Intercostal cartilage. Perichondritis or Tietze syndrome: causes and treatment of the inflammatory process in the cartilage tissue of the ribs

Chest pain is a very common complaint among people of any age, including children. Many patients immediately consider such symptoms to be manifestations of heart disease, but this is far from the case. There are many pathological processes that are accompanied by pain in the chest, among them there is a disease such as Tietze syndrome.

What it is

Tietze syndrome (or costochondritis) is an inflammatory lesion of one or more costal cartilages. This pathology was first described in 1921 by the German physician A. Titze.

All the anterior ends of the ribs end in costal cartilages, through which they are connected to the sternum and to each other. The main function of these cartilaginous formations is to attach the ribs to the sternum and provide elasticity to the walls of the chest. The first 7 pairs of cartilage are attached directly to the sternum, the next 3 pairs articulate with the cartilage of the rib located above, and the last 2 pairs end blindly in the wall of the abdominal cavity.

Schematic structure of the chest

According to international classification diseases of the 10th revision (ICD-10), costochondritis has the code M94.0 (cartilaginous costal junction syndrome - Tietze).

The disease is quite rare, usually affecting older children and adolescents, as well as adults under 40 years of age. Men and women get sick equally often.

Causes and risk factors

Define real reasons To date, the development of Tietze syndrome has not been successful. Alexander Titze believed that inflammation of the costal cartilages develops due to rational nutrition and, as a consequence, due to violation metabolic processes in the body, which lead to dystrophic changes cartilage tissue.

On this moment Experts have developed 3 theories about the possible origin of the disease:

Traumatic theory

The point is that constant microtrauma of the cartilage tissue of the costal cartilages in people of a certain type of occupation (athletes, workers physical labor) or suffered serious injuries to the chest, organ surgery chest cavity provoke an abnormal process of regeneration of the perichondrium. Cartilage cells, which are formed in this case, differ from normal ones, in addition, they are formed in excess quantities.

This is accompanied by the development of aseptic inflammation, as well as compression or irritation of nearby nerve fibers, which causes the development of symptoms of Tietze syndrome and pain.

This theory has received many clinical confirmations today, so it occupies a leading place in the etiology of this disease.

Athletes are at risk of developing Tietze syndrome due to frequent injury

Infectious-allergic theory

IN in this case The development of costochondritis is associated with past infections, especially damage to the respiratory system. As a result of such infections, normal operation immune system of the body, which leads to the formation of a peculiar allergic process. In this case, the antibodies that are formed have the ability to affect the cartilage tissue of the ribs.

Alimentary-dystrophic theory

According to this theory, dystrophic disorders in cartilage tissue develop due to dysmetabolic processes, which are facilitated by a violation of a balanced diet. In particular, Tietze syndrome may be one of the manifestations of a deficiency in the body of calcium, vitamins B, C, D. At the moment, this theory is practically not considered by specialists as the etiology of costochondritis.

Deficiency of vitamins and microelements can provoke the development of Tietze syndrome

The main risk factors for developing Tietze syndrome include:

• daily physical exercise which involve the shoulder girdle and chest;
• frequent damage and microtrauma to chest structures;
• bruises and fractures of the chest skeleton;
• respiratory diseases, especially chronic ones;
• past infectious diseases;
• autoimmune processes and systemic diseases connective tissue;
• history of arthrosis and arthritis;
• tendency to allergic reactions;
• metabolic disorders in the body;
• endocrinological pathology.

How the disease develops

In most cases, Tietze syndrome is unilateral and is more common on the left side of the chest. In 60% of cases, the cartilaginous zone of the 2nd rib is inflamed, in 30% of cases the cartilage of the 2-4 ribs is inflamed, and in 10% the costal cartilage of the 1st, 5th, 6th ribs is affected.

The disease has a long course with periods of exacerbations and remissions. A few months after the onset of inflammation, degenerative-dystrophic changes begin in the cartilage tissue. Cartilage loses its shape, decreases in size, and becomes intractable. Some of them are impregnated with calcium salts and are susceptible to the process of sclerosis. The damaged area appears bone density, which contributes to the development of visible deformation of the chest, reducing its motor efficiency and elasticity.

Pectus excavatum may be a consequence of Tietze syndrome

Symptoms of costochondritis

Unfortunately, Tietze syndrome does not have pronounced clinical signs, therefore identify this violation is often problematic. As already mentioned, the pathology is characterized by a long course with periods of exacerbations and remissions.

