Costochondritis: Causes, symptoms, and treatment

Costochondritis is an inflammation of the cartilage connecting the ribs to the breastbone. It can cause a stabbing, burning, or aching pain in the chest wall, especially around the second to fifth ribs. Coughing and a blow to the chest are among the causes.

The ribs are connected to the breastbone by tough, protective tissue called cartilage. When this cartilage becomes inflamed, the condition is known as costochondritis or chest wall pain.

While this condition is usually temporary, it can be alarming, as the pain can become so significant it mimics a heart attack.

Doctors may also refer to costochondritis as costosternal syndrome or costosternal chondrodynia. The condition will usually resolve on its own with home treatments.

Fast facts on costochondritis

• In many cases, doctors do not know what causes costochondritis.
• Pain in the chest and breastbone area is the chief symptom of costochondritis.
• The pain may be so severe that the person feels they are having a heart attack.
• Treatment includes anti-inflammatory medications.

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Share on PinterestUsually costochondritis will resolve itself with home treatment, and is a temporary condition.

Though causes are often unknown, in some instances, the condition can be the result of one or more of the following:

• history of an illness that causes a lot of coughing
• heavy lifting or strenuous exercise, involving the upper extremities and chest wall
• carrying heavy bags, such as a heavy backpack on one side or the other
• having large breasts
• history of chest injuries or chest infections
• undergoing surgery that affects the chest wall, such as cardiac bypass

Doctors call costochondritis that has no known causes idiopathic costochondritis.

Chest discomfort and pain may be stabbing, burning, or aching in nature. The ribs most affected are the second to fifth ones.

The condition most commonly affects those older than age 40, according to an article in the journal American Family Physician. An estimated 13-36 percent of those who seek emergency medical attention for chest pain are experiencing costochondritis.

The following activities usually worsened the pain associated with costochondritis:

• significant amount of coughing
• strenuous exercise
• physical activity using the upper arms, such as lifting boxes

The pain associated with costochondritis usually occurs on the left side of the body but can affect both sides.

Tietze syndrome

There is a variation of costochondritis called Tietze syndrome. This condition causes pain associated with costochondritis, as well as swelling of the rib cartilage.

The swelling of Tietze syndrome affects at least one of the upper four ribs, usually the second or third ribs. While the pain associated with costochondritis may subside with time, some people with Tietze syndrome will still experience the swelling.

Although doctors have not defined how prevalent this condition is, they do consider it to be a rare disorder. Other than pain and discomfort, it does not cause any long-term harmful effects.

Share on PinterestThe symptoms of costochondritis can be worsened by certain activities, such as lifting heavy objects, or strenuous coughing.

Doctors usually treat costochondritis conservatively. Resting and avoiding strenuous exercise that affects the chest wall can help. So can over-the-counter pain relievers, such as ibuprofen or acetaminophen.

Children under age 18 should not take aspirin due to the increased risk for Reye’s syndrome.

In rare instances, a doctor may recommend injections of lidocaine or corticosteroids to reduce pain and inflammation. Other treatments that may help to relieve chest pain include:

• Applying moist heat by way of warm compresses.
• Taking cough suppressants to ease coughing and reduce pressure to the cartilage.
• Physical therapy to ease tension in the chest wall.

If these treatments do not reduce a person’s incidence of costochondritis, they should seek a follow-up with their doctor.

If a person is having chest pain, they should not try to determine for themselves if it is a heart-related issue or costochondritis. Instead, they should seek immediate medical attention.

If a younger person who is not at risk of heart attack experiences these symptoms, they should seek emergency attention if their chest pain is sharp and does not improve with rest.

If someone has gone to a doctor for their symptoms and has been diagnosed with costochondritis, there are still some instances when a person should seek immediate medical attention again. These include:

• feeling faint, dizzy, or lightheaded
• feeling as if the heart is beating irregularly or too fast
• pain that worsens over time or cannot be relieved by pain medicine
• having a shortness of breath
• a fever that is higher than 100.4 °F in an adult
• coughing up dark-colored sputum or blood

If the chest pain is radiating to the arms, neck, shoulder, jaw, or back, a person should seek immediate medical attention.

Share on PinterestSome conditions may seem similar to costochondritis, including an injured shoulder or neck, or arthritis of the surrounding joints.

