Tietze syndrome is a benign painful swelling of one or more costal cartilages that connects the ribs to the breastbone. It typically affects people under 40 years of age and presents as sudden or gradual onset of chest pain that may radiate to the arms and is aggravated by coughing, sneezing, deep breathing or twisting motions. While the exact cause is unknown, it often results from physical strain or minor injury. Diagnosis is usually made clinically without need for imaging, though x-rays may sometimes show rib end enlargement. Treatment focuses on rest, anti-inflammatory drugs, physical therapy or corticosteroid injections for pain relief.