Dr Ozello's Sports Medicine Report: Costochondritis and Tietze's Syndrome

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Serious pathology must be ruled out first in all chest and ribcage pain.

Costochondritis and Tietze’s Syndrome
Localized pain in costochondral or costosternal joints is typically associated with Costochondritis or Tietze’s syndrome.
Higher prevalence in females in general and athletic populations.

Costochondritis and Tietze’s Syndrome are similar except Costochondritis exists without swelling, heat or redness.

Tietze’s Syndrome usually associated with the second or third costal cartilages unilaterally. Ultrasound has proven to be effective to assist in the diagnosis of Tietze syndrome as it can quickly demonstrate soft tissue swelling at the site of inflammation.

Costochondritis is associated with multiple ribs, typically ranging from two to five and is not associated with localized swelling over the affected joints.

In both conditions, pain can be provoked with upper extremity movements, especially shoulder adduction.
Pain will also typically be worse when the patient takes a deep breath. Aggravated by coughing, sneezing and vomiting.
Pain is usually described as sharp or dull.
Recurrent and persistent conditions.

Costochondritis: No known etiology. Insidious onset.
Proposed mechanisms of injury include: Pull of surrounding musculature, Repetitive arm adduction and hypomobility of posterior spinal structures.
Costochondritis is thought of as a selflimiting condition allowing individuals to continue activity as symptoms allow.

Altered thoracic spine and rib mobility may be a factor associated with development of Costochondritis and Tietze's Syndrome.
Possibility of a thoracic spine disc herniation or bulge.

Recent clinical suggestions and case reports have included use of manual therapy interventions directed at thoracic spine in management of ribcage conditions.
Rib and associated thoracic vertebral segment can be described as a fixed ring. Movement and stress applied at one part can be transmitted through entire ring.

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Normal breathing exercises. Chest Stretching, Strengthen scapular retractor muscles.

Normal Breathing: Practice normal breathing until it’s second nature.
Supine: Relax abdominal muscles to allow greater diaphragm motion.
Place one hand or both hands on stomach.
Inhale slowly through nose.
Focus on diaphragm movement.
Feel the abdominal cavity rise.
Exhalation should be twice as long as inhalation.
Start in the supine position, advance to kneeling, seated, standing and quadruped.

References
Treatment of a female collegiate rower with costochondritis: a case report
Discussion: Based on the findings associated with this case report, as well as our clinic experience with the management of both costochondritis and rib stress fractures, that hypomobility of the thoracic spine and costovertebral joints may contribute to anterior thoracic cage pathology.
https://www.ncbi.nlm.nih.gov/pmc/arti...

Costochondritis https://www.ncbi.nlm.nih.gov/books/NB...

Tietze Syndrome https://www.ncbi.nlm.nih.gov/books/NB...

Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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