Important! Tietze syndrome has a benign course. That is, an exacerbation most often goes away on its own and does not require drug treatment. In addition, the pathology is very rarely accompanied by any complications or negative consequences.

The main symptoms of the debut or exacerbation of Tietze syndrome:

• painful sensations in the anterior region of the chest, which are most often acute in nature, but aching in nature is also possible pain syndrome;
• increased pain with movement and deep breathing;
• the pain also intensifies when pressing on the affected rib cartilage;
• swelling or swelling in the area of ​​inflammation;
• the appearance of crepitus during movements in the area of ​​damaged cartilage tissue.

Pain in the sternum is the main symptom of costochondritis

Some patients experience additional symptoms:

• anxiety, irritability, fear;
• cardiopalmus;
• sleep disturbance;
• development of shortness of breath;
• lack of appetite;
• temperature increase;
• redness in the area of ​​damage to the costal cartilage.

As a rule, an exacerbation lasts from several hours to several days. If the disease progresses, it becomes difficult for the patient to lie on his side or carry out any movements. upper limbs and torso. The pain also intensifies when coughing, sneezing, or laughing.

Symptoms of Tietze syndrome subside on their own. But if the pain is intense and interferes daily activities person, then treatment is needed. By the way, the use of non-steroidal anti-inflammatory drugs is a peculiar diagnostic test. If pain decreases or disappears after taking NSAID tablets With high probability Tietze syndrome should be suspected.

Complications and consequences

Complications of Tietze syndrome develop extremely rarely. But sometimes a syndrome of excessive calcification of cartilage tissue develops. This is accompanied by ossification of the costal cartilages, their deformation and loss of basic functions. In this case, the pain may intensify and become chronic.

In such cases, the breathing process may be disrupted and develop respiratory failure due to chest rigidity. One more possible consequence is a deformation of the chest.

Diagnostic methods

Diagnosis of Tietze syndrome is difficult and is based on clinical symptoms and patient history. No specific laboratory signs does not exist. There are no changes in general and biochemical analyzes urine and blood. If the disease has developed for the first time, then there may be nonspecific signs inflammation - inflammation increase in ESR, appearance C-reactive protein, shift leukocyte formula to the left.

Radiography can be used as an additional diagnostic method. In this case, in the image you can see a thickening of the costal cartilages in the form of a spindle in the front of the costal bones.

Chest X-ray allows diagnosis of Tietze syndrome

If the doctor remains in doubt, he may prescribe a magnetic resonance imaging scan. This research method allows you to visualize in detail everything pathological changes, which occurred in the tissues of costal cartilage. Can also be used for diagnostic purposes CT scan and ultrasound diagnostics.

Conduct differential diagnosis Tietze syndrome with the following diseases:

• rheumatic fever;
• chest injuries;
• diseases of the mammary glands in women;
• illnesses of cardio-vascular system– angina pectoris, myocardial infarction, cardialgia;
• intercostal neuralgia;
• myositis;
• tumor formations in this area;
• ankylosing spondylitis.

In case of development of symptoms that resemble Tietze syndrome, you need to contact specialists such as a neurologist, orthopedic traumatologist, or family doctor.

Treatment of Tietze syndrome

As a rule, Tietze syndrome does not require any treatment and completely goes away on its own after a few hours to a day. But in cases where pain is severe and other symptoms of pathology are present, specific therapy may be required.

Conservative treatment

An indispensable standard conservative therapy costochondritis is the use of non-steroidal anti-inflammatory drugs - Diclofenac, Piroxicam, Indomethacin, Meloxicam, Celecoxib, Etoricoxib, Ketoprofen, Nimesulide. These drugs can be used in the form of tablets, injection solutions, ointments, gels, and patches for local use. Experts also recommend supplementing treatment with warming medications for local application– Capsicam, Finalgon, Fastum-gel, etc.

The course of therapy is usually from 3 to 7 days. At this time, the patient must also observe a regimen - complete physical rest, avoidance of hypothermia.

A good addition to drug therapy is physiotherapeutic treatment. Most often in such patients positive effect observed when using:

• laser treatment,
• electrophoresis,
• phototherapy,
• darsonvalization.

If the pain syndrome cannot be relieved by the described methods, then resort to intercostal blockades using local anesthetics, glucocorticosteroid hormones.

Intercostal blockade allows you to eliminate even very intense pain with Tietze syndrome

Surgical intervention

Surgery is the last resort for patients with Tietze syndrome. Surgery is used only if all other treatment methods are ineffective. The essence of the operation is subperiosteal resection of damaged costal cartilages.