Doctors often diagnose costochondritis by ruling out other potential causes of the chest pain and discomfort connected with the condition. For example, if a person is older than 35, a doctor may first want to rule out coronary artery disease (CAD), as a potential cause.

Individuals who are at risk of CAD, such as those with a family history, those who are obese, or those with a history of smoking, should usually have an electrocardiogram (ECG or EKG) and chest X-ray to check for CAD.

Other medical conditions that may closely resemble costochondritis include:

• arthritis of the shoulder or nearby joints
• chest wall infections or cancer
• fibromyalgia, a condition that causes nerve pain
• slipping rib syndrome, when there is too much mobility in the cartilage supporting the ribs
• injuries to the shoulder or neck that causes pain to refer or travel to the chest wall

A physical examination to detect tenderness of the cartilage to the touch may also be performed. If a person is having a heart attack or has another type of heart condition, the cartilage in the chest is not usually sensitive to the touch.

A doctor will also listen to the heart and lungs, as well as examine the skin for any signs of infection. An X-ray or other imaging studies will not show signs of costochondritis.

Doctors can usually diagnose a child, adolescent, or young adult by asking questions about their medical history and by conducting a physical exam. The doctor will often check for tenderness in the chest cartilage, as part of this.

According to American Family Physician, costochondritis can last anywhere from a few weeks to months. It may also recur if it has been caused by physical exercise or strain.

The condition does not usually last longer than one year. However, adolescents with costochondritis can sometimes have a longer period of symptoms.

Costochondritis | Physio Check

Costochondritis is a painful inflammation of the ribs’ cartilage. This cartilage is located both in front of the chest where the ribs connect to the sternum, and also at the back, where the ribs attach to the spinal column.

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Costochondritis is a relatively unknown rheumatic condition. As the condition often causes pain in the chest, it is always important to rule out cardiac problems before making the diagnosis.

Description of condition

The chest (rib-cage) is formed by the ribs, the breastbone and a number of vertebrae. Along the front, the ribs are connected to the breastbone by cartilage structures. These cartilage connections are referred to in medical terms as “costal cartilage”. If this cartilage becomes inflamed, this is referred to as costochondritis. Inflammation of the “costal cartilage” causes annoying pain on the chest.

Along the back, the ribs are connected to the vertebrae of the spinal column via small joints (that also contain a layer of cartilage). These joints are called the “costovertebral” and the “costotransverse” joints. Again, if the cartilage becomes inflamed, this is referred to as costochondritis. Costochondritis along the back can cause upper back pain.

Tietze’s Syndrome
Costochondritis is very similar to Tietze’s syndrome. However, there are a few important differences. When the cartilage of the ribs along the front of the body is inflamed and is accompanied by swelling, this is referred to as Tietze’s syndrome. If there is no swelling, or if the cartilage along the back side of the ribs is inflamed, this is referred to as costochondritis. Unfortunately, both terms are often used interchangeably in the literature.

Cause and history

The cause is currently unknown. However, we suspect that the following factors play a role in the development of the condition:

• Physical exertion.
• Incorrect posture (for example, a stooped posture with your back rounded and shoulders protruding forward).
• Overload or trauma (for example, falling or a blow to the chest).
• Pregnancy.
• Respiratory tract infection.
• Emotional struggles/tension.
• Stress.
• Repetitive movements that expand the chest, causing pressure or stretching on the ribs (for example, deep breaths, frequent coughing or repeated clearing of the throat).

People with a family history of rheumatic conditions have an increased risk of developing the condition. Postural abnormalities, limited muscle strength, fear of movement and a low tolerance of exercise are also linked to an increased risk of developing costochondritis.

Signs & symptoms

Usually several cartilage connections are affected in costochondritis. In many cases it affects the second to fifth rib. It is worth noting that generally only one side is affected.

• Pain in the chest and/or pain in the upper back at the level of the cartilage connections.
• The pain is often sharp and comes in waves.
• Pressing on the inflamed cartilage makes the pain worse.
• Coughing, sneezing or deep inhalation is extremely painful.
• The pain may radiate into the ribs, the arm, the shoulder or the abdomen.
• Movements of the upper body cause further pressure or stretching of the cartilage connections. This may result in additional pain.
• As the entire rib cage moves with the various arm movements, certain movements of the arm may provoke the symptoms.

