man with chest pain

Tietze syndrome vs. Costochondritis

Pain in the chest area is one of the most common reasons people are brought to the hospital or doctor for a check-up. It said that physicians evaluate no less than 600,000 cases of thoracic pain in patients ages 10 to 21 every year. As always with chest pain, the greatest concern is the potential for heart conditions. However, there are many different conditions that can cause pain. In this article, we’ll compare Costochondritis and a similar but rare condition called Tietze (or Tietze’s) syndrome.

What is Tietze syndrome?

Tietze syndrome is an inflammatory disorder that usually presents with symptoms of chest pain as well as swelling of the cartilages of the upper ribs (the costochondral junction). The costochondral junction is where the ribs attach to the sternum (breastbone). 

A German Surgeon named Alexander Tietze first described this syndrome in medical literature in the year 1921. This disorder is quite rare, and its pain can start either suddenly or gradually and may spread to the arm or shoulder region. It sometimes resolves itself without treatment.

What is Costochondritis?

Costochondritis is one of the most common causes of chest pain in children and adolescents, although the condition is more common in adults aged 40 years and above.

Costochondritis is an inflammation of the costal cartilages where the ribs articulate with the sternum (also known as the sternal articulations or costoternal joints). It usually presents with primary symptoms of chest pain, which can be mild or severe.

In mild cases, your chest could feel tender, or you could feel some pain when you push the area around the chest cartilage. In severe cases, you may experience pains that shoot down your limbs or intense pain in the chest that seems to persist for a while. 

Costochondritis is common and occurs more often in women than in men.

What is the difference between Costochondritis and Tietze Syndrome?

Costochondritis is usually described with different terms such as chest wall pain, costosternal chondrodynia, or costosternal syndrome. It is characterized by a temporary or acute inflammation of the costal cartilage. This condition often resolves on its own, though it tends to be reoccurring for many people. 

Costochondritis is often mistaken for Tietze syndrome, which also refers to inflammation of the costochondral joints. However, they are not the same. What then distinguishes one from the other?

Facts about Costochondritis and Tietze syndrome

  • Costochondritis is an inflammation of the costochondral joints
  • Factors like viruses, genetics, and injury could play a role in causing costochondritis
  • Costochondritis can either present as a medical condition by itself, or it could be a symptom of an even more widespread disorder
  • Both costochondritis and Tietze syndrome can be diagnosed based on the signs and symptoms a person gets, such as chest pain and tenderness in the costochondral joints.
  • Tietze syndrome is quite rare
  • Tietze syndrome comes with a localized swelling at the costochondral joint
  • Tietze syndrome usually comes suddenly with pain in the chest which later radiates to the arms or shoulder and can last for some weeks

Comparison between Costochondritis and Tietze syndrome

Feature Tietze syndrome Costochondritis
Prevalence Rare More common
Signs of inflammation Present Absent
Swelling Presence or absence could dictate severity Absent
Nature of pain Sharp, stabbing during the onset and later persists as a dull aching Sharp, pressure-like
Onset of pain Triggered by a new vigorous activity like excessive coughing and vomiting, chest impact Triggered by repetitive physical activity
Age People younger than 40 years People older than 40 years
Number of sites affected One (in most cases) More than one (in most cases)
Costochondral joints mostly affected Second and third Second to fifth

What causes costochondritis?

The exact causes of costochondritis are not known (it is said to be idiopathic). However, some studies have proposed that series of microtrauma to the anterior thoracic region could predispose one to the development of this syndrome. 

Other conditions that could cause costochondritis include:

  • The strain from repetitive physical activities such as heavy lifting and strenuous exercise
  • Certain types of arthritic diseases
  • Some viruses or inflammatory conditions e.g., syphilis and tuberculosis that can cause inflammation of the joint
  • Benign or cancerous tumors in the costosternal joint such as PMBCL

People who take part in high-impact activities and those with certain conditions like ankylosing spondylitis and rheumatoid arthritis are at a greater risk of developing costochondritis.

