Definition / Introduction

The Tietze syndrome describes a change of the costal cartilage at the approach to the sternum. It presents with pain and swelling of different strength and radiance. More detailed information on the development of chondropathy (cartilage damage) in the course of Tietze syndrome are not yet found.


The symptoms that describe patients in the course of Tietze syndrome have very different characteristics.


The main symptom of Tietze syndrome is chest pain. In some cases, the pain also radiates to the back, neck, shoulders, or arms, and may be provoked and intensified by coughing, sneezing, or deep breathing in and out. This pain can sometimes trigger an oppressive sensation in the chest, and it is not uncommon to first have frightening thoughts on heart problems, which are the ultimate reason for going to the doctor. The pain is caused by an inflammatory process in the sternum cartilage.

In most cases, rib pain in and at the articulated junctions from the ribs to the sternum is complained of. This can be the case in peace. Often, however, the pain comes on during exercise. The occurrence begins, for example, after a new or unfamiliar activity (a little heavy lifting). Thereafter, the problem persists for days to weeks or even longer and restricts those affected in the exercise of their everyday activities. In addition, in some cases inflammation, reddening and externally visible and palpable hardening or swelling of the affected joints can be seen in the course of inflammation.

Very often the ribs 1-3 are affected by the problem described above. The symptoms can also be seen on the other ribs attached to the sternum (up to the 7th rib).

Due to the partly high position on the first ribs, the pain can radiate into higher-lying body regions. Some patients complain of pain in the neck region and a radiation of pain in the shoulder and arms. Accordingly, an adequate examination is indicated to rule out any other causes of the symptoms.

By taking a restraint to avoid pain can result in pain in other places, such as muscle cramps in the chest, shoulder and back. During inhalation and exhalation, the movements of the thorax (chest) can trigger pain.

  • Pain ribs left
  • Pain ribs right

difficulty in breathing

The breathing process involves movement of the entire thorax with joints and muscles. The simple respiratory motion comes from the diaphragm, which contracted by contracting to create a vacuum that expands the lungs - this process takes place when inhaled. When exhaling, the diaphragm relaxes again and the air is squeezed out. In addition to the diaphragm, other muscles are involved in the breathing process - eg the inner and outer intercostal muscles ( intercostal interni and externi muscles ). These muscles have their origins and attachments on the ribs. In a breathing movement, therefore, train takes place on the ribs, which can lead to pain in the presence of Tietze syndrome. Pain is often limited in the ability to adequately perform the respiratory motion - there is a risk that the patient may develop a sense of respiratory distress due to pain prevention.

It is important to clarify this respiratory distress and to ensure that no illness of the heart, lungs (pneumonia, metastases, COPD, edema, etc.) or psychological reasons is responsible.

Furthermore, the respiratory distress must be treated symptomatically. If it is an acute event after a wrong movement (ie newly occurring Tietze syndrome), an improvement should be achieved with analgesic (pain-relieving) therapy or with orthopedic options. In case of prolonged shortness of breath can be used with the same means - but here should be placed more emphasis on other causes and causes.

back pain

The Tietze syndrome is actually defined as a painful disease in the area of ​​cartilaginous ribs that are in communication with the sternum. The occurrence of back pain can therefore be described rather as a symptom of Tietze syndrome. Rather, back pain may appear as a secondary, ie subsequent discomfort when affected persons take due to the severe pain in the sternum area defensive postures. The restraint is usually equated with a malposition, so that the symptoms of the symptom preferably shifted to the back and shoulder area.


The causes of the Tietze syndrome are not fully understood. However, the various symptoms are often described in connection with unfamiliar activities and burdens. So could be a reason in the overuse of the respective ribs approaches on the breastbone, for example, when practicing a new activity in the professional life or in the spare time (sports, unusual lifting movements, for example when Kistentragen).

Overstressing the cartilage at the ribs can also be caused by an incorrect loading of the joint. For example, if one or more vertebral or rib joints are blocked (limited mobility of the respective joint), the resulting nonphysiological (non-normal) posture and exercise may result in some joint areas being loaded in a shape and strength that would otherwise burden them are not exposed. This abnormal load can cause inflammation and irritation of the corresponding costal cartilage.