Diagnosis

The diagnosis is made based on a physical examination and the patient’s story.

Treatment

Unfortunately there is no known treatment. Patients are often prescribed analgesics to relieve the pain, or anti-inflammatories. Sometimes injections are administered at the site of the inflammation.

In some cases the symptoms disappear without treatment within a few days or weeks. However, the condition may become chronic, causing suffering for months or years. Sometimes the symptoms never go away completely.

Physiotherapy can be used to work on improved posture, which reduces pressure on the painful cartilage connections. Therapy can also consist of stretching the pectoralis major muscle and strengthening the rhomboid muscles located between the shoulder blades. If necessary, relaxation exercises and breathing exercises will be provided.

Exercises

Follow this exercise program here exercises for costochondritis or make an appointment with the physiotherapist.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

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References

Albarran, J. W. & Tagney, J. (2007). Chest Pain. Advanced assessment and management skills. Blackwell Publishing.
Haga, P., Biesen-’t Riet, J. van der & Broekema, A. (2008). Protocol syndroom van Tietze en costochondritis. Oefentherapeuten Mensendieck.
Lawless, C.E. (2011). Sports cardiology essentials: Evaluation, management and case studies. Springer: New York, Dordrecht, Heidelberg, London.
Proulx, A.M. & Zyrd, T.W. (2009). Costochondritis: Diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20.

Tietze’s syndrome: symptoms and treatment, causes of the disease costal chondritis

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cartilage. Most often, the pathology occurs in people aged 20-40 years, with the same frequency in men and women. The causes and clinical manifestations are diverse, so in patients with Tietze syndrome, symptoms and treatment can be drastically different. The main manifestation of the disease is chest pain, which also occurs in many pathologies of the internal organs and the musculoskeletal system. Due to the blurring of the clinical picture, it is difficult to make a differential diagnosis.

This article is a recommendation. Treatment is prescribed by a specialist after consultation.

Causes

The first ten pairs of ribs are connected to the sternum through cartilage, forming the costosternal joints, which can be damaged due to overload of the shoulder girdle. Microtraumatization of the perichondrium, the shell of the cartilage, leads to the development of non-infectious inflammation in it. Over time, the cartilage deforms, grows, compresses the surrounding nerve endings, causing pain. According to histological studies, after two to three months from the onset of the development of Tietze’s syndrome, the cartilage tissue is actually transformed into bone.

Fig. 1 Costosternal joints

Tietze’s syndrome is a rare pathology. The reasons for its development can be any diseases that disrupt the metabolism in the connective tissue and reduce immunity, as well as mechanical damage.

Risk factors for the development of Tietze’s syndrome:

• The same monotonous physical activity on the arms and chest

• Chest injuries

• O chest surgery

• Metabolic defects in the connective tissue

• Costal chondritis – inflammation of the costal cartilages

• COPD), bronchial asthma, etc.

Symptoms

The clinical picture of the disease is similar to pneumonia, exacerbation of COPD, bronchial asthma, coronary heart disease, myocardial infarction, intercostal neuralgia and osteochondrosis.

Possible symptoms of cartilaginous rib joint syndrome:

• 1

  Sharp shooting pain in the anterior chest wall. It can hurt on one side, rarely on both. Sometimes it radiates to the neck, back or arms

• 2

  Over time, the pain becomes undulating, aggravated by movement, deep breathing and pressure on the attachment points of the ribs to the sternum

• 3

  900 02 Possible spasm of the sternocleidomastoid muscles located on the anterior-lateral surfaces of the neck, right or left pectoralis major muscle – depending on which side of the chest the ribs are affected

• 4

  Limited range of motion in the neck, right or left shoulder joint, limitation of the depth of inhalation and exhalation

• ber with sternum. Education gradually hardens, becoming “bone”. When pressing on it, the pain intensifies, “shoots through”

• 6

  Increase in body temperature up to 38-39 degrees, general weakness, sweating

• 7

  Possible shortness of breath, loss of appetite, insomnia and tachycardia

Symptoms may develop acutely or gradually. Most often, Tietze’s disease of the chest affects the II-IV ribs.