Prevention and prognosis

To prevent further exacerbations of costochondritis, you can follow these simple recommendations:

• avoid hypothermia;
• minimize excessive physical activity;
• protect yourself from injury;
• regular Spa treatment, mud resorts are especially useful;
• rational and healthy nutrition;
• timely treatment of infections respiratory tract.

The prognosis of the disease is favorable. To avoid possible complications, you just need to consult a doctor in time, who will prescribe the appropriate treatment.

Perichondritis of the costal cartilages is an inflammatory disease that develops in the perichondrium - a thin connective tissue membrane that envelops the cartilage like a case.

The pathological process can develop as primary (appears during acute or chronic injuries of the costal cartilage) or secondary (when a microbial agent is introduced from an infectious focus already existing in the body).

Manifested by pain and swelling of the affected area. When suppuration occurs, the tissue may melt and form a fistula. The diagnosis is made based on clinical symptoms, ultrasound and fistulography (for purulent processes). Treatment of perichondritis can be conservative or surgical.

Total information

Perichondritis of the costal cartilages is not observed as often as other lesions chest wall. It should also be borne in mind that inflammation of the perichondrium is generally less common than inflammatory lesions of other tissues.

Damage to the perichondrium of the costal cartilages is more common than other perichondritis - along with the same and auricle it makes up the top 3 perichondritis in terms of frequency of occurrence. At the same time, perichondritis of the costal cartilages is more often observed due to trauma than similar damage to other locations. Thus, inflammation of the connective tissue membrane of the ear cartilages mainly develops during purulent processes in the area of ​​the outer and middle ear, and perichondritis of the laryngeal cartilages is often a complication of intubation or radiation therapy with cancer of the larynx.

note

In comparison with other perichondritis, the described disease develops against the background infectious lesion much less often than against the background of trauma.

All perichondritis of the costal cartilages are divided into:

• aseptic - without the participation of an infectious agent;
• purulent - with the addition of microbial pathogens.

Causes

All the main causes of the development of perichondritis of the costal cartilages can be divided into groups:

• physical;
• chemical;
• infectious.

The physical reasons for the formation of this pathological process are:

• mechanical;
• thermal;
• radioactive.

Mechanical reasons that can provoke the development of perichondritis of the costal cartilages include

• non-penetrating;
• penetrating.

Non-penetrating injuries are bruises of the chest in the area of ​​the costal cartilages. The chest wall is often injured, which explains the “leadership” of injuries among other factors that cause an inflammatory process in the perichondrium of the costal cartilages. Injury can happen:

• household;
• production;
• sports;
• criminal.

A separate mechanical cause of perichondritis of the costal cartilages is violation of the integrity of the periosteum during operations on chest.

Everyday life is a “storehouse” of conditions for the subsequent development of perichondritis of the costal cartilages. Bruises can be easily caused by:

• due to inappropriate living conditions - in particular, cramped rooms filled with furniture;
• when bulky objects (mezzanines, shelves) fall;
• as a result of noisy children's games or capricious behavior of a child, who can purposefully or unintentionally hit the mother in the chest area.

Injury in industrial conditions, which can lead to the development of perichondritis of the costal cartilages, occurs in most cases when the principles of labor protection are not observed at work or when safety rules are ignored. By production we mean conditions not only in a factory or plant, but also in agriculture.

Thus, the occurrence of the described disease is quite often observed in workers who care for farm animals - a horse can hit the chest with its hoof, a cow can butt it with its horn, and so on.

Sports injury is also one of the most common reasons development of perichondritis of the costal cartilages. Athletes who engage in strength and team sports are mainly exposed to traumatic danger - these are:

• wrestlers;
• boxers;
• hockey players;
• basketball players;
• football players

Also often injured:

• skiers;
• cyclists;
• jumpers.

Somewhat less frequently, perichondritis of the costal cartilages is diagnosed in people who have been subjected to physical violence (beating):

• in family;
• in a criminal environment.

Penetrating wounds of the chest, which can lead to the development of the described pathology, are punctured, cut, torn, chopped, etc.

Thermal factors that can provoke the development of perichondritis of the costal cartilages are mainly low temperatures. Banal ignorance of clothing according to the season can provoke the occurrence of this pathology. Especially often it develops against the background.

But critically elevated temperatures can also cause the formation of this disorder - for example, inflammatory processes in the perichondrium can occur with.