A possible cause of the Tietze syndrome lies in so-called micro fractures of the ribs. These are smaller fractures of the ribs, which have previously caused no symptoms, but in the long term by the altered force on the costal cartilage cause irritation or inflammation. Another reason for this may also be in previous operations on the thorax (thorax) in which the original position of the ribs or articular surfaces was not completely restored in the healing process.

Because no complete mechanism for the development of Tietze syndrome is known, however, it must be assumed that other causes exist. Accordingly, an unambiguous problem should be looked at for further possible causes of the person concerned.


The diagnosis is made after questioning the person concerned. Depending on the type and severity of the symptoms, diseases of the heart (angina pectoris) and other organs must be excluded.

Many patients are very worried that the symptoms are due to cancer or the heart. However, an experienced doctor can rule out a different disease through appropriate diagnostics and laboratory testing.

The rib-sternum joints that are affected by Tietze syndrome are described by the physician as painful or pressure-sensitive when palpated (scanned). The severity of pain severity can vary widely from patient to patient.


The depiction in the X-ray is in many cases no further, as in the Tietze syndrome usually no injuries or significantly different positions of the bony structures lead to the manifestation of the symptoms. To exclude fractures of the bony structures involved, such as the respective rib, however, the preparation of an X-ray image may be helpful.

MRI of the sternum

For further clarification, the MRI of the sternum may be helpful. In contrast to X-rays, soft tissue structures can be visualized on MRI. Therefore, it is possible to see swelling and fluid retention (in the course of inflammation). If the Tietze syndrome is present, the affected joints or the cartilage on MRI are swollen.

Therapy / Treatment / What helps?

Due to the inflammatory process, many patients have pain during movement, exercise or in part also in the breathing movement.

Through the use of analgesics (painkillers ) and anti-inflammatory drugs (anti-inflammatory), the pain and also the inflammatory process can be reduced. Ibuprofen and diclofenac (Cox inhibitors) are the drugs of choice. However, these should not be taken over long periods in high doses, as they can lead to dangerous bleeding in the stomach. In acute pain, muscle relaxants ( muscle relaxants ) can also be used - this reduces the tone (tension) of the muscles and thus also the pull on the areas affected by the Tietze syndrome.

Furthermore, for acute relief of pain, the respective joint may be locally treated with an anesthetic. A local anesthetic (drugs for local anesthesia) is injected into the affected costal cartilage.

Osteopathy / Manual therapy

In the application of manual therapy / osteopathy it is possible to remedy the pain by correcting malpositions of the ribs, vertebrae and sternum (breastbone) to each other.

The idea behind this is that blockages in the joints between the ribs and vertebrae cause an unnatural posture and movement of the upper body. Targeted removal of these blockages with various manual therapy techniques will remove or reduce the burden of distress and, in the ideal case, reduce the pain. Since the malpositions have in many cases been present over longer periods of time, it often takes time for the inflammation to recede and the body to adapt to the original posture. Strengthening the muscles in the course of physical therapy or targeted training are helpful for long-term stabilization and the prevention of other cases.

What exercises can help with a Tietze syndrome?

In general, a special therapy in a Tietze syndrome is not required because the disease and thus the pain on its own disappear.

In some cases, the doctor may prescribe concomitant anti-inflammatory painkillers as well as refer to various very simple exercises for the home. Sitting down deliberately for 5 minutes and focusing on breathing and breathing is one way to help make things better at home. Since the respiratory movement can often trigger pain in the chest / sternum, a conscious "counter-breathing" against the pain is conducive to counteract the often automatically occurring shallower respiratory respiration.
A postural correction can also be done consciously several times a day: straighten your back, pull your apex slightly to the ceiling, guide your chin slightly to the chest, lower your lower back slightly into the hollow back, merge your shoulder blades so that the chest moves forward.
Lastly, a stretching exercise for the middle back and the thorax can be carried out: in the quadruped stand, first go into the hollow cross (place the head in the neck), and then make a cat hump by guiding the chin to the chest. Alternate both positions several times in succession.