Diagnosis

The symptoms of Tietze’s syndrome are similar to those of other diseases of systems and organs. In addition, some patients do not have local signs of inflammation, further complicating the diagnosis. An important role is assigned to a thorough clarification of complaints, anamnesis, visual examination and palpation. To clarify the diagnosis, an instrumental examination is often prescribed.

Additional diagnostic options:

• Chest x-ray to rule out lung disease and cancer
• Chest spiral computed tomography (SCT) for better visualization of pathological changes
• MRI chest for soft tissue assessment
• ECG
• Echocardiography, or ultrasound of the heart to rule out cardiac pathology

Which doctor to contact

In case of chest pain, they often turn to cardiologists and neurologists, and in case of induration in the anterior chest wall, to an oncologist. However, Tietze’s syndrome is dealt with by surgeons and orthopedic traumatologists.

The doctor conducts a survey and examination of the patient, prescribes additional examinations to clarify the diagnosis. How to treat costal chondritis, the specialist decides, taking into account the cause and severity of the condition.

Make an appointment with a neurologist

Appointment lasts 60 minutes, includes diagnostics, analysis of your MRI and preparation of a treatment plan, takes place both in person and online.

Treatment

At the Temed Clinic, patients with Tietze’s syndrome are treated in a complex manner by several narrow specialists: a neurologist, an orthopedic traumatologist, a masseur, a physiotherapist. Treatment of the disease is conservative. Surgical intervention – removal of the affected part of the rib – is resorted to extremely rarely, with an advanced stage of the disease. The emphasis in the treatment of costal chondritis is on taking medications, physiotherapy.

Medical treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) and, in some cases, glucocorticosteroids to relieve inflammation, localized swelling, and pain.

Tietze’s syndrome often occurs in a chronic form, requiring constant pain relief. But due to long-term use of medications, there are side effects. Therefore, drugs are prescribed only during the period of exacerbation in order to relieve inflammation. The basis of treatment is physiotherapy.

Temed Clinic focuses on modern and effective techniques:

• Acupuncture . The doctor introduces special thin needles into biologically active points, stimulating the nerve fibers leading to the pathological focus. Pain intensity decreases and tissue recovery accelerates

• Pharmacopuncture . Subcutaneous injections of drugs into the pathological focus relieve inflammation, swelling, stimulate tissue healing and eliminate pain. The procedure quickly relieves the patient’s condition. The choice of drugs and their combination depends on the severity of symptoms

• Taping . By fixing the elastic bands along the course of the muscles in a certain direction, the doctor redistributes the load on the joints of the shoulder girdle and chest. Kinesio taping for post-traumatic costal chondritis accelerates recovery, makes you feel better and allows you to reduce the dosage of drugs taken

• Magnetotherapy . The modern BTL Super Inductive System technology relieves chest pain, increases the mobility of the costosternal joints and triggers regeneration processes

• Laser therapy . MLS 6, a robotic multi-wavelength system, emits various tunable waves. With its help, the doctor achieves analgesic, anti-inflammatory and anti-edematous effects. The laser acts pointwise, the procedure is as safe as possible

• exercise therapy . Therapeutic exercise for Tietze’s syndrome includes individually selected exercises aimed at improving the mobility of the chest, developing the rib-sternal joints. Exercise therapy is often combined with taping: tapes increase the effectiveness of gymnastics

• Massage . The specialist kneads the muscles of the chest, which improves the nutrition of soft tissues. The procedure is carried out only after the exacerbation is removed

The treatment lasts from two to three weeks to several months until the symptoms are completely resolved. To improve and consolidate the result of therapy, patients perform exercises for Tietze’s syndrome at home for at least 2 weeks. Costosternal joints can crackle, during their development recovery occurs, nutrition and mobility of the chest as a whole improves.

In case of slow dynamics or its absence during therapy, it is recommended to consult an oncologist and repeat an in-depth examination of the patient with a mandatory puncture biopsy of the chest mass.

Prophylaxis

No specific prophylaxis. Overloading of the shoulder girdle, chest injuries and diseases of the respiratory system should be avoided. To prevent exacerbations, it is enough to follow the simple recommendations of a traumatologist, regularly perform gymnastics, eat a balanced diet and lead an active lifestyle.

Consequences

With timely diagnosis and treatment, the prognosis is favorable. Without therapy, the disease becomes chronic: exacerbations alternate with remissions. The pain may disappear spontaneously after 2-4 weeks, and reappear after a couple of months.