The radioactive factor leads to the development of perichondritis of the costal cartilages less often than others physical factors. Most often this happens due to:

• frequent chest;
• radiation therapy prescribed for malignant tumors chest organs;
• contact with radioactive substances or equipment due to professional activity– often due to the same personal failure to comply with safety regulations or inadequate labor protection conditions at work.

Chemical factors that can lead to the development of perichondritis of the costal cartilages include chemical substances, which by contact, with the blood or lymph flow, entered the tissue of the perichondrium and provoked the occurrence of inflammatory process.

Such toxic compounds are:

• exogenous;
• endogenous.

Exogenous provoking toxins include chemicals that are used in everyday life, in production and in agriculture.

Endogenous toxins are those produced in the human body. Most often their synthesis occurs:

• directly in human tissues due to a pathological process - most often suppuration and necrosis (death);
• during development infectious process– such toxic substances are toxins of microorganisms that are released during their life activity or are formed as decay products of dead microbial bodies.

IN the latter case damage to the perichondrium develops against the background of a general infectious disease:

Less commonly, perichondritis of the costal cartilages is formed due to a local infectious lesion.

As for the specifics of the pathogen, the disease described is mainly caused by damage to a nonspecific infectious agent - this is:

and others.

Very rarely, specific and perichondritis of the costal cartilages are formed, but the possibility of their development should also be remembered.

Purulent perichondritis of the ribs often appears due to reasons such as:

• open chest injury accompanied by damage to the costal cartilages;
• contact spread of infection.

The latter can occur with such diseases, How:

• – inflammation of the mediastinum (organs located between the lungs);
• pleural empyema – diffuse purulent lesion pleura;
• sternum and ribs (for example, post-traumatic) - purulent melting of them bone tissue, which leads to the formation of fistulas (pathological passages).

Development of pathology

The perichondrium is similar in its functions to the periosteum (the connective tissue membrane covering bone structures) - first of all, it:

• provides blood supply to cartilage (in this case, costal cartilage);
• protects it from the influence of various harmful factors.

On the other hand, pathological processes in the periosteum and perichondrium occur differently. In addition, their consequences are also different - this difference is explained different structure and nutrition of bones and cartilage. Bone structures have their own blood vessels and receive nutrients not only from the outside (from the periosteum), but also from the inside (from bone marrow). Cartilaginous structures do not have blood vessels, therefore the perichondrium acts as single source nutrients. The result is that with periostitis, bone necrosis does not always develop, but destruction or detachment of the perichondrium in any case provokes cartilage necrosis. This state of affairs emphasizes the importance of the perichondrium and the fact that any damage to it (in this case, perichondritis) can lead to critical consequences.

Unlike the periosteum, the perichondrium does not have pronounced proliferative properties (the ability to grow). Therefore, when the inflammatory process develops in it, excess cartilage is not formed. As a result, the only forms of perichondritis (in this case, costal cartilage) that matter are the aseptic and purulent forms of the lesion.

Acute inflammatory changes during perichondritis of the costal cartilages can develop over a long period of time – up to 3 months. During this period, foci of destruction (destruction) are formed in the perichondrium, from which infectious agent penetrates into the central part of the cartilage. Chondritis gradually forms, which spreads beyond the primary purulent focus, and from the affected central areas of the cartilage, provoking microorganisms enter the unchanged perichondrium. Such features of the spread of the purulent process lead to damage to large areas of cartilage. After 3 months, the inflammation of the perichondrium gradually regresses, tissue regeneration (restoration) is observed, but necrosis of the cartilage tissue may continue.

The cartilage destroyed due to perichondritis is replaced:

• more often - scar tissue;
• less often - bone.

Complete restoration of cartilage occurs very rarely.

Symptoms of rib perichondritis

The clinical picture of perichondritis of the costal cartilages largely depends on its shape.

With aseptic perichondritis, symptoms, having arisen, will increase, then a gradual regression of symptoms is noted. At the same time, symptoms purulent form The described pathology can only increase over time - this state of affairs is explained by the destruction (destruction) of cartilage and the formation of fistulas.

The clinical picture of aseptic perichondritis is manifested by local signs - these are:

• pain;
• breathing disorder.

Characteristics of pain syndrome:

• by localization - in the area of ​​the affected costal cartilages;
• by distribution - there is no irradiation as such, but in some cases pain can spread to bone fragment affected rib;
• by nature - the “range” of pain sensations is different, it can be stabbing, aching, tugging pain;
• by severity - intensity depends on the degree of damage, as well as pain threshold patients. Often, with minor perichondritis of the costal cartilages, patients complain that pain prevents them from working, sleeping and generally living as usual;
• by occurrence - they appear almost with the beginning of the development of the pathological process in the perichondrium, and as it progresses they intensify. Also, increased pain is observed with movements and deep breathing.

