Why even your doctor might miss a Tietze’s syndrome diagnosis
I consider myself to be a fairly smart person, and I consider doctors in general to be pretty smart. However, Tietze’s syndrome is a rare disorder, so rare that even your doctor might miss the diagnosis (he’s going to be trying to decide between about three dozen different possibilities for your pain, and Tietze’s is way down on that list). Two general practitioners and two specialists missed my diagnosis of Tietze’s syndrome; it took one year for me to finally get diagnosed–and that made it a lot easier to deal with. This short article will let you know how to tell if you have Tietze’s syndrome–a benign inflammation of the ribs–or something more sinister, like Pleomorphic T-cell lymphoma, a rare cancer.
How to tell if you have Costochondritis or Tietze’s syndrome
(Small disclaimer, I’m going to assume that you’ve already seen a physician to make sure your Tietze’s syndrome pain isn’t caused by heart problems or other serious illness).
Tietze’s syndrome clue #1
Do you have intense pain in the rib cartilage area? That’s at the junction between your sternum and ribs. The pain could be so severe you might even mistake it for a heart attack. The pain may radiate, and you may not even be sure of the central location for the pain–just that it’s somewhere in or on your chest.
Tietze’s syndrome clue #2
Do you have pain in the chest area when rolling over in bed, or trying to get out of bed? This is caused by pressure from the ribs squeezing the inflamed breast plate cartilage. You might feel this pain when otherwise twisting, turning or bending.
Tietze’s syndrome clue #3
Does the pain radiate from the chest to the arms and shoulders? (The pain might be so severe it could feel like it is coming from everywhere).
Tietze’s syndrome clue #4
Is the pain worse when breathing? Sometimes even a little movement of the rib cage will cause intense pain.
Tietze’s syndrome clue #5
Lightly press down on the cartilage area between your sternum (breast plate) and ribs. Is it is tender and painful in at least one area highlighted in red?
These questions are the most common observations about Tietze’s syndrome and costochondritis. If you can answer yes to all five of these questions (or most of these questions–as you can tell, a diagnosis at this stage isn’t an exact science!), it is probably Tietze’s syndrome…but it could also be about one of dozens of other diseases (see my other articles here and here for other diseases that are often mistaken for Tietzes).
The Definitive Hallmark for Tietze’s Syndrome
The hallmark for Tietze’s syndrome is that in addition to the pain described above, usually only one rib is affected–the second or third rib down. There are rare exceptions–for example, if the swelling is in the first joint, it may be hidden under your clavicle and you won’t be able to feel the swelling. Feel the connections around your other ribs to see what’s normal for you. If you feel swelling at the first, second, or third junctions, you most probably have Tietze’s syndrome (according to Harrison’s Rheumatology). However, make sure you see a doctor: there are a couple of cancers that can cause one costal junction to be swollen and painful–namely skin cancer that has invaded the chest area and Pleomorphic T-cell lymphoma.
Can a Tumor be causing my Tietze’s Syndrome?
The chances of a tumor causing your pain are about as rare as Tietze’s syndrome itself (only a few hundred cases have ever been documented in the medical literature). However, the same tests that check for Tietze’s syndrome (an MRI or CT-scan) will also be able to definitively tell if you have a tumor. See this article for more information on cancers and other rare causes of Tietze’s syndrome, and this article for more information on tests.
Tietze’s syndrome(unlike cosotchondritis) can turn into a chronic condition lasting years, or even decades. Why should you get a diagnosis instead of waiting for the pain to go away? If your doctor tells you that you have “costochondritis,” you might expect the pain to disappear in a few weeks. If it doesn’t, you should insist on a test to rule out other causes.
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