What is Titz Syndrome?
Titz syndrome is a benign disease characterized by a thickening and tenderness of the front ends of the II, III or IV ribs. The etiology and pathogenesis are unknown.
Symptoms of Titz Syndrome
Morphological changes are localized in the cartilage of the rib, which is hypertrophied or unusually curved. There are no histochemically pathological changes in it, but sometimes there is a slight edema or nonspecific chronic inflammation in the surrounding cartilage tissues. The syndrome develops in both men and women, most often between the ages of 30-40.
The appearance of acute or gradually increasing pain in the upper chest, usually on the one hand, is characteristic. Sometimes this is preceded by a slight injury. The pain can be very intense, radiating to the shoulder or arm, aggravated by movement.
When viewed in the area of the affected costal cartilage, pronounced soreness and a clear dense spindle-shaped swelling of 3-4 cm are determined, which confirms the diagnosis. In no other disease (RA, spondylarthritis, fibrositis, etc.), in which bone-chondral joints can be affected, such a dense swelling of the costal cartilage is detected.
Diagnosis of Titz Syndrome
The x-ray picture is not very characteristic and can be even normal with a single study. However, during dynamic observation, it is possible to establish a violation of calcification of the affected cartilage (premature calcification), the appearance of calcareous and bone lumps along the edges of the cartilage, and its thickening. After a few weeks, the picture changes, which brings confidence in the correctness of the diagnosis and eliminates the normal anatomical version of calcification and ikiaeniya cartilaginous ribs. Slight periosteal stratification occurs at the anterior end of the bone rib and the rib is moderately thickened. The intercostal space is therefore narrowed. Subsequently, the bone and cartilage segments of the rib merge together, and a deforming osteoarthrosis develops in the rib-sternal joint, sometimes with significant bone growths.
The process lasts from several weeks to several years and often ends with spontaneous remission. In the differential diagnosis of Titz syndrome, it is necessary to exclude not only rheumatic diseases, trauma, but also the pathology of the cardiovascular system, in particular coronary heart disease, as well as diseases of other internal organs.
More often, chest pain and palpation of the soreness of individual ribs, corresponding to the localization of spontaneous pain, in the absence of signs of hypertrophy of the costal cartilage, are a manifestation of another benign disease – bone chondritis. Pain in the xiphoid process of the sternum, aggravated by pressure on it, may be a sign of isolated xyphoid idalgia.
Titz Syndrome Treatment
Treatment of Tietze syndrome comes down to the appointment of analgesics, heat, local novocaine blockade of the intercostal nerves or parachondral injection of hydrocortisone.