With the aseptic form of the described pathology, the general condition often does not worsen.

The purulent form of perichondritis of the costal cartilages manifests itself:

• local signs;
• violation general condition body.

Local symptoms are most indicative. When visiting a doctor, the patient complains of typical signs suppuration, which successively replace each other. First, an infiltrate forms in the affected area - tissue compaction. After a certain period of time (on average it can last from 3-4 to 7 days), the dense lesion softens. At severe course inflammation can spread throughout bottom part chest and top part front abdominal wall. The formed abscess is opened - often through the skin (in this case the patient complains of purulent discharge from the “hole”), less often through the posterior perichondrium (pain in the chest will bother you). In the first case, a fistula is formed, in the second - purulent leaks in the soft tissues.

The characteristics of pain with purulent perichondritis of the costal cartilages are as follows:

• by localization - in the affected area;
• by distribution - along the ribs on the affected side;
• by nature - at first vague aching, then jerking, with large abscess– pulsating;
• by intensity - by early stages the diseases are minor, they grow as the abscess matures, and can be very severe;
• by occurrence - appear when the first inflammatory changes appear in the perichondrium, intensify with any activity in the chest area on the affected side.

Signs of a general condition disorder are:

• hyperthermia – increased body temperature. Can reach 38.5-39.0 degrees Celsius;
• general weakness caused by the products of the purulent process entering the bloodstream;
• malaise;
• loss of appetite;
• decreased performance – both mental and physical.

Diagnostics

The diagnosis of perichondritis of the costal cartilages is made on the basis of the patient’s complaints, anamnesis data (history of the disease), results additional methods research – physical, instrumental, laboratory.

Physical examination findings will be as follows:

Instrumental research methods that are used in the diagnosis of perichondritis of the costal cartilages are as follows:

Laboratory diagnostic methods used for perichondritis of the costal cartilages are as follows:

• – an increase in the number of leukocytes and ESR is determined;
• microscopic examination of the biopsy - allows you to confirm inflammatory nature pathological process and identify pathogens;
• bacteriological examination - if there is pus in the punctate, it is inoculated on nutrient media, and the infectious agent that provoked the development of the purulent process is determined from the grown colonies.

Differential diagnosis

Differential (distinctive) diagnosis of perichondritis of the costal cartilages is primarily carried out with such pathologies as:

Complications

Most often, a complication of aseptic perichondritis of the costal cartilages is the addition of an infectious agent with the subsequent development of purulent perichondritis.

Complications of the septic (purulent) variety of the described pathology most often are:

• fistula;
• chest wall - its diffuse purulent lesion;
• empyema of the pleura.

Treatment of rib perichondritis

Treatment methods depend on the type of pathological process. In all cases they are general and local.

With the development of aseptic perichondritis of the costal cartilages general purposes the following:

• functional rest of the chest;
• non-steroidal anti-inflammatory drugs (NSAIDs);
• antibacterial drugs - for the prevention of septic complications.

The following are used as local treatments:

• physiotherapeutic methods;
• blockade with novocaine - with severe pain.

The most effective methods of physiotherapeutic treatment are:

• dry heat.

If signs of suppuration appear, surgical treatment is performed:

• the purulent focus is opened;
• the abscess cavity is washed with antiseptics;
• carry out drainage.

IN postoperative period are prescribed, the drains are washed, the bandages are changed.

If the perichondrium is critically damaged and cartilage is involved in the pathological process, it must be removed. If pus spreads to the bone fragment of the rib, 2-3 cm of bone tissue is removed.

Prevention

The main measures to prevent this pathology are as follows:

• avoiding injury, exposure to too low or too much high temperatures, radioactive exposure;
• identification and elimination of infectious foci in the body;
• avoiding contact with toxic substances.

Forecast

The outcome of perichondritis of the costal cartilages is generally favorable. The aseptic type of pathology is typical inflammatory lesion, general principles treatments for which have been successfully developed.

The prognosis worsens with purulent type diseases. In this case, they will help cope with the disease timely diagnosis and adequate surgical treatment.

