Cardiovascular Medicine Book



Aka: Costochondritis, Costosternal Syndrome, Parasternal Chondrodynia, Anterior Chest Wall Syndrome
  1. See Also
    1. Chest Pain
    2. Chest Wall Pain
    3. Chest Wall Pain Prediction Rule
  2. Definitions
    1. Costochondritis
      1. Chest Wall Pain due to costochondral joint inflammation
  3. Epidemiology
    1. Peak Incidence age 40 to 50 years old
    2. Slightly more common in women
  4. Pathophysiology
    1. Chronic inflammation affecting the costochondral joints
    2. Idiopathic
  5. Symptoms
    1. Bilateral, parasternam Chest Wall Pain accentuated by respiratory movements (e.g. deep breathing, cough)
    2. Localized pain to the costochondral margin at ribs 2 to 5
    3. Affects more than one costochondral margin in most patients
  6. Signs
    1. NO swelling, erythema, warmth at costochondral margins (inflammatory changes absent)
    2. Costochondral margin tenderness
      1. Precaution: Many patients with Acute Coronary Syndrome also have Chest Wall Tenderness
    3. Palpation reproduces Chest Pain
    4. Crowing Rooster Maneuver
      1. Patient extends neck AND
        1. Places hands behind their head or
        2. Places hands, palms out, in front of chest, with flexed elbows and abducted Shoulders
      2. Provider pulls patients arms posteriorly and superiorly behind them
    5. Crossed Chest Adduction
      1. Ipsilateral arm adducted across chest AND
      2. Neck rotated toward ipsilateral Shoulder
  7. Differential Diagnosis
    1. See Chest Wall Pain
    2. See Chest Pain
    3. See Pleuritic Chest Pain
    4. Tietze Syndrome
      1. Local edema of involved joint
      2. Common unilaterally at second rib margin
      3. Provoked by infection or Trauma
  8. Evaluation
    1. See Chest Pain
    2. Evaluate Costochondritis as a diagnosis of exclusion
      1. Delayed Costochondritis diagnosis is not associated with significant adverse effects
      2. Missed coronary syndrome, Pulmonary Embolism, Aortic Dissection risks death
        1. At minimum, obtain a throrough Chest Pain history and exam, and at least an EKG in most patients
      3. No lab test or imaging test is definitive for Costochondritis
        1. Testing is intended to exclude other, more serious Chest Pain Causes
  9. Imaging
    1. See Chest Pain for non-musculoskeletal indications
    2. XRay Indications
      1. Respiratory symptoms (e.g. Shortness of Breath, cough)
    3. CT Chest Indications
      1. Neoplasm or infection-associated local destruction suspected
    4. Gallium Scanning Indications
      1. Infection suspected
  10. Management
    1. Avoid provocative activities
    2. Local measures
      1. NSAIDs
      2. Local heat or ice to the area
      3. Lidocaine 4% patch on for 12 of every 24 hours
      4. Diclofenac Gel applied to affected area
    3. Other measures that may have benefit
      1. Acupuncture
      2. Physical Therapy
        1. Small benefit with physical therapist directed targeted Stretching Program
        2. Rovetta (2009) G Ital Med Lav Ergon 31(2): 169-71 [PubMed]
  11. Prognosis
    1. Conservative management (rest, NSAIDs)
      1. Resolution within 3 weeks in 91% of patients, and a 4% recurrence rate after 2 years
      2. Boran (2017) World J Pharm Res 6(8): 76-85 [PubMed]
  12. References
    1. Chicarilli (1986) Plast Reconstr Surg 77(1): 50-9 [PubMed]
    2. Mott (2021) Am Fam Physician 104(1): 73-78 [PubMed]
    3. Proulx (2009) Am Fam Physician 80(6): 617-20 [PubMed]

Tietze's Syndrome (C0040213)

Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (CHV) a benign inflammation of one or more of the costal cartilages
Definition (MSHCZE) Bolestivé zduření jedné nebo více žeberních chrupavek (kostochondrálního spojení). Onemocnění obv. po čase samo ustupuje, léčí se analgetiky, někdy se místně podávají kortikoidy. Příčina je nejasná, původně popsáno jako mikrofraktury z přetížení nebo z únavy tkáně. (cit. Velký lékařský slovník online, 2013 )
Definition (MSH) Idiopathic painful nonsuppurative swellings of one or more costal cartilages, especially of the second rib. The anterior chest pain may mimic that of coronary artery disease. (Dorland, 27th ed.)
Concepts Disease or Syndrome (T047)
MSH D013991
ICD9 733.6
ICD10 M94.0
SnomedCT 64109004, 30128009, 156848001, 91226007, 203323007, 203529005, 268130001, 393606005, 203523006, 240136001
English COSTOCHONDRITIS, Chondritides, Costal, Chondritis, Costal, Costal Chondritides, Costal Chondritis, Tietze Syndrome, Tietze's Syndrome, Tietzes Syndrome, Syndrome, Tietze's, COSTAL CHONDRITIS, Costochondral junction syndrom, Chondrocostal junction syndrome [Tietze], Costochondritis NOS, TIETZE'S SYNDROME, Costalchondritis, Costalchondritis (disorder), Costal chondritis (disorder), Costal chondritis, costochondritis (Tietze's syndrome), costochondritis, costochondritis (diagnosis), Tietze disease, Tietze's Syndrome [Disease/Finding], chostochondritis, costal chondritides, slipping rib syndrome, costal chondritis, tietze's disease, tietze's syndrome, costalchondritis, costochondral junction syndrome, tietze syndrome, Costochrondritis, Cyriax's syndrome (disorder), Costochondritis (disorder), Costochondritis NOS (disorder), Tietze's disease, Costochondritis, Tietze's syndrome, Costochondral junction syndrome, Cyriax's syndrome, Peristernal perichondritis, Slipping rib syndrome, Tietze's disease (disorder), chondropathia tuberosa, chondritis; costal, Tietze, chondritis; costal, chondrocostal junction syndrome, chondrocostal junction; syndrome, costal; chondritis, Tietze, costal; chondritis, costochondral junction; syndrome, Tietze, overlap syndrome; chondrocostal (Tietze), syndrome; chondrocostal junction, syndrome; costochondral junction, Costalchondritis, NOS, Costochondritis, NOS, Tietzes syndrome
Dutch costale chondritis, syndroom van Tietze, ziekte van Tietze, costo-chondrale overgangssyndroom, slipping-rib-syndroom, Cyriax-syndroom, chondritis; rib, Tietze, chondritis; rib, chondrocostale overgang; syndroom, costochondrale overgang; syndroom, overgangssyndroom; chondrocostaal (Tietze), rib; chondritis, Tietze, rib; chondritis, syndroom; chondrocostale overgang, syndroom; costochondrale overgang, Chondropathia tuberosa [Tietze], costochondritis, Chondritis, costale, Chondropathia tuberosa, Costale chondritis, Syndroom, Tietze-, Tietze-syndroom
French Maladie de Tietze, Syndrome de la jonction costo-chondrale, Syndrome de Cyriax, Syndrome de la côte glissante, Syndrome sterno-costal de Tietze, Syndrome sternocostal de Tietze, Chondrite costale, Syndrome de Tietze, Syndrome des articulations chondro-costales, Syndrome des articulations chondrocostales
German kostale Knorpelentzuendung, Tietze-Krankheit, Gleitrippe, Cyriax Syndrom, Costochondritis, Chondritis, Kosto-, Kostochondritis, Tietze-Syndrom
Italian Condrite costale, Sindrome della giunzione costocondrale, Malattia di Tietze, Sindrome di Cyriax, Sindrome da slittamento costale, Sindrome costosternale, Costocondrite, Sindrome di Tietze
Portuguese Condrite costal, Síndrome da união costocondral, Doença de Tietze, Síndrome de costela deslizante, Síndrome de Cyriax, Costocondrite, Condrite Costal, Síndrome de Tietze
Spanish Síndrome de la unión costocondral, Enfermedad de Tietze, Condritis costal, Síndrome de Cyriax, Síndrome de la costilla deslizante, síndrome de Cyriax (concepto no activo), costocondritis, SAI (trastorno), costocondritis, SAI, síndrome de Cyriax, síndrome de la costilla deslizada, costalcondritis, costocondritis (trastorno), costocondritis, enfermedad de Tietze (trastorno), enfermedad de Tietze, pericondritis periesternal, síndrome de Tietze, síndrome de la articulación costocondral, Costocondritis, Condritis Costal, Síndrome de Tietze
Japanese ティーツェ病, 肋軟骨骨結合症候群, 肋軟骨炎, ロクナンコツエン, ティーツェビョウ, ロクナンコツコツケツゴウショウコウグン, ティーツェショウコウグン, すべり肋骨症候群, シリアクス症候群, スベリロッコツショウコウグン, シリアクスショウコウグン, Tietze症候群, ティーツェ症候群, 栄養障害性肋軟骨萎縮症, 肋骨軟骨炎, 軟骨炎-肋骨
Swedish Tietzes syndrom
Czech Tietzeův syndrom, Syndrom dislokovaného žebra, Syndrom kostochondrálního spojení, Tietzova nemoc, Cyriaxův syndrom, Kostochondritida, syndrom chondrokostálního spojení, Tietzův syndrom, kostochondritida
Finnish Tietzen oireyhtymä
Korean 연골갈비뼈 이행부 증후군[티체]
Polish Zespół Tietze'a
Hungarian Costochondritis, Elcsúszó borda syndroma, Tietze-betegség, Cyriax-syndroma, Costochondralis junctio syndroma, Tietze-syndroma, Costalis chondritis
Norwegian Kostokondritt, Tietze-syndrom, Tietzes syndrom, Ribbensbrusk-smertetilstand, Ribbeinsbrusk-smertetilstand
Derived from the NIH UMLS (Unified Medical Language System)

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