Costochondritis and Tietze Syndrome (Investigational Adjunct)

Patient Summary

Is this FDA-cleared for this use?

Not FDA-cleared for costochondritis. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, June 2004). Use for costochondritis or Tietze syndrome is investigational.

What evidence exists?

Tier C (investigational). Only anecdotal reports; there are no randomized controlled trials. Evidence-based therapy for costochondritis: reassurance after cardiac and pulmonary causes are excluded, NSAIDs (oral or topical diclofenac), heat or cold application, and activity modification. Most cases resolve within 6-12 months. Tietze syndrome (with visible swelling) may benefit from corticosteroid injection. Cardiac chest pain must always be ruled out first.

Main risks

• Bleeding from bite sites for 6 to 24 hours after detachment
• Bruising and tenderness over the anterior chest for 5 to 14 days
• Local skin infection or, rarely, Aeromonas infection
• Allergic reaction to leech saliva (uncommon)
• Increased chest-wall pain after the procedure
• Risk of mistaking cardiac chest pain for costochondritis (delay in cardiac diagnosis)
• Permanent small scars at bite sites on the chest
• Delay of NSAID therapy or corticosteroid injection for Tietze syndrome

Who should not consider this

• Patients with chest pain that has not been cardiac-evaluated (ECG, possibly stress test or troponin)
• Patients with suspected pulmonary embolism, pneumothorax, or aortic dissection
• Patients with active myocardial infarction or unstable angina
• Patients on anticoagulants, with hemophilia, or with severe anemia
• Pregnant patients
• Patients with rib fracture or chest-wall trauma in the past 6 weeks

What to ask your clinician

• Have cardiac causes of my chest pain been adequately excluded?
• Have I been evaluated for pulmonary embolism if I have risk factors?
• Have I tried oral or topical NSAIDs for at least 2-4 weeks?
• If I have Tietze syndrome with visible swelling, am I a candidate for corticosteroid injection?
• What evidence specifically supports leech therapy for costochondritis?
• Are leeches from an FDA-registered supplier and used only once?
• What is the cost and is it covered by insurance? (typically not covered)

When to seek urgent care

• Crushing or pressure-like chest pain with radiation to arm, jaw, or back (possible heart attack — call 911)
• Sudden severe shortness of breath or chest pain (possible pulmonary embolism or pneumothorax)
• Pain with sweating, nausea, or lightheadedness (possible cardiac event)
• Fever above 38.0 C / 100.4 F or chills
• Bleeding from a bite site lasting more than 24 hours
• Hives, facial or tongue swelling, throat tightness, or breathing difficulty