Theses

• 1

  Tietze’s syndrome is a rare disease characterized by non-infectious inflammation of one or more upper costal cartilages where the ribs meet the sternum

• 2

  The main symptom of Tietze’s syndrome is chest pain and an elastic mass on the anterior chest wall

• 3

• 4

  Treatment of Tietze’s syndrome is based on drugs, physiotherapy and therapeutic exercises

List of sources:

1. Shesternya P. A., Vasilyeva A.O., Shkil L.M., Onishchenko S.B., Mikhailova K.O., Nikitina M.A., Siberian Medical Review magazine, article “Tietze syndrome – an interdisciplinary clinical case”, 2017, Krasnoyarsk.
2. Vodoevich V.P., Breido A.A., Varnakova G.M., Lemeshevskaya P., Masilevich A.M. Grodno, Belarus.
3. Zhukovskaya A.O., Moskalenko I.S., journal “Symbol of Science”, article “Titze’s disease (costal chondritis)”, 2017,

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How to Diagnose Tietze’s Syndrome (Costocartilaginous Syndrome, Costal Chondritis) : Costochondral syndrome is 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. The initial diagnosis of Tietze’s syndrome will require an X-ray or CT scan of the ribs and a subsequent consultation with a rheumatologist.

Which doctor treats costocartilaginous syndrome: If you have symptoms of Tietze’s syndrome, you should first consult a rheumatologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with an orthopedist.

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Tietze’s syndrome is a rare condition that causes chest pain in the upper ribs. It is a benign disease that mainly affects patients under the age of 40. The exact cause of its occurrence is unknown.

Costochondral syndrome symptoms

The main symptom of Tietze’s syndrome is chest pain. In this condition, pain is felt around one or more of the 4 upper ribs, especially where the ribs attach to the sternum. In 70-80% of cases, the pain is localized around one rib. Usually only one side of the chest is affected. Inflammation of the cartilage of the affected rib causes pain and swelling. The area may hurt, look swollen, or red. Tietze syndrome pain can:

• come on suddenly or gradually
• be sharp, stabbing, blunt or painful
• vary from weak to strong
• extend to arm, neck and shoulders
• aggravated by exertion, coughing or sneezing.

Causes of Tietze’s syndrome

The exact cause of Tietze’s syndrome is unknown. However, researchers believe that it may be the result of a minor injury to the ribs. Injuries caused:

• severe cough
• violent vomiting
• upper respiratory infections, including sinusitis or laryngitis
• strenuous or repetitive physical activity
• injuries or wounds.

Risk factors

The biggest risk factors for Tietze syndrome are age and possibly season. Tietze’s syndrome mainly affects children and patients under the age of 40. The number of cases is higher in winter and spring. The syndrome develops most often in women, but can also affect men.

How Tietze’s syndrome differs from costochondritis

Tietze’s syndrome and costochondritis cause chest pain around the ribs, but there are important differences:

Diagnosis of Costochondral Syndrome

Tietze’s syndrome is difficult to diagnose, especially when it is necessary to distinguish it from the more common costochondritis. During your initial appointment, your doctor will perform an orthopedic examination and ask you about your symptoms. He will prescribe certain tests to rule out other causes and make the correct diagnosis. These include:

• blood test to check for signs of a heart attack or other disease
• Ultrasound to check ribs for cartilage inflammation
• X-ray of the ribs to detect diseases associated with organs, bones and tissues
• Chest MRI to look more closely at cartilage thickening or inflammation
• CT fins
• electrocardiogram.

Treatment

General treatment regimen for Tietze’s syndrome:

• rest
• avoidance of strenuous activity
• applying heat to the affected area.

In some cases, the pain resolves on its own without treatment. For relief, the doctor will recommend painkillers. Other possible treatments for ongoing pain and inflammation include steroid injections to reduce swelling, or injections of lidocaine into the affected area to relieve pain. Tietze’s syndrome pain usually improves within a few months. Sometimes the condition improves and then resume. In extreme cases where conservative treatments fail to reduce pain and swelling, surgery is required to remove excess cartilage from the affected ribs.

