How do cortisone injections help treat Tietze syndrome. What role does ultrasound guidance play in administering corticosteroid injections for costochondritis. How effective are ultrasound-guided corticosteroid injections for managing Tietze syndrome symptoms.

Understanding Tietze Syndrome and Costochondritis

Tietze syndrome is an uncommon condition characterized by pain and tenderness in the parasternal joints, particularly where the ribs connect to the sternum. It shares similarities with costochondritis, which also involves inflammation of the costal cartilages. However, Tietze syndrome is distinguished by visible swelling of the affected area.

Key facts about Tietze syndrome:

• Primarily affects the upper ribs, especially ribs 2-3
• Cause is unknown but may be related to repetitive trauma or strain
• More common in young adults but can occur at any age
• Symptoms include localized chest pain, swelling, and tenderness

Is Tietze syndrome the same as costochondritis? While related, they are distinct conditions. Tietze syndrome always involves visible swelling, while costochondritis does not. Additionally, Tietze syndrome typically affects only one costal cartilage, whereas costochondritis may involve multiple sites.

Diagnostic Challenges in Tietze Syndrome

Diagnosing Tietze syndrome can be challenging due to its rarity and similarity to other chest wall conditions. Traditionally, diagnosis has relied primarily on clinical examination and patient history. However, imaging techniques are increasingly being utilized to improve diagnostic accuracy.

Why is accurate diagnosis important for Tietze syndrome? Proper diagnosis ensures appropriate treatment and helps rule out more serious conditions that may present with similar symptoms, such as cardiac issues or malignancies.

Role of Ultrasound in Diagnosis

Ultrasound imaging has emerged as a valuable tool in the diagnosis of Tietze syndrome. It offers several advantages:

• Non-invasive and radiation-free
• Can visualize soft tissue swelling and inflammation
• Allows real-time assessment of the affected area
• Can guide therapeutic interventions

How does ultrasound aid in differentiating Tietze syndrome from other conditions? Ultrasound can reveal characteristic findings such as localized swelling of the costochondral junction, increased vascularity, and hypoechoic areas indicative of inflammation.

Cortisone Injections as a Treatment Option

Corticosteroid injections have long been used to manage inflammatory conditions, including Tietze syndrome. These injections work by reducing inflammation and suppressing the immune response in the affected area.

Benefits of cortisone injections for Tietze syndrome:

1. Rapid pain relief
2. Reduction in swelling
3. Improved mobility
4. Potential long-term symptom resolution

Are cortisone injections always effective for Tietze syndrome? While many patients experience significant relief, individual responses can vary. Some may require multiple injections or additional treatments for optimal results.

Risks and Considerations

Despite their benefits, cortisone injections are not without risks. Potential side effects include:

• Temporary pain at the injection site
• Skin discoloration
• Cartilage damage with repeated injections
• Infection (rare)

How can the risks of cortisone injections be minimized? Proper technique, sterile conditions, and limiting the frequency of injections can help reduce the likelihood of adverse effects.

Ultrasound-Guided Corticosteroid Injections

The use of ultrasound guidance for corticosteroid injections represents a significant advancement in the treatment of Tietze syndrome. This technique allows for precise targeting of the affected area, potentially improving outcomes and reducing complications.

Advantages of ultrasound-guided injections include:

• Increased accuracy in needle placement
• Ability to visualize and avoid nearby structures
• Real-time confirmation of medication delivery
• Potential for improved efficacy and safety

How does ultrasound guidance compare to blind injection techniques? Studies have shown that ultrasound-guided injections can result in better pain relief and functional outcomes compared to traditional blind injections in various musculoskeletal conditions.

Case Study: Ultrasound-Guided Treatment for Tietze Syndrome

A recent case report published in the American Journal of Physical Medicine & Rehabilitation highlights the successful use of ultrasound-guided corticosteroid injections in treating a patient with Tietze syndrome. The case involved a 70-year-old man presenting with left chest pain lasting several weeks.

