Tietze Syndrome

Tietze syndrome is a rare inflammatory condition that causes chest pain and cartilage swelling near your upper ribs. Symptoms include chest pain, swelling and tenderness near your ribs. Tietze syndrome treatments include rest, NSAIDs and corticosteroids.


An illustration of Tietze syndrome in a ribcage
Tietze syndrome happens when the cartilage in the joint where your ribs connect to your breastbone — your costochondral joint — is irritated

What is Tietze syndrome?

Tietze syndrome is a painful inflammation in the cartilage where your ribs attach to your breastbone (sternum). You might see it referred to as Tietze’s syndrome or costochondral junction syndrome. These names all refer to the same condition.

Cartilage is a strong, flexible connective tissue that protects your joints and bones. It acts as a shock absorber throughout your body. The cartilage that connects your ribs to your breastbone is stiff and strong to help your ribcage protect organs like your heart and lungs.

Tietze syndrome happens when the cartilage in the joint where your ribs connect to your breastbone — your costochondral joint — is irritated. This irritation leads to inflammation around the joint and causes chest pain and swelling.

Tietze syndrome is treated with rest and over-the-counter medicine. It usually takes a few weeks for the inflammation to go away and your symptoms to get better.

Tietze syndrome vs costochondritis

Tietze syndrome is very similar to costochondritis, another type of irritation in your costochondral joint.

The biggest difference between them is swelling and which ribs they usually affect.

Tietze syndrome causes pain, tenderness and swelling near affected costochondral joints. It usually affects ribs higher up on your ribcage, closer to your shoulders — usually your second or third ribs.

If you have costochondritis, you’ll feel pain that may start on the left side of your chest and spread (radiate) out to the rest of your chest. The symptoms are almost identical to Tietze syndrome, except costochondritis doesn’t cause swelling that you can see or feel outside your body. It usually affects ribs lower down your ribcage — usually ribs two through five.

Because Tietze syndrome and costochondritis are so similar, they’re sometimes confused for each other. The good news is they’re usually treated and diagnosed the same way. Talk to your healthcare provider if you have any pain or swelling in or around your chest.


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Who does Tietze syndrome affect?

Tietze syndrome can affect anyone, but it’s more common in people under 40. People older than 40 are more likely to experience costochondritis rather than Tietze syndrome.

You might be more likely to irritate your costochondral joint and develop Tietze syndrome if you have certain conditions, including:

How common is Tietze syndrome?

Tietze syndrome is rare. Experts don’t know exactly how many people each year develop Tietze syndrome because it’s not recorded very often.


How does Tietze syndrome affect my body?

The most obvious way Tietze syndrome will affect you is the pain in your chest.

Depending on which ribs are affected, it might hurt more when you move or twist your upper body. It can also hurt to sit or lie down in certain positions.

Coughing, sneezing and vomiting while you have Tietze syndrome will be painful.

Symptoms and Causes

What are the symptoms of Tietze syndrome?

Symptoms of Tietze syndrome include:

  • Chest pain.
  • Tenderness on or near your ribs.
  • Swelling.
  • A feeling of warmth.
  • Discoloration.

Your symptoms might appear suddenly or develop over time.


What causes Tietze syndrome?

Experts aren’t sure what causes Tietze syndrome. Some experts think activities that put small, repeated stress on your ribs over time (microtraumas) can lead to Tietze syndrome. Microtraumas can include:

  • Coughing.
  • Vomiting.
  • Infections.
  • Getting hit in the chest frequently during a sport or other physical activity.

Studies have found that traumas like car accidents, falls and sports injuries might cause Tietze syndrome.

Diagnosis and Tests

How is Tietze syndrome diagnosed?

Diagnosing Tietze syndrome is sometimes called a diagnosis of elimination. This means your provider might do an exam and perform tests to rule out other, more serious conditions before diagnosing Tietze syndrome as the cause of your pain.