In the literature, Tietze syndrome can be found under different names: perichondritis, anterior chest wall syndrome, costal chondritis, idiopathic costochondral pain syndrome, etc. However, they all mean a connective tissue disease, which manifests itself as inflammation of the costal cartilages in the upper part of the sternum . Tietze syndrome is most often observed in adolescents between 12 and 14 years of age and in adults between 20 and 40 years of age. As a rule, the lesion is unilateral, but in practice there are other cases. Despite the fact that Tietze syndrome is considered to be a relatively harmless disease that can go away without treatment, it often causes a person regular pain and discomfort in the chest area.

Causes of Tietze syndrome

The German surgeon Tietze, after whose name the anterior chest wall syndrome was named, considered its main cause to be insufficient nutrition, which leads to metabolic disorders (for example, hypovitaminosis or calcium metabolism). In his opinion, the disease can also be provoked by frequent illnesses upper respiratory tract, accompanied severe attacks cough.

In fact, the exact causes of Tietze syndrome have not been established to this day, since costochondritis is considered rare pathology. At the same time, it is possible to identify several factors that actively contribute to the emergence and development of of this disease:

• Regular physical activity on the upper shoulder girdle;
• Constant physical activity on the chest;
• Periodic microtraumas of the chest, for example, bruises when practicing certain combat sports;
• Respiratory diseases;
• Past infectious diseases;
• Allergy;
• Autoimmune diseases;
• Collagenosis;
• Arthritis;
• Arthrosis.

We can say that the cause of Tietze syndrome is often any disease, disruptive exchange in connective tissues and reducing the immunological properties of the human body.

Since blood circulation in cartilage tissue after surgical intervention is damaged and is more susceptible to infection, Tietze syndrome can also be caused by surgery in the chest area.

Symptoms of Tietze syndrome

Tietze syndrome does not have pronounced symptoms, so it is usually very difficult to determine: doctors often make mistakes with the diagnosis. However, some basic symptoms of Tietze syndrome can be mentioned:

• Acute attacks of pain in the front of the chest;
• Movement of pain down or to the left area of ​​the sternum;
• The center of pain is usually the fourth, fifth and sixth ribs;
• With any movement of the body, the pain worsens;
• With deep breathing, pain also intensifies and, conversely, at rest and during easy breathing– retreat;
• When you press your fingers into the area where the ribs attach to the sternum, noticeable pain is observed.

It should be noted that the last symptom of Tietze syndrome on the list is the most common sign of the disease. If no pain is felt during palpation in the area of ​​the junction of the chest and ribs, the likelihood of having this disease is extremely low.

Another characteristic symptom of Tietze syndrome is a slight swelling in the area of ​​the affected costal cartilage. As a rule, its size is 3-4 cm and it has a dense surface. Any touch to this area causes the person to painful sensations. If a patient has one of these main signs, the development of Tietze syndrome can be assumed.

In some patients, the above symptoms of costochondritis are accompanied by shortness of breath, decreased appetite, insomnia and tachycardia. Rarely additional symptoms Tietze syndrome involves swelling of the skin in the chest area and local increase temperature.

X-rays are practically meaningless when diagnosing this disease, since early stages does not reveal the occurrence of costochondritis. It is necessary only to exclude the presence of lung diseases or all kinds of cancer during examination. To determine Tietze syndrome, it is recommended to undergo a computed tomography scan, which can recognize changes characteristic of the disease in the early stages.

Treatment of Tietze syndrome

Many experts agree that complete treatment of Tietze syndrome is possible only with the help of surgical intervention. But subperiosteal resection, which is performed in such situations, is considered extreme case, since costochondritis often does not bother patients much, even for decades. Some of them do not even suspect the existence of Tietze syndrome, since there are no characteristic symptoms not visible.

That is why treatment of Tietze syndrome, as a rule, comes down to the use of the most common conservative methods:

• Local therapy using various ointments and gels that have an anti-inflammatory effect;
• Compresses with dimexide;
• Physiotherapeutic treatment and reflexology;
• Novocaine blockade of intercostal nerves;
• Injections of an anesthetic with a steroid into the area where the pain is located;
• Non-steroidal anti-inflammatory drugs and analgesics.

Treatment of Tietze syndrome using such methods, of course, will not help eliminate fibrocystic formation. However, these drugs help reduce swelling and inflammation, and also alleviate pain. On the other hand, Tietze syndrome is considered chronic disease, which, even if it disappears for a while, still returns. Thus, from constant use Anti-inflammatory and pain-relieving medications may cause side effects.

Treatment of Tietze syndrome with folk remedies

Some recipes may also help with costochondritis traditional medicine. Main folk remedies Treatments for Tietze syndrome are:

• Therapeutic baths;
• Decoctions;
• Compresses;
• Rubbing.

