Sternum pain and arthritis
Tietze Syndrome is an inflammatory condition of the breast area, and is one form of costochondritis. Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage. In general, costochondritis is a relatively harmless condition and usually goes away without treatment. Tietze Syndrome, on the other hand, is associated with swellings at the rib-cartilage junction, and lasts longer. (Costochondritis has no noticeable swelling.) Neither condition involves pus or abscess formation. Tietze syndrome usually affects the bone-cartilage junctions of the second and third ribs. The swelling may last for several months. The syndrome can develop as a complication of surgery on your sternum, months to years after the operation. However, the cause is usually unknown. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for the pain, and sometimes local injections of corticosteroids are required. In women, breast pain is cyclical or non-cyclical. In cyclical breast pain there is a clear relationship with the menstrual cycle. A number of other conditions (apart from breast cancer) can give rise to non-cyclical pain in the breast. In these conditions, the pain is present most of the time at varying levels of intensity, but is not related to the menstrual cycle. Such conditions include inflammation of the costochondral junctions (Tietze syndrome), trauma, "trigger point" mastalgia, fat necrosis, fibroadenomas and breast cysts. Septic arthritis, also known as infectious arthritis or pyogenic arthritis, is an infection in the joint (synovial) fluid and joint tissues. The infection usually reaches the joint(s) though the bloodstream, although some joints may become infected due to an injection, surgery, or injury. Infectious arthritis can occur in any age group, including newborns and children. In adults, it usually affects the wrists or one of the patient's weight-bearing joints--most often the knee--although about 20% of adult patients have symptoms in more than one joint. Multiple joint infection is common in children and typically involves the shoulders, knees, and hips. The most common joint affected by infection is the knee. Small joints, such as those in fingers and toes, are more likely to become infected after a viral infection or direct injury, such as a bite. Among intravenous drug users, joints such as those in the spine or sternum (breastbone) may be involved. People who already have rheumatoid arthritis or other joint disease are more likely to develop infectious arthritis. Septic arthritis is considered a medical emergency because of the damage it causes to bone as well as cartilage, and its potential for creating septic shock, which is a potentially fatal condition. Ankylosing spondylitis (AS) is a chronic inflammatory form of arthritis that affects the spinal joints. The hallmark feature of AS is the involvement of the joints at the base of the spine where the spine joins the pelvis - the sacroiliac (SI) joints. The disease course is highly variable, and while some individuals have episodes of transient back pain only, others have more chronic severe back pain that leads to differing degrees of spinal stiffness over time. In almost all cases the disease is characterized by acute painful episodes and remissions (periods where the problem settles). Over the years AS has been known by many different names including poker back, rheumatoid spondylitis, and Marie-Strumpells spondylitis. Since the early 70s with increasing knowledge about the disease, there is almost universal use of the term ankylosing spondylitis (AS). AS is a member of the family of diseases that attack the spine. These are named spondylarthropathies. In addition to AS, these diseases include Reiters syndrome, some cases of psoriatic arthritis and the arthritis of inflammatory bowel disease. AS is three times more common in men than in women. It typically affects young people, beginning between the ages of 15 and 30. It may affect younger people also, although in very young people it may take a slightly different form, causing pain around the heels, knees, and hips rather than beginning with the spine. Onset after age 40 is uncommon. Common symptoms include: Frequent low back pain.
The back pain is usually dull and diffuse rather than sharp and localized. The most common site of pain is deep within the buttock, on one side, or on both sides. In addition to the buttock, there could be pain further up the back, perhaps between the shoulder blades or in the neck. In a lesser number of individuals, pain does not begin in the spine but starts in a hip, knee or shoulder joint. This can be confusing when there is no back pain present and may initially look like some other form of arthritis. The pain of AS results from inflammation of the joints. When inflammation is present, the involved area hurts. To avoid the pain there is a natural tendency to stoop forward as extending backwards is more uncomfortable. This reflex can lead to bad posture. Also in bed there is a tendency to curl up, as this may feel more comfortable. If the inflammation associated with AS continues unchecked, it can produce changes within the spinal column. Small bony outgrowths extend from the edges of the vertebrae and can eventually bridge across from one vertebra to the next. Should this occur, over time it can result in stiffness and immobility between the vertebrae. While there are 24 different spinal vertebrae in the back, stiffness of any two can limit function. Stiffness of more can lead to progressive disability. While spinal stiffness is to be avoided, even greater potential disability can occur if AS affects the hips, knees or shoulders. The hip joints are quite often involved and can progress to where the joint is damaged, becoming limited in mobility, and painful. The end stage of this hip damage is frequently total hip joint replacement. Most commonly the joints in the buttocks, called the sacroiliac joints, are affected. The low back is commonly involved, as is the mid-back (the thoracic spine) and the neck (the cervical spine). Of the non-spinal joints, the hips are the most commonly involved and to a lesser extent the knees and shoulders. Involvement of the small joints of the hands and feet, wrists and ankles is unusual. The joints between the ribs and the spine and between the ribs and the breast bone (sternum) can also become painful and stiff. Stiffness of these joints can result in decreased chest expansion. Individuals with AS have a much greater likelihood of having episodes of iritis (inflammation of the iris of the eye). This results in the eye being painful and irritated. It is often described as a feeling of having had a handful of sand thrown in the eye. The individual may also be sensitive to bright light. This is usually treated with eye drops. Although it is relatively uncommon, there is a possibility of inflammation involving the aorta near the heart. If you have AS, your physician may therefore listen to your heart from time to time.
