Tietze syndrome: symptoms, causes, treatment and how long it lasts

The ribs at the front of the chest join the breastbone through bands of cartilage. In Tietze syndrome, the cartilage at one of these joints becomes inflamed, tender and swollen. Patient.info's professional reference describes a tender, fusiform swelling of the costal cartilage at the costochondral junction that can be felt on examination.

Costochondritis describes tenderness at these junctions without that swelling. The NHS defines costochondritis as inflammation where your ribs join the breastbone, causing sharp chest pain. The professional reference says both are musculoskeletal causes of chest pain, and that the underlying pathology is thought to be localised inflammation.

Costochondritis is more common than Tietze syndrome, according to the same source.

The key features are localised pain and tenderness with a firm swelling over one rib joint. The professional reference says the pain usually settles by itself but the swelling may persist long after the tenderness has disappeared. There is commonly a history of a recent illness with coughing, or strenuous exercise.

For costochondritis, the NHS says the sharp pain may be worse when moving the upper body, lying down, breathing deeply, or pressing on the middle of the chest or ribs. The swelling is the feature that points towards Tietze syndrome rather than costochondritis.

The professional reference says Tietze syndrome can present at any age but is most common in people under 40, and affects males and females in equal proportions.

• A tender lump beside the breastbone, often at the second or third rib

• Usually one side and one joint

• Pain that may worsen with movement, deep breaths or pressing

• A recent cough or strenuous activity in some people

• Swelling that can outlast the pain

The two conditions are close relatives. The Patient.info professional reference calls both subtypes of chest wall pain, and says they are musculoskeletal causes of chest pain with localised inflammation as the likely mechanism. The main practical difference is swelling, which points towards Tietze syndrome.

The professional reference says the cause of Tietze syndrome is unknown. Preceding upper respiratory infections and excessive coughing have been described in some people. It can also appear after an injury, and it has been associated with a recent asymptomatic covid infection.

For costochondritis, the NHS says it is not always known what causes it, but it has been linked to chest injury, repetitive upper body movements like lifting, a lot of coughing, and infection.

The professional reference says diagnosis can usually be made from a careful history and examination. The challenge is to distinguish it from other causes of chest pain. It lists heart problems, pericarditis, heart failure, pneumonia, pulmonary embolism, aortic dissection, rib fracture and gastrointestinal causes.

Investigations may be needed to rule these out. The reference lists an ECG to exclude cardiac causes, a chest X-ray, and sometimes ultrasound, MRI or PET. It says Tietze syndrome may show raised inflammatory markers (CRP or ESR). Rarely, a persistent swelling can have another cause, and the reference mentions a case of non-Hodgkin lymphoma presenting this way, so a lump that does not settle should be reviewed.

The NHS chest pain page says most chest pain is not a sign of anything serious, but it advises getting medical advice just in case.

The professional reference says Tietze syndrome tends to be self-limiting and resolves in weeks. Simple analgesia, such as an NSAID or paracetamol, is often recommended if needed, and warm pads are sometimes suggested. It reports that a local injection of long-acting corticosteroid has been shown to help in Tietze syndrome if conservative measures had not helped for 3 months.

For costochondritis, the NHS says it usually gets better on its own and can last from a few weeks to several months. It says painkillers that help with inflammation, like ibuprofen, may be recommended, and that a steroid injection or local anaesthetic may be offered for very bad pain that does not improve over time.

The professional reference notes there are few good studies of treatment, and that physiotherapy has shown some benefit in small series.

The professional reference says the pain usually subsides within a few weeks, with most people reporting full resolution within 1 to 2 weeks and some residual swelling persisting for longer. It adds that the course varies from spontaneous remission to persistent symptoms that have been reported to last a year, and that recurrences are possible.

For costochondritis, the NHS says it can last from a few weeks to several months. The reference quotes one large study in which 91% of people with costochondritis had resolution within 3 weeks of rest and analgesia, with a recurrence rate of 4% at 2 years.

Call 999 for chest pain that started suddenly, spreads to the arm, neck or jaw, or makes the chest feel tight, which the NHS says could be a heart attack. Also call 999 for chest pain with difficulty breathing, a fast heartbeat or coughing up blood, which could be a pulmonary embolism, or sudden tearing chest or back pain. Do not drive yourself.

NHS 111 can help if you think you have costochondritis. See a GP if chest pain comes and goes or goes away quickly but you are still worried.

Most people with chest wall pain are assessed in general practice, where a history and examination may be followed by an ECG and chest X-ray to exclude heart and lung causes. NHS 111 can advise if you are unsure how urgent your symptoms are.

If symptoms persist, a further specialist opinion may be arranged. A private consultation may offer quicker imaging in some areas, but whichever route you use, the first priority is excluding heart and lung causes.