Orthopedics-Online

Rib pain - How dangerous is it?

introduction

Pain in the costal arch can be due to a variety of causes. In many cases, the symptoms are harmless and some of them go away on their own after a short time. Sometimes, however, serious illnesses are also the cause of the pain, so that one should consult a doctor promptly if such a clinical picture is suspected. Depending on which costal arch or in which spatial relationship the pain is localized to the ribs, specific organic diseases can be responsible for the symptoms. In addition to the liver and spleen, this also includes the stomach and pancreas. Furthermore, a medical consultation should take place as soon as possible, especially in the case of symptoms that appear suddenly, as this can also be an indication of an acute event in the heart, which may express itself as radiating pain.

Pain in the right costal arch

Pain in the right costal arch can have various causes:

Gallbladder diseases

Pain in the right costal arch may indicate a problem with the gallbladder. In the case of biliary colic, severe, cramp-like pain occurs in the right upper abdomen and thus also in the area of the right costal arch. Bile colic is caused, for example, by gallstones that block the bile duct. This reacts with spasmodic contractions that are supposed to drive out the stone. Inflammation of the gallbladder (Porcelain gallbladder) can cause such symptoms. The region in the right upper abdomen is usually tender on pressure.

Liver disease

The liver lies directly under the lower right ribs and normally ends a maximum of 1 cm below the right costal arch. When inhaling deeply, it can be felt there. Liver disease can manifest itself as pain in this area, e.g. an enlarged liver or inflammation of the liver (hepatitis). With chronic alcohol consumption, a so-called fatty liver develops over time, i.e. the liver stores more fat and thereby enlarges. The tension in the organ consequently increases and the organ capsule is put under tension (increased capsule tension). This can manifest itself as pain in the area of the right costal arch and a feeling of fullness. Inflammatory processes can also lead to reactive enlargement of the liver and cause symptoms like this.

Do you have pain on the right side of your chest? Read more about this under: Right Rib Pain - What Do I Have?

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Diseases in the intestine

The intestine is distributed throughout the abdomen. The large intestine in particular extends to the right costal arch, as it runs in the so-called colonic frame, i.e. it forms a frame from the right lower abdomen over the right upper abdomen to finally the left upper and lower abdomen. Inflammation of the intestines or brief constipation can also cause pain in the costal arch area.

Herpes zoster as a cause

Herpes zoster (Shingles) is a viral disease caused by the same virus as chickenpox. Shingles manifests itself as a one-sided skin rash, which is noticeable by itchy and burning blisters and a significant reddening of the skin. In its course, the rash follows the course of the nerves along the ribs, as the viruses stay in the nerve plexuses on the spine before they find their way along the nerves. The pain can be very severe. Shingles can be treated, for example, with antiviral drugs.

Pain from trauma

A more harmless cause of pain in the costal arch area is a rib injury from an accident or the like, which can result in rib bruises. The bruised ribs are usually very painful, but generally considered harmless because the ribs are not broken. The therapy is based on conservative measures such as cooling and, if necessary, pain relievers. In the event of a broken rib, injury to the lungs must always be excluded. This can quickly be perforated by a fragment of bone, causing the lungs to collapse (Pneumothorax) can come. This must be treated surgically. Uncomplicated rib fractures usually heal without surgical therapy and are treated with painkillers.

Read more on the topic: Broken rib pain

Muscular causes

Incorrect movement or sports injuries can lead to muscle strains, muscle fiber tears between the ribs and irritation of nerves. All of these conditions can manifest themselves in rib and costal arch pain. Most of the time, however, these injuries are harmless and will heal on their own.

Read more on the topic: Pain in the right costal arch

Figure pain in the costal arch

Figure pains costal arch: internal organs from the front

Costal arch pain

Sternum - sternum
Right costal arch -
Arcus costalis dexter
Liver - Hepar
Gallbladder -
Vesica biliaris
Pancreas -
Pancreas
Colon -
Intestinum crassum
Pericardium - Pericardium
Left costal arch -
Arcus costalis sinister
Rib 7 - Costa VII
Spleen - Sink
Rib 8 - Costa VIII
Rib 9 - Costa IX
Rib 10 - Costa X
Stomach - Guest
The costal cartilages of the 7th - 10th rib
merge into the costal arch.

