Primary infectious costochondritis due to Prevotella nigrescens in an immunocompetent patient: clinical and imaging findings.

Infection of costal cartilage is a rare observation. We report the case of a 43-year-old male patient without relevant history who presented with a progressive painful swelling of the left chest wall since 4 months. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess within the left ninth costal cartilage with surrounding reactive changes. A CT-guided biopsy was performed and the culture of the sample revealed the presence of Prevotella nigrescens. Musculoskeletal infections by Prevotella are rarely described in the literature, Prevotella oralis and Prevotella bivia being the most frequently observed pathogens. These infections usually originate from a hematogenous spread after thoracic surgery or dental procedure. In our patient, conservative treatment was chosen. A clinical improvement was noted after 1-month antibiotherapy, confirmed by short-term and 6-month imaging follow-up showing the complete disappearance of all previously observed abnormalities.

Prolotherapy: An effective therapy for Tietze syndrome.

PURPOSE: To compare the short-term effect of prolotherapy and conservative terapy for the Tietze syndrome. PATIENTS AND METHODS: From 2013 to 2014, twenty-one patients underwent prolotherapy (group 1) and thirteen underwent conservative therapy with analgesics (group 2). A visual analogue score (VAS) was recorded for measurement of pain intensity in all patients before (Pre VAS) and after injection first day (VAS1), first week (VAS2) and fourth week (VAS3). Group 2 were received systemic nonsteroidal anti-inflammatory drug. VAS score was recorded similarly at the same times (Pre VAS, VAS1, VAS2, VAS3), and clinical affects were compared between the two groups. RESULTS: The mean VAS score (mm) before prolotherapy was 7.10 in patients who received prolotherapy, and 7.14 mm in patients who treated nonsteroidal anti-inflammatory drug. The mean VAS after the fist injection was 2.19 mm and dropped to 1.52 mm after the third injection. The mean VAS after the nonsteroidal anti-inflammatory drug treatment dropped 2.62 mm and during the same scores to 3 weeks later. There was no significant difference between the group 1 and group 2 in the age, sex and comorbidity. Also there was no significant difference between the group 1 and group 2 in clinical and radiological evidence. The prolotherapy group showed a faster recovery, including significantly reduced clinic findings (p: 0.001). Third VAS is significant finding for the prolotherapy group. CONCLUSION: Prolotherapy could be performed safely and is a method with a favorable long term treatments for Tietze Syndrome. It may be the ideal procedure for patients with drugs side effects and advers events especially for those with limited liver and kidney reserve or significant comorbidities.

Late costal osteomyelitis with a cutaneous fistula after flame burns: a case report.

Chest wall defects are an unusual complication of burn injury, generally seen after high-voltage electrical burns. Here we report the case of a 57-year-old man who developed costal chondritis and osteomyelitis 23 months after flame injury, which covered 50% of the total body surface area. Management included the resection of two ribs and coverage with an omental flap, overlaid by a split-thickness skin graft during the same surgical procedure. Declaration of interest: The authors have no conflict of interest to declare.

Evaluation and treatment of musculoskeletal chest pain.

This article summarizes the evaluation and treatment of musculoskeletal causes of chest pain. Conditions such as costochondritis, rib pain caused by stress fractures, slipping rib syndrome, chest wall muscle injuries, fibromyalgia, and herpes zoster are discussed, with emphasis on evaluation and treatment of these and other disorders. Many of these conditions can be diagnosed by the primary care clinician in the office by history and physical examination. Treatment is also discussed, including description of manual therapy and exercises as needed for some of the conditions.

Stretching exercises for costochondritis pain.

The term costochondritis (ChC) indicates a painful and persistent inflammation at the costochondral or costosternal junction. The usual conservative treatment (NSAIDs), local splinting, local heat) and sometimes disappointing. The aim of this study is to evaluate the effect of stretching exercises in a group of patients affected with ChC. This retrospective open study involved 51 outpatients with diagnosis of ChC: thirty four consecutive patients were treated with stretching exercises, 34 patients matched for age, pain and disease duration constituted the control group. All the patients had spontaneous pain at least in the one of the costochondral junctions at the third to seventh rib. The intensity of spontaneous pain was measured by means of the visual analogic scale of Scott-Huskisson. The homogeneity of the two groups at the beginning of the study was checked for VAS, for disease duration and age by means of Mann-Whitney test for non-parametric measures. The statistical analysis of pain was done by Friedman analysis of variance and Student-Newman-Keuls multiple comparisons tests. The results showed a progressive significant amelioration in patients treated with stretching exercises as respect as the control group (p<0.001). The goal of therapy of costochondritis is to reduce inflammation and the pain. The NSAIDs, local injection of anaesthetic or steroid has insufficient effectiveness. The possibility to improve the pain by means of simple stretching exercises can supply a useful instrument in order to treat the condition of these patients.