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Medical experience: since 2018

Where does the appointment: SM-Clinic on Malaya Balkanskaya, SM-Clinic on Danube, CMRT Petrogradsky

Borisova Olga Mikhailovna

Specialization: Orthopedist, Traumatologist, Surgeon

Medical experience: since 2007

Where does the reception: SM-Clinic on Danube

Garifulin Marat Sagitovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2004

Where does the appointment: SM-Clinic on Danube, SM-Clinic on Malaya Balkanskaya

Dergulev Igor Olegovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2012

Where does the reception: SM-Clinic on Danube

Zimin Denis Vitalievich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2017

Where does the appointment: SM-Clinic on Vyborgsky, Clinic TT Life

Islamov Magomedgadzhi Magomedhabibovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2016

Where does the reception: SM-Clinic on Danube

Kazak Roman Alekseevich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2017

Where does the reception: SM-Clinic on Malaya Balkanskaya, Trauma Center on Kolomyazhsky

Karapetyan Sergey Vazgenovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2007

Where does the appointment: SM-Clinic on the Danube, SM-Clinic on Malaya Balkanskaya, Children’s Clinic No. 5, Children’s Rehabilitation and Rehabilitation Center. G.A.Albrecht on the Bolshoi Sampsonevsky

Karpushin Andrey Alexandrovich

Specialization: Orthopedist, Traumatologist

Medical experience: from 1967 years old

Where does the reception: SM-Clinic on Danube

Kikaev Adlan Olkhozurovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2016

Where does the reception: SM-Clinic on Marshal Zakharov, SM-Clinic on Udarnikov

Kolyadin Maxim Alexandrovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2008

Where does the appointment: SM-Clinic on Danube, SM-Clinic on Malaya Balkanskaya

Kustikov Anton Alexandrovich

Specialization: Orthopedist, Traumatologist, Surgeon

Medical experience: since 2012

Where does the reception: SM-Clinic on Marshal Zakharov

Lortkipanidze Ruslan Badrievich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2016

Where does the appointment: SM-Clinic on the Danube, Children’s Clinical Hospital No. 5 named after. Filatov

Mitin Andrey Viktorovich

Specialization: Orthopedist, Traumatologist, Surgeon, Urologist

Medical experience: since 1999

Where does the appointment: SM-Clinic on Udarnikov, SM-Clinic on Danube, SM-Clinic on Vyborgsky

Nikitin Alexander Vladimirovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2008

Where does the appointment: SM-Clinic on the Danube, MC “Dynasty” on Lenin, Reaclinic on Lenin, City Hospital No. 40 of the Kurortny District

Petrov Artem Viktorovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2007

Where does the reception: SM-Clinic on the Danube, Research Institute of Emergency Medicine. Janelidze

Popov Evgeny Sergeevich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2001

Where does the reception: SM-Clinic on Vyborgsky

Urbanovich Sergey Ivanovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2011

Where does the appointment: SM-Clinic on Marshal Zakharov, SM-Clinic on Vyborgsky

Fil Stepan Yurievich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2018

Where does the reception: SM-Clinic on Vyborgsky

Shikhzagirov Arsen Zagidinovich

Specialization: Orthopedist, Traumatologist

Medical experience: since 2003

Where does the reception: SM-Clinic on Malaya Balkanskaya

Author: Viktor Evgenievich Tolnikov

Specialization: Orthopedist, Traumatologist, Sports doctor Harmful

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Literature

1. Gamaley I. A. On the regulatory role of reactive oxygen species in the cell. // Int. conference “Free radical processes: ecological, pharmacological and clinical aspects”, abstracts of reports. St. Petersburg, 1999. – S.767.
2. Atakhanov P.K. Surgical correction of congenital pectus excavatum using multidisciplinary bone xenofixators: Diss. . cand. honey. Sciences. Frunze, 1989. -150 p.
3. Dolnitsky O.V., Dirdovskaya L.N. Congenital deformities of the chest in children. – K .: Health, 1978. – 117p.
4. Zahariu, Z. Keeled deformity of the chest: review and results of orthopedic compression therapy / Z. Zahariu // Medical Bulletin of the North Caucasus. – 2016. Vol. 11. No. 2. – 2016.
5. Kadurina, T.I. Connective tissue dysplasia: hands. for doctors. / T.I.Kadurina, V.N.Gorbunova. – St. Petersburg: ELBI-SPb, 2009. – 702 p.

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