You can find an overview of all Dr-Gumpert images at: medical illustrations

Pain in the left costal arch

Spleen:

Due to its location, diseases of the spleen can manifest themselves as pain in the area of the left ribs and the left costal arch. The spleen is usually not palpable in its niche. This is only the case if it is enlarged (e.g. in the case of inflammation). In this case, the enlarged organ can press on the nerves and cause pain in the rib and costal arch area. A disease that is often associated with severe swelling of the spleen is Pfeiffer's glandular fever caused by the Epstein Barr Virus (EBV). In this case, sports activities must be temporarily avoided, as the risk of a ruptured spleen is increased. When the spleen ruptures, the spleen tears due to the increased capsule tension. This creates heavy bleeding that can quickly become life-threatening. Also a splenic infarction, i.e. acute occlusion of an artery supplying the spleen can cause severe pain. This can lead to the destruction of spleen tissue. During a splenic infarction, the patient usually has severe pain, often nausea, vomiting and fever. A splenic abscess is a possible differential diagnosis. This leads to an accumulation of pus in the spleen, which can also cause discomfort in the area of the left costal arch due to spleen swelling and compression of the surrounding nerves.

Heart:

Acute pain in the area of the left costal arch or the left ribs can always be an indication of a cardiac cause. Heart attacks often lead to chest pain that can radiate into the upper abdomen and ribs. These symptoms are particularly common in women. Radiation into the jaw, left arm and back is also observed.

Stomach:

The stomach is in the upper abdomen a little to the left of center. Inflammation of the stomach lining (gastritis), Stomach ulcers (Ulcers) or other stomach problems can cause upper abdominal discomfort as well as pain in the rib area.

Intestines:

As with right-sided rib arch pain, the bowel can also be the cause of the symptoms on the left side. In the left-sided large intestine, inflammations occur particularly frequently, for example the Diverticulitis, in which small protuberances in the intestinal wall become inflamed. Typically there is pain on the left side of the lower abdomen; However, since the diverticula can in principle occur anywhere in the intestine, a different localization of the symptoms is also conceivable.

Pancreas:

The pancreas (pancreas) is also slightly shifted to the left in the upper abdomen. Accordingly, diseases of this organ can also cause left-sided pain in the upper abdomen and rib area. Inflammation of the pancreas (Pancreatitis) usually manifests itself in sudden, violent pain in the upper abdomen, which radiates in a belt-shaped manner into the back. The pain also radiates to the rib area. The patient's stomach is usually tense. Often there is also nausea and vomiting, as well as fever and low blood pressure.

Herpes zoster

Herpes zoster (Shingles) can occur on the left side of the body just like on the right. The burning and itchy, vesicular rash often causes severe pain in the rib area (see above).

Trauma, muscular causes

Left-sided rib arch pain can also arise from incorrect movements or accidents.
Muscle strains, muscle fiber tears and nerve irritations can be very painful, but are generally harmless and heal on their own. In principle, the so-called side stitches can also cause pain in the costal arch area, as the diaphragm cramps through irregular or strong breathing and causes the sharp pain. Another cause of side stitches that is being discussed is swelling of the spleen from physical exertion. The increased capsular tension of the organ could also be responsible for the sharp pain in the left costal area.

Read more on the topic: Left rib pain

Pain in the center of the costal arch

The connection of the costal arches represents a bony structure, the breastbone (medical: sternum). There, too, pain can occur, which may be related to the costal arch.

In general, it is important to distinguish between two different types of pain. If the pain can be modulated by changing body position or by applying pressure to the painful area, an organic cause is usually unlikely. If this is not the case, however, and the pain may even radiate to the jaw, left arm or back, it is known as angina pectoris. There are various possible causes for existing angina pectoris. A common reason is coronary artery disease, which can cause pain in the middle of the chest due to insufficient oxygen supply to the heart.
It can also be called an aortic dissection, in which the wall of the aorta is damaged. Ultimately, a pulmonary embolism can also be the cause of the pain. In any case, if there is chest pain that cannot be explained by disorders of the musculoskeletal system, a doctor should be consulted as soon as possible. Particularly if the pain radiates in the jaw, arm or back, it can be the symptoms of angina pectoris and thus a serious illness.

Other organs in the middle upper abdomen can also trigger the pain in the middle of the chest or the costal arch. Above all, the stomach or intestines, but also the pancreas, can be the cause of the symptoms in this area. For example, gastric reflux may be responsible for the pain.

However, if the symptoms can be modulated by movement or pressure on the affected area, angina pectoris is at least unlikely. The reason for the existing problem in these cases is usually a skeletal or muscular cause. Problems with the spine can also cause pain in the middle of the chest. Muscle strains or pain that arise after an injury are also typical of the problem. It may also be that the joints that connect the ribs to the sternum or spine need to be straightened and a dislocated joint is the cause of the pain. Even in cases where the joints or muscles are the cause of the pain, a doctor should be consulted who will examine the problem and find a solution with the help of suitable therapy.