Costochondritis: diagnosis and treatment.

Costochondritis, an inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, is a common condition seen in patients presenting to the physician's office and emergency department. Palpation of the affected chondrosternal joints of the chest wall elicits tenderness. Although costochondritis is usually self-limited and benign, it should be distinguished from other, more serious causes of chest pain. Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation. History and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults. Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph. Consider further testing to rule out cardiac causes if clinically indicated by age or cardiac risk status. Clinical trials of treatment are lacking. Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance.

Conservative treatment of a female collegiate volleyball player with costochondritis.

OBJECTIVE: This study was conducted to discuss the conservative care used to treat a female collegiate volleyball player with acute costochondritis. CLINICAL FEATURES: A 21-year-old collegiate volleyball player had right anterior chest pain and midthoracic stiffness of 8 months duration. INTERVENTION AND OUTCOME: High-velocity, low-amplitude manipulation was performed to the associated hypokinetic costovertebral, costotransverse, and intervertebral zygapophyseal thoracic joints. Instrument-assisted soft tissue mobilization was performed by using the Graston technique. Pain levels improved on numeric pain scale, as did functional status identified on Dallas Pain Questionnaire and Functional Rating Index. CONCLUSION: This athlete seemed to respond positively to manipulation, soft tissue mobilization, and taping.

Pleomorphic T-cell lymphoma with chondropathia tuberosa; a case report and review.

Pleomorphic T-cell-lymphoma (anaplastic IgA-plasma cell tumor) belongs to the group of malignant non-Hodgkin's lymphomas (NHL). The histological and immunophenotypical subtypes differ with genetic and environmental etiologic factors. Lymphomas arise from the clonal proliferation of precursor cells within lymphoid organs with acquired chromosomal abnormalities. Approximately 5% of all primary malignant bone tumors are NHL, the majority of diffuse large B-cell type. Our case history can be regarded as the first published in English language reporting on a pleomorphic T-cell-lymphoma imitating a Chondropathia tuberosa (Tietze's syndrome): The tumor appeared with a tender tumescence over the sternum and a painful swollen left sterno-clavicular joint--as a rule a typical sign for Tietze's syndrome. Only sternal puncture followed by immune histology confirmed an anaplastic IgA-plasma cell tumor. The primary tumor, and later on an osteolysis of cervical vertebrae I-III with a complete destruction of the axis and an affection of the dens atlantis could not be detected by radiographic examinations. Moreover, this tumor infestation could only be depicted by the magnet resonance imaging and the computed tomography. Furthermore, other results of our report are the very rare manifestation of a T-cell lymphoma as a pedicled tumor near the pancreas or of pancreatic origin and the excellent result of an autologous stem cell transplantation. Reviewing the literature, we want to discuss the present scientific and clinical standards of diagnosis, progress and treatment of Chondropathia tuberosa and T-cell lymphoma, and we want to point out some new aspects of both diseases.

[Tietze's syndrome]. / Sindrom Tittse.

The results of treatment of 14 patients (11 males and 3 females) with Tietze's syndrome are discussed. The patient's ages ranged from 22 to 56 years. Most of them were engaged in heavy physical work. The correct diagnosis was established before admission only in 9 patients. The complaints and clinical symptomatology were of the same type almost in all of the patients: pain and swelling in the region of the II-IV costal cartilages at the sternum or along the whole cartilaginous part of the ribs, in some cases pain was referred to the upper part of the shoulder girdle. Clinical and X-ray methods of examination failed to make recognition of the disease easier. The diagnosis was established on basis of scrupulous investigation of the complaints, the history of the disease, and the local clinical manifestations. Most patients were subjected to nonoperative treatment, 2 patients were treated by operation--resection of the hypertrophied cartilage. Local application of hydrocortisone and kenalog produced good results. Pain disappeared completely in 7, was relieved significantly in 5, and was not relieved at all in 2 patients.

Tietze's syndrome: a critical review.

A critical review of Tietze's syndrome and the relevant literature to date is presented. The disease has been characterized as a tender, non-suppurative swelling in the upper costosternal region. The etiology and pathology of the disease are still unknown. In the past decade new knowledge concerning rheumatic diseases affecting the anterior chest wall has modified our approach to this condition. Tietze's syndrome could be more a part of seronegative disease than has been previously recognized, even if the existence of this condition as an entity cannot be totally denied.