What happens to costal cartilage?
The upper ribs are connected to the sternum not directly, but through elastic cartilage, which allows the rib cage to expand with breathing. With Tietze syndrome, aseptic, that is, non-microbial, inflammation with edema develops in one of these cartilages. The cartilage thickens, and a visible or palpable swelling appears above it, usually up to three to four centimeters in size. The second and third ribs on the left are most often affected. Suppuration, bone destruction and malignant degeneration do not occur, and the thickening itself can persist even after the pain goes away.
- The cartilaginous part of the upper ribs near the sternum is affected
- Most often the second and third ribs, usually on one side
- The inflammation is non-microbial, there is no suppuration
- The swelling is dense, fused with cartilage, the skin over it is unchanged
- The thickening may remain longer than the pain
Causes and provoking factors
The exact reason is unknown. It is believed that repeated microtraumas of the cartilage play a role: heavy physical work, heavy lifting, prolonged strong cough, sports loads on the shoulder girdle, blows to the chest, chest surgery. Sometimes the syndrome develops after a respiratory infection. It is not related to smoking, diet or “salt deposition” and is not a manifestation of heart disease. For some people, an obvious reason cannot be found, and this is normal.
- Heavy physical activity and heavy lifting
- Prolonged hacking cough
- Direct trauma or contusion to the chest
- Previous chest surgery
- Past respiratory infection
- Exercises with load on the shoulder girdle
Symptoms
The pain usually increases gradually and is located in the upper part of the sternum, less often it begins suddenly. It is sharp or aching, intensifies with a deep breath, coughing, sneezing, turning the body, raising the arm, and especially when pressing on the painful point. May radiate to the shoulder, neck or arm of the same side. A distinctive sign is a persistent dense swelling, which is found by both the doctor and the person himself. The general condition does not suffer: no fever, shortness of breath at rest and weakness.
- Pain at the edge of the sternum, usually on the left
- Dense painful swelling on the rib
- Increased pain when inhaling, coughing and turning the body
- Sharp pain when pressed
- Referring pain to shoulder and arm
- Normal temperature and well-being
Diagnosis and exclusion of dangerous causes
The diagnosis is made clinically: typical swelling and pain reproducible with pressure are very characteristic. But since chest pain can be a manifestation of a heart attack, thromboembolism, pleurisy and other conditions, at the first visit the doctor must evaluate risk factors, take an ECG and, if necessary, prescribe a chest x-ray. Ultrasound shows thickening and swelling of the cartilage, CT helps with an atypical picture and suspicion of another process. Blood tests are usually normal: an increase in inflammatory parameters forces us to look for another cause.
- Inspection with palpation of the costosternal joints
- ECG to rule out a cardiac cause
- Chest X-ray in two projections
- Ultrasound of costal cartilage
- CT scan of the chest with an atypical picture
- Complete blood count and C-reactive protein
Treatment
Treatment is aimed at reducing pain and reducing stress on the chest. During an exacerbation, avoid lifting heavy objects, push-ups, working with raised arms, and treat a cough, if any. The doctor may prescribe nonsteroidal anti-inflammatory drugs orally or locally for a short course, dry heat, and physical therapy. For persistent pain that interferes with sleep and work, local blockades are used - the procedure is performed only by a doctor. Surgical removal of cartilage is used extremely rarely. It is important to remember that ointments and warming do not speed up recovery on their own, but only alleviate symptoms.
- Limiting loads on the shoulder girdle and chest
- Non-steroidal anti-inflammatory drugs as prescribed by a doctor
- Local forms of drugs and dry heat
- Treatment of cough as a provoking factor
- Physiotherapy course
- Local block for persistent pain