Rib pain - How dangerous is it?

Depending on the localization of the pain on the costal arch, there are numerous possible organic causes, whereby in most cases there is only one musculoskeletal, harmless cause underlying the symptoms. These are usually muscle strains or tension or nerve irritation, which arise in the context of excessive or incorrect loading and can be very painful. Compared to pain caused by an organic disease, these are usually pointed, sharp and easily localized by the person affected. They show a typical course with the first appearance either in temporal association with the responsible activity or trauma-related and usually heal independently with slow regression of the symptoms in a few days.

In relation to this, the occurrence of pain on the costal arch, which is caused by a serious organic disease, is extremely rare. In this regard, particular attention should be paid to warning signs, such as the sudden onset of symptoms. Since most serious clinical pictures are accompanied by other specific symptoms in addition to pain, these can already be indicative of the underlying disease.
If the cause of the pain lies in the gall bladder, for example, the symptoms on the right side occur more frequently in relation to food intake, whereas if a disease of the spleen manifests itself, the pain appears below the left costal arch and is usually associated with swelling of the organ.
However, if the pain is caused by inflammation of the pancreas, it typically manifests itself as a belt-like radiation to the back.
Above all, clinical pictures that involve the main artery or the heart are characterized by sudden pain, associated with shortness of breath, radiation of pain or fear of death.

All in all, it is important to emphasize that pain in the costal arch is largely due to a harmless cause, especially if it occurs in connection with increased or unusual stress. If, contrary to expectations, the symptoms do not decrease within a few days, a medical examination is recommended.

Concomitant symptoms

Pain in the costal arch from coughing

Pain in the costal arch, which can mainly be caused by a strong cough, suggests a disorder of the musculoskeletal system in the affected area. If a certain organ is the cause of the pain in the costal arch, the pain usually cannot be modulated by movements or coughing and is constantly present. The cause of pain in the costal arch, which is only noticeable when coughing, can be traced back to trauma in most cases. Bruised ribs or broken ribs in particular can trigger these complaints. Muscular causes can also be the cause of the symptoms. The reason for this is that when you cough, pressure is involuntarily created in the lungs and the costal arch is stressed. If there are rib injuries, these are particularly painful when moving like coughing. In the case of pulled muscles, nerve irritation can also lead to discomfort when coughing. Especially after an accident, the symptoms of the costal arch when coughing should be examined by a doctor in order to diagnose major injuries and, if necessary, to treat them correctly.

Read more on the subject at: Pain in the costal arch from coughing

Pain in the costal arch with shortness of breath

Shortness of breath is not a rare symptom with pain in the costal arch. The shortness of breath can have the same cause or it can be caused by the pain itself. In particular, if the musculoskeletal system or the lungs are involved, severe, breathing-dependent pain can occur. In addition to injuries to the ribs, nerves or muscles in the chest area, these can also include inflammatory lung diseases that cause pain when the lungs move in the lung membrane.

Rarer causes can be traced back to organs in the chest area and upper abdomen. Heart attacks and pulmonary embolisms are two common acutely life-threatening diseases that are associated with shortness of breath and lead to chest pain. The pain cannot be triggered by targeted pressure on the costal arch and can be felt indefinitely and diffusely in the chest. The diaphragmatic hernia is a rare clinical picture. Under certain circumstances, the stomach can get through the diaphragm into the chest. A sharp pain in the area of the costal arch is not uncommon. If the stomach displaces the lungs, shortness of breath can also occur.

Pain in the costal arch when breathing

Breath-dependent pain occurs in some diseases of the chest area. With each breath, the muscles between the ribs tighten, lifting the rib cage and pleura, and causing the lungs to expand. Any muscular, neural or skeletal damage to the chest can result in stabbing pain as part of this movement. If the lungs are inflamed, the breathing-related shifts in the pleura can also lead to friction and unpleasant pain in the costal arch. The breath-dependent pain is therefore an essential indicator in the investigation of chest pain.

Pain in the costal arch with a cold

A cold can be accompanied by inflammation of the airways and a cough. In severe cases, pneumonia can develop, leading to chest pain. Not infrequently, a severe cough can lead to sore muscles in the respiratory muscles. This affects the diaphragm and rib muscles. These sore muscles lead to mild pain with every breath.

Pain in the costal arch with flu

Pain in the costal arch with flu is rare. Usually these pains occur in connection with a strong cough and the resulting sore muscles in the chest area.