For medicinal bath you need to pour 300 g pharmaceutical chamomile 5 liters of boiling water, leave for an hour and strain. Pour the decoction into the bath with warm water. It is recommended to take such a bath for 20 minutes every other day. Instead of chamomile, sage and fresh spruce branches are also used.

Treatment of Tietze syndrome with folk remedies using decoctions is aimed primarily at improving blood circulation and increasing immunity. As a rule, the following are used for decoctions: medicinal components How:

• St. John's wort;
• Sage;
• Thyme;
• Yarrow;
• Juniper fruits;
• Nettle roots.

Compresses for Tietze syndrome are made from a decoction of rosemary, steamed lemon balm leaves or horseradish. A shawl or warm cloth should be tied over the applied compress.

Rubbing the chest with a bear or pork fat. Often rubbed into inflamed areas alcohol tinctures from eucalyptus and birch buds. After the procedure, you need to cover yourself with a warm blanket to prolong the warming effect.

However, it should be remembered that before practicing treatment of Tietze syndrome with folk remedies, you must consult a doctor.

– a disease from the group of chondropathy, accompanied by aseptic inflammation of one or more upper costal cartilages in the area of ​​their articulation with the sternum. It manifests itself as local pain at the site of the lesion, aggravated by pressure, palpation and deep breathing. Typically occurs without visible reasons, in some cases there may be a connection with physical activity, operations in the chest area, etc. The diagnosis is made on the basis of complaints and examination data after excluding more serious pathologies using radiography, ultrasound, CT and other studies. Treatment is usually conservative: NSAIDs, blockades, physiotherapy.

Tietze syndrome also has to be differentiated from rheumatic diseases(fibrositis, spondyloarthritis, rheumatoid arthritis) and local lesions of cartilage and sternum (costochondritis and xyphoidalgia). To exclude rheumatic diseases, a number of special tests are performed. Costochondritis is indicated by the absence of hypertrophy of the costal cartilage; xyphoidalgia is indicated by pain in the area that increases with pressure. xiphoid process sternum.

In some cases, Tietze syndrome is clinical picture may resemble intercostal neuralgia (both diseases are characterized by long-term pain aggravated by movement, sneezing, coughing and deep breathing). Tietze syndrome is supported by a less pronounced pain syndrome, the presence of dense swelling in the area of ​​the costal cartilages and the absence of a zone of numbness along the intercostal space. Changes in biochemical composition blood, general analyzes There is no blood or urine in Tietze syndrome. Immune reactions are normal.

Treatment of Tietze syndrome

Treatment is carried out by orthopedists-traumatologists. Patients are under outpatient observation; hospitalization, as a rule, is not required. Patients are prescribed local treatment using ointments and gels containing non-steroidal anti-inflammatory drugs. Compresses with dimexide are also used. In case of severe pain, NSAIDs and painkillers are prescribed for oral administration.

For persistent pain combined with signs of inflammation that cannot be relieved by taking analgesics and non-steroidal anti-inflammatory drugs, good effect provides the introduction of novocaine with hydrocortisone and hyaluronidase into the affected area. In addition, physiotherapeutic treatment, reflexology and manual manipulation are used.

Extremely rarely, if the disease persists and conservative therapy is ineffective, it is required surgical treatment, which consists of subperiosteal resection of the rib. Surgical intervention is performed under general or local anesthesia in a hospital setting.

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For the first time in our country about Tietze Syndrome as a independent illness they started talking only in 1921.

Despite almost 100 years of observation, doctors have not come to a consensus on the causes of the pathology.

In specialized medical literature besides official name“Tietze syndrome” can also be found under other names: costochondritis, rib dystrophy or.

How the disease develops

The disease is an inflammation of the connective tissue, manifested by thickening and tenderness of the cartilage tissue in the upper part of the sternum.

Men and women are at risk age category whose age ranges from 20 to 40 years and whose work or sports activities are characterized by increased physical activity.

As treatment practice shows, in most cases, costochondritis is unilateral and forms on the left side of the chest.

As for the percentage of localization of foci of pathology, it looks like this:

• cartilage zone of the 2nd rib – 60%;
• zone of cartilage of the III-IV ribs – 30%;
• zone of cartilage of the I, V, VI ribs is about 10%.

As a result of damage to the perichondrium, located in the area of ​​the upper ribs, the nutrition of the hyaline cartilage is disrupted.