Key aspects of the case:

• Physical examination revealed focal tenderness of the left third costochondral joint
• Ultrasound imaging showed swelling of the affected joint
• Diagnosis of Tietze syndrome with costochondral joint swelling was made
• Patient received three ultrasound-guided corticosteroid injections
• Complete resolution of pain, swelling, and tenderness was achieved

What does this case study suggest about the use of ultrasound in Tietze syndrome management? The report underscores the potential value of ultrasound in both diagnosing and treating Tietze syndrome, particularly when combined with targeted corticosteroid injections.

Efficacy of Ultrasound-Guided Corticosteroid Injections

While large-scale studies on ultrasound-guided corticosteroid injections specifically for Tietze syndrome are limited, evidence from related conditions and case reports suggests promising results. The precise targeting afforded by ultrasound guidance may contribute to improved outcomes.

Potential benefits of this approach include:

• More rapid symptom relief
• Longer-lasting effects
• Reduced need for repeat injections
• Improved patient comfort during the procedure

How long do the effects of ultrasound-guided corticosteroid injections typically last? The duration of relief can vary, but many patients experience improvement for several months or longer. Some may achieve long-term resolution of symptoms after a series of injections.

Comparing Treatment Modalities

While ultrasound-guided corticosteroid injections show promise, it’s important to consider how they compare to other treatment options for Tietze syndrome:

Which treatment approach is best for Tietze syndrome? The optimal treatment may vary depending on individual factors such as symptom severity, duration, and patient preferences. A combination of approaches is often most effective.

Future Directions in Tietze Syndrome Management

As our understanding of Tietze syndrome and imaging technologies continues to advance, several areas of research and development show promise for improving patient care:

1. Refined diagnostic criteria incorporating imaging findings
2. Development of standardized ultrasound protocols for Tietze syndrome
3. Exploration of alternative injectable medications (e.g., platelet-rich plasma)
4. Long-term studies on the efficacy and safety of ultrasound-guided injections
5. Investigation of potential underlying causes to inform prevention strategies

How might these advancements impact the management of Tietze syndrome in the future? Improved diagnostic accuracy and more targeted treatments could lead to better outcomes, reduced healthcare costs, and improved quality of life for patients with this condition.

Emerging Technologies

Beyond ultrasound, other imaging modalities and treatment approaches are being explored for Tietze syndrome:

• MRI for detailed soft tissue evaluation
• CT-guided injections for complex cases
• Radiofrequency ablation for refractory cases
• Regenerative medicine techniques (e.g., stem cell therapy)

What role might these emerging technologies play in Tietze syndrome management? While still in early stages for this specific condition, these approaches could offer alternative options for patients who don’t respond to conventional treatments or provide more comprehensive diagnostic information.

Patient Education and Self-Management Strategies

While medical interventions like ultrasound-guided corticosteroid injections can be highly effective, patient education and self-management strategies play a crucial role in long-term symptom control and prevention of recurrence in Tietze syndrome.

Key aspects of self-management include:

• Understanding triggers and aggravating factors
• Proper posture and ergonomics
• Gentle stretching and strengthening exercises
• Stress reduction techniques
• Application of heat or cold therapy

How can patients actively participate in their Tietze syndrome management? By implementing these self-care strategies and working closely with healthcare providers, patients can take an active role in managing their symptoms and improving their overall quality of life.

Lifestyle Modifications

Certain lifestyle changes may help reduce the frequency and severity of Tietze syndrome flare-ups:

1. Avoiding repetitive chest wall movements or strain
2. Maintaining a healthy weight to reduce pressure on the chest wall
3. Quitting smoking to improve overall chest health
4. Practicing good sleep hygiene and using supportive pillows
5. Managing underlying conditions that may exacerbate symptoms (e.g., asthma, GERD)

Can lifestyle modifications alone resolve Tietze syndrome? While these changes can significantly improve symptoms and prevent recurrence in some cases, many patients benefit from a combination of lifestyle modifications and medical interventions for optimal management.