It is also possible that the infection leads to a generalized, sensitized pain sensation. Usually this manifests itself in pain in the limbs, which can radiate into the costal arch.

Pain in the costal arch with fever

Fever is a common sign of an existing infection. Together with a cough, sore throat, body aches, chills and fatigue, it can indicate a respiratory disease. The pain in the costal arch is caused by the pleura being involved in the inflammation. The pain can also occur as part of sore muscles in the chest if the cough is too strong.

You might also be interested in: Signs of pneumonia

Costal arch pain and nausea

If nausea is another symptom in addition to the pain in the costal arch, there may be several causes. Pain in the right costal arch, along with nausea, and sometimes vomiting and constipation, are typical of gallbladder inflammation. Diseases of the intestine or stomach can also be the reason for the pain in the costal arch if there is also nausea. Reflux or diseases of the colon are particularly important here.

Another cause of pain in the costal arch and the simultaneous nausea is a special form of preeclampsia during pregnancy. This is the so-called HELLP syndrome, a serious disease in pregnant women, which, in addition to high blood pressure, leads to liver dysfunction, which can be perceived as pain in the right costal arch.

Read more on this topic at: Pain in the ribs during pregnancy

In addition to pain, the typical symptoms of HELLP syndrome also include nausea, vomiting and diarrhea. Since this is a dangerous complication during pregnancy, if you notice these symptoms you should consult your doctor as soon as possible, who can carry out a diagnosis and, if necessary, initiate suitable therapy.

Pain in the costal arch after eating

Chest pain that occurs right after eating can be due to various organs. The acid build-up creates a burning sensation in the stomach. This is a common problem in many adult people. Bile colic can be less common. A blockage of the bile ducts leads to a backlog of the bile fluid and severe pain. Since the liquid is poured out mainly during the meal, this pain occurs a little later than the food intake.

In rare cases there may be a hole in the diaphragm behind it. This allows the stomach to lie in the chest area and press on organs there. As you eat, the stomach increases and the pressure on the surrounding organs increases, making the pain worse.

Read more about this under: Upper abdominal pain after eating

With involvement of the stomach

The stomach can cause pain in the chest and costal arch in various diseases. Very common is a burning pain caused by acid reflux (heartburn). In the initial stage, the reflux manifests itself as heartburn and is burning noticeable behind the breastbone. In some cases it can be mistaken for a pain in the costal arch. A stomach ulcer can also cause similar pain. Often there is stabbing pain when swallowing large bites of unchewed food. When it enters the stomach, it causes a stinging sensation in the chest area.

With participation of the diaphragm

The diaphragm is a very large muscle that makes up most of the respiratory muscles. It separates the chest area from the upper abdomen. If this muscle is damaged, holes and crevices can arise which, under certain circumstances, push abdominal organs into the chest. These diaphragmatic defects can be congenital or acquired. Parts of the stomach and intestines can get into the chest and cause pain, shortness of breath and other complications due to pressure on the organs located there.

Pain in the costal arch from tension

In the area of the costal arch there are many muscle groups that are involved in breathing and many activities and thereby move the ribs. The muscles in the chest can become tense and cramped for a variety of reasons. This can occur for no reason, in the context of sporting activity or during monotonous activities or tense sitting. The tense muscle spasms and contracts, so that many movements can trigger a sharp pain in this muscle. Breathing-dependent muscle movement can also be affected. Tensions are often released by themselves, through massages or exercise. Until then, light pain medication can make the tension more bearable.

Rib pain related to back pain

In addition to the possibilities described, the causes of the pain in the costal arch can also come from the back. The reason for this is that the ribs with small joints adjoin the spine and a problem with the back can easily be projected into the ribs. For example, pain in the costal arch can arise if the costovertebral articulation (articulatio costovertebralis) is dislocated and thus irritates the nerves that run directly on the affected structure. In these cases, just inhaling, bending or walking can lead to pain in the costal arch. Sometimes it can even lead to shortness of breath if the joints of the costal arch are affected. An orthopedist, osteopath or physiotherapist can diagnose the problem and improve the symptoms by straightening the joints.
Muscles that come from the back sometimes attach to the ribs and can explain the existing symptoms in the event of a muscular problem. Muscle strains can develop, which can explain the pain in the costal arch, especially when sports or training programs have only recently started.