Consequence similar pathology is an aseptic inflammation that occurs directly in the cells of cartilage tissue (chondroplasts).

Several months after the onset of the disease, dystrophic disorders are observed in the inflamed costal cartilage: changes in the size and location of the cartilage are noticeable.

In the absence of treatment, tissues susceptible to destruction begin to sclerose, harden and then die.

Damaged cartilage develops bone density, which contributes to the development of visible sternum deformity.

Symptoms of Tietze syndrome

Symptoms of Tietze syndrome occur unexpectedly and are characterized by gradually increasing pain in the affected area.

After some time (from a couple of hours to several days), a dense tumor can be seen forming in the area of ​​the inflamed rib. Then it begins to occupy the entire intercostal zone and reaches a height of 0.5 cm to 3 cm relative to the chest wall.

As the pathology develops, it is difficult for the patient to lie on his side and make movements with his arms and torso. The pain also intensifies when coughing, sneezing and laughing.

With further deterioration of the patient's condition, discomfort is already strongly felt in the neck, arm, shoulder blade and shoulder girdle.

Such manifestations can bother a person for quite a long time. The syndrome is characterized by repeated irregular acute periods, the duration of which varies from a couple of days to several days.

But a month later there may be a recession, and clear symptoms go away on their own.

TO common features Costochondritis includes the following manifestations:

• a feeling of anxiety, accompanied by irritability and turning into fear;
• insomnia;
• tachycardia;
• dyspnea;
• loss of appetite;
• increased temperature in the inflamed area;
• skin hyperemia;
• severe swelling.

Causes of the disease

The researcher of this disease, the German surgeon Tietze, named the main cause of the disease - this metabolic disorder the consequence of which is the wrong calcium metabolism and insufficient amounts of vitamins A and C.

However, almost a century of practice in the treatment of costochondritis has shown that this is not the only circumstance that provokes this disease.

Modern medicine puts forward several more theories:

1. Strong physical activity, to which the entire area is exposed shoulder girdle and sternum.
2. Frequent injuries and, from which athletes suffer in most cases;
3. Autoimmune diseases. The prerequisite for the development of costochondritis can be various allergies, infections and respiratory diseases, as well as failure protective functions body;
4. Disorders of metabolic processes in connective tissues. Inflammation can begin after an early illness, collagenosis, etc.

Diagnostic tests

A characteristic feature of the development of the disease is that with some laboratory research no significant anomalies can be identified.

Tietze syndrome is detected only during dynamic observation. Often the patient is misdiagnosed based on other symptoms. Therefore, when examining a patient, it is recommended to carry out parallel diagnostics for the presence of other types of pathologies.

The main marker of costochondritis is considered to be swelling in the sternum, which is absent in diseases of the gastrointestinal tract, cardiovascular pathologies, and malignant diseases.

To exclude any diagnosis, MRI, computed tomography and ultrasound examination chest cavity.

The insidiousness of the disease is that at the initial stage it is very difficult to determine even with x-ray examination.

Pathological changes in cartilage tissue become noticeable only with the formation of thickening and desalination of the perichondrium. And in advanced conditions, small deposits will be clearly visible on the affected ribs, which help reduce the intercostal space.

The photo shows where Tietze syndrome is localized

Treatment of the disease

Timely and correct treatment for Tietze syndrome gives a fairly optimistic prognosis. But as for surgical intervention, it is last resort and is prescribed only in exceptional cases.

Particular attention is paid to the patient's nutrition. Complete and enriched mineral supplements the diet helps strengthen and restore cartilage tissue. The patient is also advised to take tableted non-steroidal anti-inflammatory drugs or they are replaced with ointments and gels.

At severe pain the patient receives a course of novocaine intercostal injections with glucocorticoid hormones being administered at certain intervals to the area of ​​inflammation.

A composition consisting of a solution of iodine, sodium salicylate and water is used as a resolving agent. Take the mixture 1 teaspoon per day, and for better absorption of the components, wash it down with milk. After eliminating the pain syndrome, the patient can begin physiotherapeutic procedures.

In case of ineffectiveness conservative treatment the patient may be shown surgery. It is also necessary when there is severe deformation of the thoracic cavity.

You should not hope that the disease will go away on its own. A period of recession is not a sign of recovery.

Therefore, the specialist is advised not to postpone your visit to the doctor if you have unclear pain in the chest. If you ignore similar symptoms, there is a high probability that costochondritis will become chronic.

And in in some cases the disease can cause loss of ability to work and, as a result, disability.