contamination. Blood tests have not shown traces of bacterial infection. Anti inflammatory drugs are frequently confused with antibiotics. Anti inflammatory drugs will block the growth and reduce an infection. Therefore these can be effective for some patients. Thus penicillin has no impact because it is a antibiotic. Aspirin, Ibroprofen etc. can sometimes be effective because they are Anti inflammatory drugs.

Everybody has their own specific pain symptoms and has a different reaction to medicines. Some have benefitted from paracetamol tablets, others take ibuprofen (e.g. Advil), diclofenac (e.g. Voltaren), naproxen (e.g. Alive), or anti inflammatory drugs (e.g. Prednisolone or a Cortison injection). In addition, there are patients who receive stronger pain medication than, for example, paracetamol or ibuprofen. These can only be prescribed by the doctor and have more side effects than the lighter pain medication. The medications we sometimes see, are homeopathic remedies (for example when conventional medicine does not provide a solution) or other remedies bases on nature therapy. From the above one can see that there is not a unambiguous answer to this question. Doctors do not always immediately recognize the symptoms or make the right diagnosis. With the best intentions they try all sorts of treatments. So if you get a medicine that seem to work, stick to it as it appears to suit your specific condition.

Although not yet proven, there seems to be a relation between typical Tietze cartilage infections and pain in other cartilage joints in the body. There are known cases from similar pain symptoms in the shoulders, neck, hands and fingers. More information can be found on the page Symptoms / Manifestations.

Tietze is not malignant or life threatening, and you will never die from it. Some doctors interpret this as “easy to live with”. It should be clear that this is certainly not the case.

Various people react different on this type of treatment. The injections will reduce the pain for a period, but it is not a cure. In most cases not enough significant positive effects have been observed.

As mentioned earlier, there is no adequate treatment for Tietze available. Various patients react different on types of treatment and pain management. What works for one person, could be partly or complete ineffective for another. Only when you have identified the factors that caused pain, can you try to control these to improve your condition. A simple but time consuming way to do that is by keeping a diary. Speak with your GP and physio therapist about your observations and try to find ways to prevent escalation. In general, rest is the best medicine. Warm and cold compresses on the painful area’s can be helpful too.

Yes, the general assumption is that stress has an increasing negative effect on the disorder. The diagnosis does not always disclose what came first. Does stress and fear cause the inflammation or is Tietze causing stress and fear.

When Tietze syndrome affects either the first rib, or the collarbone, it may affect the “brachial plexus of nerves” which is a network of nerves located between the neck and shoulders, that provide sensation to the upper limbs. This is why it can cause pain to the shoulder arms and back. and hence the pain down the arm.

No, Tietze or Costochondritis do not affect any organs and thus not affect the lungs. When breathing the ribs expand and put stress on the cartilage. When the cartilage is inflamed, and causes pain, the body will instinctively try to reduce the pain by keeping the expansion of the ribs to a minimum. This can give the sensation that you don’t get enough oxygen. This can then result in feelings of panic and hyperventilation, that give the impression that something is wrong with the lungs. A fracture or a pulled rib ligament can also give that sensation.

If the inflammation is in the lower ribs the pain can radiate to the abdomen cavity and give the impression that there is something wrong with the oesophagus, stomach or intestines. Examination will show if the pain is caused disorders to these organs or if Tietze causes the pain. A clear relation between Tietze and disorders of the intestines has not yet been proven and is not plausible. In blood tests no deviations can be found which indicate to Tietze.

Although the pain is most often located on the left side of the chest and can radiate to the arms, and therefore has the same indications as a heart attack, examination will eliminate the heart as cause for the pain.

No, Although the pain is most often located on the left side of the chest and can radiate to the arms, and therefore has the same indications as a heart attack, but examination will eliminate the heart as cause for the pain.

As far as we know, there is no cure for this disorder of the cartilage. Although the disorder is not life threatening, the pain that comes with it has a very negative effect on the quality of life. In some cases, reports of good result from treatments of pain, however, this is different for every patient. A conclusive cure is not available. Some patients benefit from homeopathic therapies or aspirins. Others require more powerful drugs, injections and physiotherapy and in extreme cases even surgery is needed. You could live a long life in relative good health, but the disorder can stay for all that time and flare up more or less frequently.