Sternum pain may also occur as a consequence of bypass surgery for heart disease. Fibromyalgia is a common condition characterized by widespread pain in joints, muscles, tendons, and other soft tissues. Some other problems commonly linked to fibromyalgia include fatigue, morning stiffness, sleep problems, headaches, numbness in hands and feet, depression, and anxiety. Fibromyalgia can develop on its own, or secondary to other musculoskeletal conditions, such as rheumatoid arthritis, or systemic lupus. Diagnosis of fibromyalgia requires a history of a least three months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. These tender-point sites include fibrous tissue or muscles of the: Neck Fibromyalgia pain can mimic the pain that occurs with various types of arthritis. However, the significant swelling, destruction, and deformity of joints seen in diseases such as rheumatoid arthritis does not occur with fibromyalgia syndrome alone. The soft-tissue pain of fibromyalgia is described as deep-aching, radiating, gnawing, shooting or burning, and ranges from mild to severe. Fibromyalgia sufferers tend to wake up with body aches and stiffness. For some patients, pain improves during the day and increases again during the evening, though many patients with fibromyalgia have day-long, unrelenting pain. Pain can increase with activity, cold or damp weather, anxiety, and stress. The cause of this disorder is unknown. Physical or emotional trauma may play a role in development of the syndrome. Some evidence suggests that fibromyalgia patients have abnormal pain transmission responses. It has been suggested that sleep disturbances, which are common in fibromyalgia patients, may actually cause the condition. Another theory suggests that the disorder may be associated with changes in skeletal muscle metabolism, possibly caused by decreased blood flow, which could cause chronic fatigue and weakness. Others have suggested that an infectious microbe, such as a virus, triggers the illness. At this point, no such virus or microbe has been identified. Pilot studies have shown a possible inherited tendency toward the disease, though evidence is very preliminary. The disorder has an increased frequency among women 20 to 50 years old. The prevalence of the disease has been estimated between 0.7% and 13% for women, and between 0.2% and 3.9% for men. Symptoms Multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, knees. Sometimes, laboratory and x-ray tests are done to help confirm the diagnosis. The tests will also rule out other conditions that may have similar symptoms. Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia. In mild cases, symptoms may go away when stress is decreased or lifestyle changes are implemented. A combination of treatments including medications, patient education, physical therapy, and counseling are usually recommended. Many fibromyalgia sufferers have found support groups helpful. Certain classes of antidepressant medications are sometimes prescribed for the disorder. Studies show that antidepressants in low doses can decrease depression, relax craniofacial and skeletal muscles, improve sleep quality, and release pain-killing endorphins. Other medications that are used include anti-inflammatory pain medications and medications that work on pain transmission pathways, such as Gabapentin. Eating a well-balanced diet, and avoiding caffeine may help with problems sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia. Some reports indicate that fish oil, magnesium/malic acid combinations, or vitamins may be effective. Reducing stress and improving coping skills may also help reduce painful symptoms. Improved fitness through exercise is recommended. Studies have shown that fibromyalgia symptoms can be relieved by aerobic exercise. The best way to begin a fitness program is to start with low impact exercises, like walking and swimming. Starting slowly helps stretch and mobilize tight, sore muscles. High-impact aerobics and weight lifting could cause increased discomfort. Symptoms may be relieved by gentle stretching and light massage, as well as acupressure, acupuncture, and relaxation techniques. Severe cases of fibromyalgia may require a referral to a pain clinic. Fibromyalgia is a common and chronic problem. The symptoms sometimes improve. At other times, the symptoms may worsen and continue for months or years. The key is seeking professional help which includes a multi-faceted approach to the management and treatment of the disease. There is no proof that fibromyalgia syndrome results in an increased death rate. Conditions reported as associated with fibromyalgia or that mimic its symptoms include: rheumatoid arthritis, hypothyroidism, cervical and low-back degenerative disease, Lyme disease, chronic fatigue syndrome, sleep disorders, depression, cancer, and HIV infection.
|
