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Diagnosing pain in the chest.

Pain in the chest can be caused by a wedged nerve in the back, a gastric ulcer, gall stones etc. or a contusion of ribs or a broken rib. If local pain can be felt on the chest without swelling or pain on the ribs, and the patient can exactly  point the location of the pain and can arouse it, it is most likely plain muscle pain. It is always reassuring if a patient feels  pain when the doctor presses on a rib. After all, the hearth is sheltered beneath a bony cage and won’t hurt when the doctor presses on someone’s chest. If the local pain suddenly appears combined with redness, fever, overall tiredness and weight loss, the pain may be the result of some form of Rheuma.

Disorders with similar symptoms

  • ANGINA PECTORIS (Hart disorders) Very often someone a person with Tietze resembling symptoms ends up at the cardiologist., mostly because the pain has a tightening and pressing character.  It feels like a heart attack. Examination very often reveals that it is not Angina Pectoris.
  • OSTEOARTHRITIS This is one of the most common type of disease of the Joints. Pain and stiffness  occurs frequently and  sometimes the joint completely freezes.  With this disease the cartilage of the joint slowly disintegrate over time, the bone structure changes and sometimes a bone infection may occur.
  • OESOPHAGUS Pain in the chest can be caused by an inflammation or burning of the oesophagus from hot food and drinks or from reflux of gastric acids.
  • STOMACH PAIN The pain can radiate to chest and shoulder and therefore might indicate Tietze, but examination by a doctor will reveal it is not Tietze.
  • BOWEL PAIN Constipation, polyps or nervousness of the intestines can result in pain in the chest area. Examination will reveal the real cause.
  • OSTEOPOROSIS decalcification of the bones will occur in later age and can cause pain in the chest area.
  • PSYCHOSOMATIC CHESTPAIN  Unexplained  (imagined) chest pain that can occur in stressful situations and will disappear as sudden as they appear. Like for example the pain suddenly disappears when “a doctor looks at it”.
  • FYBROMYALGIA (Soft tissue Rheuma)  Fibromyalgia syndrome is a common and chronic disorder characterized by widespread pain, diffuse tenderness, sleep deprivation and a number of other symptoms. Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person’s ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition, a medical condition that impairs the joints and/or soft tissues and causes chronic pain. Fibromyalgia affects approx. 2 out of 100 people, mostly women but men and children can be affected too. Symptoms look very much like Tietze when they occur in the chest area. Diagnosis is difficult as x-rays and blood tests don’t show anything abnormal. Patients very often end up at rheumatologist or chronic pain clinics. The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. For others, fibromyalgia seems to occur spontaneously. Because of its character, fibromyalgia can have a negative effect on the quality of life.
  • ARTHROSIS DEFORMANS With arthrosis deformans, there is a painful swelling at the end of the collarbone, which can easily be confused with Tietze’s syndrome. The joints of the collarbone may be affected by a primary arthrosis deformant. With arthrosis deformans the pains persist and there is often “cracking” to hear in the affected joint.
  • REUMA In 1952, eight patients were examined in Amsterdam at the consultation office for Rheumatic diseases. Here is a quote from a Dr. W.H.D. de Haas: “What our research has yielded to positive is the following: There was always a slight eosinophilia (4-7%, intestinal parasites could be eliminated as a cause). The uric acid and cholesterine content of the blood was on the high side (between 4 and 5 mg%, and between 300 and 400 mg% respectively). You can not speak of a “forme fruste” of gout. Before that the numbers were too low again, also gout treatment had no success, on the contrary. Personally we tend to see the condition as a distortion in the cartilage rib (according to many anatomists a joint), caused by direct trauma or by a period of coughing. The biochemical findings could be reminiscent of a predisposition by the so-called arthritic diathesis for the disease (the syndrome) of Tietze. We saw no success in psychological and therapeutic measures. In intractable cases the chondrocostal connection has been resected (with complete success, this does support our view). Also treatment with testosterone should be considered “(end of quote).
  • COSTOCHONDRITIS / TIETZE Finally, it often appears that the cartilaginous connections between ribs and the sternum or between ribs and collarbone are painful (costochondritis). If there is also a noticeable painful thickening (usually on the underside of the sternum), then the diagnosis ‘Tietze’ has been made. In principle it is an innocent, but because of the pain often a negative life-influencing condition.

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