This may vary from person to person. With some people the disorder will disappear over time and never returns. For others however, the disorder will follow them for the rest of their life. The pain is often very sharp and intense in the beginning, but becomes less distressing over time.

Normally the ribs, chest and the cartilage are constantly in motion as a result of breathing. The assumption is that the disorder is caused by a too wide expansion of the chest and the ribs as a result from strenuous activity or exercise, coughing or sneezing, punches on the chest, stress and anxiety. The pain is caused as the cartilage between ribs and sternum gets irritated and inflamed.

In the onset of a Tietze attack the pain is extremely sharp. The pain can be felt near the sternum but also on other places near the ribs. It feels like someone is sitting on your chest. It is so painful that you hardly can breathe or dare to breathe. There are cases known where people faint from the pain. No wonder that a patient has the feeling that he is having a heart attack. Later the pain subsides and a persistent nagging pain will stay for a while. Many patients also experience painful ribs.With Costochondritis the pain is mostly on the backside. More information on this matter can be found on the webpage pain.

Rheumatism is an umbrella term for more than 100 chronic disorders of the joints, muscles and tendons. Typical symptoms are stiffness and pain caused by inflammations and/or exertion and limitations in daily activities. There are three groups of Rheumatism Rheumatoid Arthritis (AR): These are types of rheumatism where the body’s immune system is attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage. Osteoarthritis (OA): This is a type of joint disease that results from breakdown of joint cartilage and underlying bone. Fibromyalgia (FM): Is group of medical conditions of which one of the characteristics is chronic widespread pain in muscle tissue and other weak tissues. Tietze Syndrome and Costochondritis are related to Rheumatism

When you have such painful symptoms it is advisable to contact a GP. But there is a simple test that you can do yourself. Put some light pressure on the painful area. If the pain gets worse, there is a good chance that this is Tietze. However, the pain can also be caused by other afflictions on the ribs like a fracture or a contusion. The heart lies safely enclosed behind the ribs and will not react to light pressure. More information on this subject can be found on the page Self diagnosis on our website.

This question is not easy to answer. Large breasts are also often heavy in weight. The body will try to find a balance and this could result in an unnatural posture which in turn could put some extra stress on the ribcage. Clinical research to see if large breast have an effect on Tietze has as far as we know not been conducted yet, but from feedback we learn that patients who underwent a breast reduction from cup size F or G, have noticed an improvement of their condition.

Prostaglandins are hormones created during a chemical reaction at the site where an injury or other issues occur. They are unique among hormones because unlike most of the chemical messengers, they are not secreted from a gland, but rather are created at the time they are needed directly where the problem exists. Prostaglandins control several processes in the body, especially as it relates to the healing process. When tissue is damaged or infected, this group of hormones will create the reactions that cause pain, fever and inflammation, which sparks the healing process. The amount of prostaglandins increases before a period and is at its highest peak during the period. This large amount of prostagladins causes cramps and pain. These cramps actually contract the womb and thereby squeeze the blood vessels to reduce the bleeding. These cramps are painful because the muscles are deprived of oxygen. Unfortunately some of these prostaglandins escape to other parts of the body and can cause headache, muscle ache, dizziness, diarrhea and hot flushes. They can also increase the Tietze or Costochondritis pain. Many women benefit from prostaglandin blockers, which can be taken a few days before the beginning of a period. Ask your GP about it.

In this situation one can choose not to wear a bra. But when the situation requires you to wear a bra there are companies that produce more comfortable bras made from soft cotton with soft wide elastic bands instead of metal wire. Ulla Popken fashion, with shops in most large cities have soft cotton bras with front close from size 42. The web shop www.klingel.nl has a large selection soft bras. Other useful websites are www. decentexposures.com www.onehanesplace.com

Yes, this is possibly caused by pain radiating from nerves that lie around the ribs. Do consult a GP when there is pain in the breasts.