Signs and symptoms of costochondritis

Someone suffering from costochondritis would often experience pain on the sides of the sternum and tenderness on palpation. It usually affects multiple ribs and could be stabbing, aching, or burning in nature. The second to fifth ribs are most commonly affected. Costochondritis is often worsened with deep breathing, extreme physical activity, and coughing.

Emergency symptoms of costochondritis

In emergency cases, one with costochondritis could have sudden trouble breathing or feel intense chest pain. If you experience such debilitating pain in your chest region, then you should see a doctor as soon as you can to avoid further complications, especially if there is an underlying cause of the costochondritis.

How is costochondritis diagnosed?

Costochondritis is diagnosed after a careful clinical evaluation, which is meant to exclude other diseases that can be mistaken for costochondritis such as Tietze syndrome, lung pleural inflammation, coronary diseases, or other cardiac diseases. 

A detailed physical examination and assessment of pain levels could be performed by the doctor and patient history should be taken as well. To rule out other similar disease conditions, different tests such as x-rays, electrocardiograms, and blood tests might as well be carried out. 

Treatments for costochondritis

Costochondritis is typically treated by medication or lifestyle changes.


Costochondritis can be treated with over-the-counter medications such as:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
  • Other pain relievers like narcotics
  • Anti-anxiety medications
  • Oral steroids or steroidal injections into the affected area

Lifestyle changes

The doctor could recommend:

  • Physical therapy
  • Bed rest
  • Hot or cold therapy (use of a hot pad or ice)
  • Diet changes

Costochondritis is a common cause of chest pain and 13-36% of patients who seek medical attention for chest pain are diagnosed with the condition.

Costochondritis shares many similarities with Tietze syndrome in that they both present with similar symptoms and even have similar causes. However, with a proper diagnosis, they can be distinguished from each other.

As always, information on this blog is not a substitute for medical advice. Speak to your doctor with any questions you may have regarding a medical condition.

Do you have experience with Costochondritis or Tietze syndrome? Please feel free to share your experience in the comment section below.

5 thoughts on “Tietze syndrome vs. Costochondritis”

  1. Dear Dr Adil, I have suffered with what’s identified as “Bornholm disease” after a few weeks in hospital with pneumonia & pleurisy. I was just 50, now 66 and my life has been dominated and hell. I. Was told that it can cause costochondritus and might be teitze syndrome. I would be willing to be studied if it might just help. I would love to be rid of my living hell and be of use to my lovely family again instead of laying on pillows in bed
    Please help if you can after16yrs

  2. I had obstructive jaundice due to falls Staines and have ended up wit costo – rib pain the same side as where my gall bladder was so how does that happen ?

  3. I was diagnosed with costochondritis at the hospital about 3 years ago, after going to the er, thinking I was having a heart attack. I have had these same chest pains on and off, every few years, since I was a freshman in high school. Doctors have always blown it off. Very curious if it was actually this syndrome instead.

  4. Dear dr Alil,

    I have been diagnosed with tietzes after an accident where an elevator fell down and my chest was compressed. Pain in the middle of chest started middle
    Of rib cage (couldn’t sleep on my side, sharp foul pain) and after a few months pain spread with its more dull aching and burning sensation out to armpit area or just before and shoulder and upper arm. Heart started raising and I was ekg examined few times. No signs of heart failure.

    I am 47 and it is triggered by physical repetitive activity such as painting a wall or push ups etc. Even twist to much upper rib age in yoga can trigger. I do have swelling still. What makes it little better is rest and ibuprofen.

    I am confused and don’t know which one of the two conditions I have since I have symptoms described for both. Pain dull or bad burning, aching now for 8 months. As I have understood on of them is more chronic and other one goes away. How can I know which one I do have as I do have swelling as well?

    Kindly, TOVE

  5. i have pain in middle of chest mostly where the rib cage connect together. very pain and i think is is brought on by stress. i’76 and the pain is completely ruining my life


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