Ultrasound-Guided Corticosteroid Injection in a Patient With Tietze Syndrome Combined With Costochondral Joint Swelling

Case Reports

. 2019 Jul;98(7):e71-e73.

doi: 10.1097/PHM.0000000000001072.

Ju Young Cho 
¹
, Donghwi Park

Affiliations

Affiliation

• ¹ From the Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea.

• PMID:

  30362978

• DOI:

  10.1097/PHM.0000000000001072

Case Reports

Ju Young Cho et al.

Am J Phys Med Rehabil.

2019 Jul.

. 2019 Jul;98(7):e71-e73.

doi: 10.1097/PHM.0000000000001072.

Authors

Ju Young Cho 
¹
, Donghwi Park

Affiliation

• ¹ From the Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea.

• PMID:

  30362978

• DOI:

  10.1097/PHM.0000000000001072

Abstract

Tietze syndrome is an uncommon disease of unknown etiology that manifests as pain and tenderness of the parasternal joints. To date, however, there has been no report on ultrasonographic findings concerning swelling of the costochondral joint in Tietze syndrome. Moreover, there has been no research investigating images of ultrasound-guided corticosteroid injection, although corticosteroid injection is one of the most important treatments for Tietze syndrome. Therefore, we report a case of Tietze syndrome where ultrasound images were used in the diagnostic and therapeutic process. A 70-yr-old man was seen for left chest pain that had lasted for several weeks. Physical examination at our clinic revealed a focal tenderness of the left third costochondral joint, and an ultrasound showed a swelling of the left third costochondral joint. Considering both the radiological and the clinical examination, the patient received a diagnosis of Tietze syndrome with costochondral joint swelling. Then, the patient agreed to an ultrasound-guided left third costochondral corticosteroid injection after receiving a detailed explanation of the disease and treatment. After receiving three ultrasound-guided corticosteroid injections, his chest pain subsided, and the swelling and tenderness also disappeared completely. Collectively, our case suggests that ultrasound is important in the diagnosis and treatment of Tietze syndrome.

Similar articles

• Computed tomography of Tietze syndrome.

  Edelstein G, Levitt RG, Slaker DP, Murphy WA.

  Edelstein G, et al.
  J Comput Assist Tomogr. 1984 Feb;8(1):20-3. doi: 10.1097/00004728-198402000-00004.
  J Comput Assist Tomogr. 1984.

  PMID: 6690519

• [Soft tissue swelling of the sternoclavicular joint].

  Kloth JK, Weber MA.

  Kloth JK, et al.
  Radiologe. 2012 May;52(5):459-62. doi: 10.1007/s00117-012-2318-z.
  Radiologe. 2012.

  PMID: 22584483

  Review.
  German.

• Ultrasonographic assessment of local steroid injection in Tietze’s syndrome.

  Kamel M, Kotob H.

  Kamel M, et al.
  Br J Rheumatol. 1997 May;36(5):547-50. doi: 10.1093/rheumatology/36.5.547.
  Br J Rheumatol. 1997.

  PMID: 9189056

  Clinical Trial.

• Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?

  Kaplan T, Gunal N, Gulbahar G, Kocer B, Han S, Eryazgan MA, Ozsoy A, Naldoken S, Alhan A, Sakinci U.

  Kaplan T, et al.
  Thorac Cardiovasc Surg. 2016 Apr;64(3):239-44. doi: 10.1055/s-0035-1545261. Epub 2015 Mar 5.
  Thorac Cardiovasc Surg. 2016.

  PMID: 25742551

• Scintigraphic and CT findings of Tietze’s syndrome: report of a case and review of the literature.

  Honda N, Machida K, Mamiya T, Takahashi T, Takishima T, Hasegawa N, Kamano T, Hashimoto M, Ohno K, Itoyama S, et al.