Your provider will diagnose Tietze syndrome with a physical exam and imaging tests.

They’ll feel your chest and ribs. They might press on your chest to feel how sensitive you are and to pinpoint where your pain is most intense (localized). They’ll examine your torso for other signs of injuries or conditions that might be causing your symptoms.

You might need a blood test to check for infections or other issues.

Your provider may also need some imaging tests, including:

Management and Treatment

How is Tietze syndrome treated?

Tietze syndrome is usually treated by resting your chest and ribcage. Your body needs time to heal the irritation inside your costochondral joint. Over-the-counter NSAIDs can lower your pain and reduce swelling. Talk to your provider before taking NSAIDs for more than 10 days in a row.

It’s rare, but if your symptoms aren’t improving after a few weeks, your provider might inject a corticosteroid into your joint to reduce the inflammation.

Some people with Tietze syndrome get better without treatment, but don’t assume you don’t need treatment. Visit your provider as soon as you notice swelling on or around your chest, especially if you’re in pain.

How long does Tietze syndrome last?

Tietze syndrome usually lasts for a few weeks, but it depends on how long it takes the inflammation in your costochondral joint to heal. Some people’s bodies take longer to repair the damage inside their joints, but Tietze syndrome shouldn’t last more than a few months.

Talk to your provider if you’re still experiencing pain and other Tietze syndrome symptoms after a few weeks.


How can I prevent Tietze syndrome?

Because experts aren’t sure what causes Tietze syndrome, it’s hard to say for sure how you can prevent it.

In general, avoid putting too much stress on your chest and ribs. Make sure to rest after intense physical activity to give your body time to recover.

Outlook / Prognosis

What can I expect if I have Tietze syndrome?

You should expect to make a full recovery from Tietze syndrome. Once the inflammation is healed, you should be able to return to all your usual activities with no long-term effects.

The worst part of Tietze syndrome is usually the chest pain that makes people think they’re having issues with their hearts. Get new symptoms examined right away to rule out something more serious.

Will I need to miss work or school while I’m recovering from Tietze syndrome?

You shouldn’t have to miss work or school while you’re recovering if you can do your job or studies without putting too much stress on your ribs.

Talk to your provider before resuming any intense physical activity, especially if you’re recovering from a sports injury.

Living With

When should I see my healthcare provider?

Visit your provider right away if you notice any new symptoms in or around your chest, especially pain or swelling. Tietze syndrome isn’t usually a dangerous condition, but it’s important to rule out other, more serious issues as soon as possible.

When should I go to ER?

Call 911 or your local emergency services phone number if you think you’re experiencing heart attack symptoms, including:

  • Shortness of breath or trouble breathing.
  • Nausea or stomach discomfort.
  • Heart palpitations.
  • A feeling of anxiety or “impending doom."
  • Sweating
  • Feeling lightheaded or dizzy.

What questions should I ask my doctor?

  • Do I have Tietze syndrome or costochondritis?
  • Which tests will I need?
  • How long will it take to heal?
  • Which activities should I avoid while I’m recovering?
  • When can I resume physical activities like sports?

Which conditions have similar symptoms to Tietze syndrome?

In addition to costochondritis, Tietze syndrome has symptoms that are similar to a lot of other conditions. Some of the most common conditions that can also cause pain in your chest or around your ribs include:

Visit your provider if you have new symptoms in your ribs or chest. Tietze syndrome doesn’t usually cause breast pain or muscle pain.

A note from Cleveland Clinic

It’s scary to experience chest pain, especially if it happens suddenly. But Tietze syndrome isn’t a sign of anything wrong with your heart. It’s temporary inflammation that will get better.

Because Tietze syndrome is rare and shares symptoms with so many other conditions, don’t ignore pain or swelling near your ribs. The sooner you see your provider, the faster you can get back to your regular routine pain-free.

Medically Reviewed

Last reviewed on 07/26/2022.

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