The operation in the presence of a Tietze syndrome is usually not a therapeutic component of the possible treatment approaches. The reason for this is, on the one hand, that the symptoms are proven to recede on their own and patients with surgery are "over-treated". Even the form of the chronic manifestation is not surgically treated, since in many cases there is no clear reason and therefore no therapeutic point of attack for an operative care exists. On the other hand, there are far more effective and less invasive treatment options (such as medications, physiotherapy and acupuncture), which usually make the need for surgery unnecessary. Finally, in general terms, the lack of necessity for surgery, with too little symptoms and the lack of clarity of the development, can be seen as a reason for deciding against surgery for Tietze syndrome.

Can physiotherapy help?

It is rarely recommended to go to the physiotherapist by the attending physician in a Tietze syndrome, the symptoms usually return by themselves after some time. Physiotherapy can make sense only in the sense that it is used to counteract a postural disturbance triggered by the pain in the trunk. A posture often leads to the fact that the trunk muscles cramped and movement does not allow freely, so that additional pain can arise from muscle hardening. Relaxing, relaxing massages of the back muscles, trigger point treatments, manual therapy, proprioceptive neuromuscular fascilisation (PNF) and craniosacral therapy are used. Also, the above exercises for the home can be taught by the physiotherapist.


For the homeopathic treatment of Tietze syndrome, various preparations for injection (for spraying) can be used. Mainly the two preparations Zeel® and Traumeel® are used. They are injected over several weeks in the affected joint. Its actual field of application lies above all in the treatment of arthroses in joints.

Forecast / Duration

The occurrence of the Tietze syndrome is in many cases a very short process in the course of a faulty movement.

Just as the occurrence can happen very quickly, the problem can disappear again. It can be a brief pain from a few seconds to minutes. In these cases, the joint has slipped back by itself into the original position and there is no formation of a chronic problem of pain. In other cases, the problem persists for days to months. In rare cases, the Tietze syndrome remains permanent.

The cure itself is almost always without medical intervention. However, many patients are limited by the symptoms in everyday life, which is why a therapy with painkillers can be used.

How long a Tietze syndrome lasts at the end depends, as with many diseases, on many unpredictable factors.

Can a Tietze syndrome become chronic?

The Tietze syndrome is a disease that usually disappears by itself, which means that special treatment is not necessary. Often the pain is accompanied by the administration of anti-inflammatory analgesics such as ibuprofen or diclofenac concomitantly, in severe cases, they can be combined with cortisone preparations. A chronic course is very rare, so the prognosis is good and damage usually does not linger.

Can a Tietze syndrome indicate an ankylosing spondylitis?

The Tietze syndrome itself is not a syndrome of ankylosing spondylitis, nevertheless, the ankylosing spondylitis should be considered as a differential diagnosis of pain in the sternum. In addition to the classic complaints of this disease can sometimes attract attention over the sternum with limited burst basket stretchability in breathing, but they are unclear cause. Since it is the disease Bechterew a chronic rheumatic disease preferably the spine and the joint between the intestinal and sacrum ( ileosacral joint ) unknown cause, the participation of other joints, such as the rib-sternum joints ( Sternocostalgelenke ) is possible,

Tietze syndrome in pregnancy

The condition of pregnancy is in many ways a burden on the body. Ribs, which can lead to the expression of a Tietze syndrome depending on the location, are therefore no rare complaints during pregnancy. The enormous belly circumference increase favors the enormous stretching of the abdominal muscles. As the abdominal muscles partially attach to the rib area, the load can be transmitted to the ribs and sternum and cause symptoms of Tietze syndrome. Also, the fact that the rib elbow is subjected to pressure from the abdomen explains the development of the discomfort, as the stretch is transmitted to the articulation between the ribs and sternum. The intensity of the complaint may vary, but in most cases the symptoms resolve after birth.

It also looks different if the Tietze syndrome existed before the pregnancy. Then, of course, the symptoms may worsen and possibly be in need of treatment, so that conservative and medicinal therapeutic resources must be resorted to.

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