Conversely, the connection of the ribs to the spine can also cause the pain in the costal arch to radiate to the back. If the pain can be modulated primarily through movements, a detailed physical examination by the orthopedic surgeon can provide information about the individual problem. Radiating pain in the back can also be an indication of a serious cause, which is why the complaints should always be clarified. Therefore, diseases of the internal organs, such as the pancreas, also belong.
Injuries to the back can also trigger pain in the costal arch. Especially when the spine is affected, pain in the costal arch can occur in addition to local complaints.
Malformations of the spine can also lead to pain in the costal arch. For example, scoliosis can cause considerable discomfort due to the displaced spine, which can sometimes occur in the costal arch. Because the ribs are connected to the spine, in addition to the spine, if there is scoliosis, the costal arch is also displaced on both sides and in many cases leads to massive pain.

Read more about this under: Causes of Back Pain

Pain in the costal arch from sitting

A pain that is mainly triggered or exacerbated by sitting often indicates a muscular problem. It is not uncommon for people who work in the office or after particularly long periods of sitting to experience pain in the rib arch. The cause is cramping and tension in the muscles. Back pain can also be associated with it. Ergonomic office chairs and muscle building of the back help in the long term against pain while sitting.

Rib pain when lying down

Some types of chest pain can worsen while lying down. Sufferers complain of sharp pains that keep them awake at night and that are made worse by pressure, breathing and lying horizontally. Lying on your side, in particular, puts more pressure on your chest and ribs and can increase muscular or skeletal pain. Only more lying on your back or soft upholstery in bed can make the night more bearable. If you have severe sleep problems caused by the pain, pain medication can be taken before bed. Breathing-dependent pain can also worsen during the night. Since the position on the back causes the structures in the abdomen and chest to shift, the existing pain can also be more noticeable when lying down.

Costal arch pain during pregnancy

Many pregnant women experience pain in the costal arch during pregnancy. These mainly occur in the second half of pregnancy.

In most cases this pain is harmless. They express themselves as sudden, stabbing pain and usually go away on their own after a short time. The cause of this is usually the baby that is getting bigger and bigger. The abdominal muscles are stressed and stretched further and further. Since these have their origin at the costal arch, a pull occurs here, which can lead to pain in this area. This pain can even radiate to both sides of the spine. The growing uterus expands increasingly upwards to under the costal arch and presses on the organs that are located there.

The pain in the costal arch during pregnancy usually occurs on the right side, as this is where the liver and gall bladder are located, which can trigger the pain due to the increasing pressure. Outstretched parts of the baby's body can also cause pain here.
To relieve the pain, lying on the opposite side and sleeping can help. Special pregnancy pillows can also provide relief. As a rule, the pain disappears on its own from the 38th week of pregnancy, as the baby's head then enters the pelvis and the weight is redistributed.

If the pain is long-lasting, or if the pain worsens, a gynecologist should be consulted. In very rare cases it can be the so-called HELLP syndrome. This is a serious complication during pregnancy that involves an enlarged liver and increased liver function tests. She urgently needs medical treatment.

Read more on the topic: Costal arch pain during pregnancy

Pain in the costal arch when exercising

It can also cause pain in the costal arch during exercise. These can result from external violence, such as a fall. Most of the time it is a bruise of the ribs, which is harmless and heals on its own. A broken rib can also be the cause of the pain. A bruised rib and a broken rib can often not be directly distinguished from one another. Often the pain is even more pronounced with a bruise than with a fracture. An X-ray examination can determine the underlying cause. In the case of a bruise, a period of about 2 weeks is to be expected, whereas in the case of a broken rib this is about 6 to 8 weeks.

In addition, irritation or inflammation of the pleura (pleurisy) can also lead to pain in the area of the costal arch.This can be triggered by an incorrect breathing technique and the resulting incorrect strain on the respiratory muscles. This should be paused until the inflammation subsides and then the breathing technique should be changed during exercise.

Pain in the costal arch after exercise

Pain in the costal arch area after exercise is more common, especially after doing exercises for the abdominal, back or chest muscles. The pain is then the result of sore muscles in the muscle groups that attach to the costal arch. In severe cases, weight training with heavy weights and incorrect loading can also lead to a shifting of a rib and tears in the rib muscles. In such a situation a doctor should be consulted.

Costal arch pain with sore muscles

Many different muscle groups start in the area of the chest or have their origin there. In addition to the muscles between the individual ribs, chest muscles, which are connected to the shoulder and arm, also work there. Back muscles, which are used to move the spine, also attach to the ribs. In the event of incorrect loading or overloading of individual muscles, muscle soreness, i.e. small muscle fiber tears, can occur. Within several hours after the incorrect load or sporting activity, the pain occurs depending on the load. In uncomfortable cases, a slight pain can be felt with every breath.

In the context of pneumonia or bronchitis, strong, persistent coughing can lead to sore muscles in the rib muscles.