  Honda N, et al.
  Clin Nucl Med. 1989 Aug;14(8):606-9. doi: 10.1097/00003072-198908000-00011.
  Clin Nucl Med. 1989.

  PMID: 2680209

  Review.

See all similar articles

Cited by

• Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis: A case report.

  Choi MH, Yoon IY, Kim WJ.

  Choi MH, et al.
  World J Clin Cases. 2023 Mar 26;11(9):2043-2050. doi: 10.12998/wjcc.v11.i9.2043.
  World J Clin Cases. 2023.

  PMID: 36998969
  Free PMC article.

• Bemoan My Collarbone: A Case of Costocondral Junction Syndrome Complicated by Methicillin Sensitive Staphylococcus aureus Sternoclavicular Osteomyelitis and Septic Arthritis.

  Patel VM, Patel SV, Pacheco L.

  Patel VM, et al.
  Cureus. 2023 Jan 23;15(1):e34108. doi: 10.7759/cureus.34108. eCollection 2023 Jan.
  Cureus. 2023.

  PMID: 36699106
  Free PMC article.

• Local treatment of pain in Tietze syndrome: A single-center experience.

  Yıldız ÖÖ, İnan K, Ağababaoğlu İ, Çınar E.

  Yıldız ÖÖ, et al.
  Turk Gogus Kalp Damar Cerrahisi Derg. 2021 Apr 26;29(2):239-247. doi: 10.5606/tgkdc.dergisi.2021.21120. eCollection 2021 Apr.
  Turk Gogus Kalp Damar Cerrahisi Derg. 2021.

  PMID: 34104518
  Free PMC article.

• The primary role of radiological imaging in the diagnosis of rare musculoskeletal diseases. Emphasis on ultrasound.

  Rossi F, Martinoli C, Murialdo G, Schenone A, Grandis M, Ferone D, Tagliafico AS.

  Rossi F, et al.
  J Ultrason. 2019 Nov;19(78):187-192. doi: 10.15557/JoU. 2019.0028. Epub 2019 Sep 30.
  J Ultrason. 2019.

  PMID: 31807323
  Free PMC article.

Publication types

MeSH terms

Substances

BET 3: The use of corticosteroids in the management of costochondritis

Article Text

Article menu

• Article
  Text
• Article
  info
• Citation
  Tools
• Share
• Rapid Responses
• Article
  metrics
• Alerts

PDF

Best Evidence Topic reports

BET 3: The use of corticosteroids in the management of costochondritis

Abstract

A short cut review was carried out to establish whether there is any evidence that for the use of corticosteroids in the treatment of costochondritis. No papers were found using the reported search. The clinical bottom line is that further research is needed in this area.

http://dx.doi.org/10.1136/emermed-2012-201590.4

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

• Linked articles 201590.1, 201590.2, 201590.3, 201590.5.

• Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

• Best Evidence Topic reports

  Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

  Simon Carley

  Emergency Medicine Journal 2012; 29 683-683 Published Online First: 11 Jul 2012. doi: 10.1136/emermed-2012-201590.1

• Best Evidence Topic reports

  BET 1: Efficacy of hypothermia for traumatic brain injury in children

  BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine

  Emergency Medicine Journal 2012; 29 683-685 Published Online First: 11 Jul 2012. doi: 10.1136/emermed-2012-201590.2

• Best Evidence Topic reports

  BET 2: Incidence of venous thromboembolism in critically injured children

  BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine

  Emergency Medicine Journal 2012; 29 685-686 Published Online First: 11 Jul 2012. doi: 10.1136/emermed-2012-201590.3

• Best Evidence Topic reports

  BET 4: Investigating flank pain: can the CT stay low?

  BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine

  Emergency Medicine Journal 2012; 29 687-688 Published Online First: 11 Jul 2012. doi: 10.1136/emermed-2012-201590.5

Read the full text or download the PDF:

Subscribe

Log in using your username and password

For personal accounts OR managers of institutional accounts

Username *

Password *

Forgot your log in details?Register a new account?

Forgot your user name or password?

Read the full text or download the PDF:

Subscribe

Log in using your username and password

For personal accounts OR managers of institutional accounts

Username *

Password *

Forgot your log in details?Register a new account?

Forgot your user name or password?

Cortisone injections for arthritis: pros and cons

In recent years, there has been a lot of talk in the medical community about the dangers of cortisone injections, which are prescribed for the treatment of arthritis pain. Negative opinions are based on the dangers of steroids for cartilage. Can cortisone really lead to further joint destruction? A new study, published in Arthritis and Rheumatology, refutes the fears, but so far only partially. Key takeaway: The judicious use of cortisone injections in the treatment of arthritis of the knee is acceptable and safe.

You can, but be careful!

Boston University Professor of Medicine and Epidemiology, Senior Research Fellow Dr. David Felson elaborates: “The study showed that multiple injections of cortisone in the knee will not lead to long-term negative consequences. But we still cannot guarantee that repeat injections every three months will be 100% problem-free.”

Researchers studied patients who were prescribed cortisone injections on an irregular basis. In this sample, the condition of the joints did not worsen faster than with injections of hyaluronic acid. What’s more, knee replacements were slightly less common in the cortisone injection group. This means that steroid injections can sometimes be given. Data on long-term and regular therapy are not yet available.

Are the fears justified?

Cartilage is the connective tissue that covers the edges of the bones that form the knee joint. It performs the function of depreciation during movement. Steroids damage cartilage, which leads to destruction of the knee joint. Melissa Leber, director of sports medicine at the Emergency Department of the Icahn School of Medicine at Mount Sinai (MSSM), says: “If you use cortisone in a course or too often, it will damage the cartilage.”

There is also a 2019 study that reports that the risk of progression of knee arthritis in people who receive repeated injections of cortisone is 3 times higher compared to patients who never had this injection. On the other hand, often injections into the knee are indispensable. The two most common drugs for this purpose, cortisone and hyaluronic acid, have never been compared in clinical trials. They have different effects on the joints and are sometimes used at the same time.

Which is better for arthritis: cortisone or hyaluronic acid?

According to Leber, these two types of injections affect the joints differently and are sometimes used in combination. Cortisone relieves inflammation, reduces pain. And hyaluronic acid, like a gel, lubricates the diseased joint, which ensures smooth sliding of the parts of the patella. At the same time, cortisone harms cartilage, but hyaluronic acid gel does not.

Of 800 study participants with knee arthritis, 4 out of 5 received cortisone blockade for pain, the rest received hyaluronic acid. Seven years of observation led to the conclusion that the destruction of cartilage in both groups was approximately the same. Also in the group that received cortisone injections, there were 25% fewer situations of knee replacement. Based on this, the researchers concluded that cortisone injections should not be feared.

“Nothing bad will happen from one or more steroid blockades,” Felson said. “Patients need to be reassured so they don’t avoid effective treatment.”

A smart approach is critical

New evidence supports the approach that orthopedic specialists already use when prescribing cortisone injections for the treatment of knee arthritis. “If the cartilage destruction in a patient with arthritic knees is already significant, we don’t worry too much about prescribing steroids. This will not have a critical impact on the situation. But the person will get relief from pain. Here, the risks are negligible compared to the benefits. On the contrary, in the group of young people from 20 to 40 years old with a small cartilage lesion, we are more careful. Here, we try to prescribe a steroid blockade no more than once, ”Leber comments. “The steroid is harmful to cartilage, but this does not mean that it is harmful for every patient. All situations must be considered on an individual basis.

Which clinics offer effective treatment for arthritis?

Diseases of the joints and connective tissues have long been effectively treated in the medical centers of Kazakhstan.