Pain between the ribs

definition

The ribs, together with the thoracic spine and the sternum, form the bony chest, which is characterized by the fact that it provides stable protection for the organs located in it, but also enables mobility through numerous joints, which allows for the expansion of the lungs , and thus for breathing, is essential. Therefore, pain between the ribs must be carefully examined so that one can determine which of the parts of the thorax is actually causing the pain or whether the pain is even due to a disease of the organs in the thorax.

causes

Intercostal neuralgia is often the cause of pain between the ribs. This is an irritation of the nerves running between the ribs. Inflammation of the pleura, which lines the inside of the chest and rests on the lungs, can also be responsible for the symptoms. Bony causes such as a bruised rib or joint discomfort are possible. Muscular imbalance or tension can also play a role. In any case, if the pain persists, an examination by an orthopedic surgeon should take place, as he can weigh up which of the various causes is most likely to be responsible for the individual complaints.

Intercostal neuralgia

Intercostal neuralgia is pain that originates from the nerves that run between the ribs. These intercostal nerves run in a belt-like manner from the thoracic spine along the ribs towards the center of the chest and are responsible for the sensitivity of the adjacent skin areas and for the motor supply of the intercostal muscles and parts of the abdominal muscles. The nerve pain between the ribs can be due to shingles or it can be caused by diseases of the spine, pleurisy, irritation of the nerve roots or hardening of the muscles.

Read more on this topic at: Intercostal neuralgia and pinched nerve on the rib

Rib block

A rib block causes the joints between the ribs and the thoracic spine to stiffen. This is noticeable through movement-dependent pain, which also increases when you inhale. Furthermore, the stiffening also slightly restricts mobility. The acute trigger can be of various kinds. The blockage can arise when lifting too heavily, incorrect, rapid turning movements or an incorrect posture.

Find out what you can do about a rib block here.
For more information on the exercises that help to break a rib block, see the following article: How to Break a Rib Block Correctly

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Concomitant symptoms

The complaints that occur together with the pain can be diverse. On the one hand, there may be restricted movement in the area of ​​the spine, and there may also be shortness of breath if the symptoms have a direct impact on the functionality of the lungs or the respiratory muscles. In addition, digestive disorders can occur if the cause is not directly related to the ribs but rather to the digestive organs located under the ribs. If there is inflammation, it can also lead to a fever.

pain

Basically, pain can be divided into nociceptive and neuropathic pain. Nociceptive pain occurs when the body is damaged by mechanical, thermal or chemical stimuli and is intended to serve as a warning signal for the body. Neuropathic pain, on the other hand, is based on irritation of the nerves themselves. This pain is usually referred to as shooting, burning or stabbing and should be treated differently from nociceptive pain. In the case of neuropathic pain, antidepressants or drugs against epilepsy (anticonvulsants) are often used, as these have a particularly good analgesic effect on this type of pain. Therefore, if there is pain between the ribs, it should be carefully considered what type of pain it is so that an optimal drug therapy can be carried out.

Shortness of breath with pain between the ribs

Difficulty breathing preceded by pain between the ribs may be due to pleurisy with resulting effusion. This effusion is also called a pleural effusion. Pleurisy manifests itself acutely as severe breath-dependent pain in the intercostal spaces. If an effusion develops in the course of the inflammation, the pain usually decreases because the two sheets of the pleura no longer rub against each other. However, the effusion can cause shortness of breath. The effusion fluid can be removed via a doctor's chest drainage, which makes the shortness of breath subside.

Read more about pleural effusion and its causes here.

Pain between the ribs when coughing

Pain between the ribs when coughing is most likely to suggest a rib fracture or sore muscles in the intercostal muscles. Sore muscles in these muscles are most likely to develop as part of bronchitis or a severe cold, as the violent coughing puts excessive strain on the intercostal muscles involved in breathing. A rib fracture, on the other hand, occurs in healthy people only as part of trauma. This could be mistreatment or the result of an accident in which the chest was hit hard. Older people have more fragile bones. This is particularly relevant if you also suffer from osteoporosis. In this case, even a minor trauma leads to a broken rib. A fracture of several ribs can lead to instability of the chest and endanger internal organs due to the sharp fractures and should therefore be treated by a doctor.

Localization of the pain

Pain in the stomach

The stomach begins roughly at the level of the 10th rib. It is therefore easy to imagine that stomach pain is mistakenly misinterpreted as intercostal pain. In order to differentiate whether the pain originates from the stomach or the intercostal nerves, one can note whether the pain can be aggravated in certain situations. A connection with food intake or an intensification while lying down suggests a cause that affects the stomach or esophagus, while breath-dependent pain suggests intercostal neuralgia. In addition, a heart attack should also be considered in older women with stomach pain, as this can also be atypical in this group with stomach pain.

Do you want to learn more about the causes of stomach pain? Then click here.

Pain on the right side of the chest

Pain between the ribs on the right side can indicate nerve irritation or bruised ribs as well as symptoms of the liver, gallbladder or intestine. If the gallbladder is the trigger for the pain, pain localized under the costal arch is common. This is perceived as extremely strong and only exists in phases. This is also known as colicky pain. If the cause actually lies in the area of ​​the right-sided abdominal organs, there are usually additional symptoms such as digestive problems.

If you are more interested in this topic, read it below: Right Rib Pain - What Do I Have?

Pain on the left side of the chest

Left-sided pain between the ribs can of course also be due to a fairly harmless cause, such as muscular tension or irritation of a nerve, but the cause can also be in the area of ​​important organs. A pain below the lower ribs on the left can indicate a heart attack, which can be perceived as radiating to this region. In addition, the pain can also indicate problems with the stomach.

Pain in the back of the chest

If the pain between the ribs is mostly behind, this may indicate a rib block. This is a stiffening of the joints between the ribs and the spine. These joints are needed to enlarge or reduce the chest while breathing. Therefore, the pain occurs especially when breathing in the joints in the back area. Furthermore, a distinction should be made between intercostal pain and flank pain. The latter is a little deeper and usually stems from a kidney problem or is due to muscular tension.

Pain in the front of the chest

An accentuated, belt-shaped pain below the ribs in the front area may indicate a disease of the pancreas. Inflammation of the pancreas is characterized by extremely severe pain and is often accompanied by nausea and fever. Furthermore, the front pain can also be triggered by costochondritis. This is an inflammation of the cartilage at the transition between the sternum and the ribs. Often there is also a swelling in this area, which is also very tender on pressure.

You may also be interested in: Symptoms of a pancreatic disease.

Pain under the costal arches

A pain under the costal arches can be harmless, but it can also be due to a disease that requires therapy. Since the costal arches are above the abdominal organs, the pain can also be due to discomfort in these organs. Inflammation of the gastric mucosa, intestinal problems, gallbladder inflammation or an enlarged spleen are possible causes. Shingles can also show up as a painful skin change between the costal arches. In many cases, however, there is only muscular tension in the intercostal or abdominal muscles.

Read more on the topic: Pain under the costal arch - How dangerous is it?

diagnosis

Since the various complaints are difficult to differentiate for the layperson, the diagnosis should always be made by a doctor. In addition to a detailed query of the ailments and a physical examination, the doctor may also carry out an ultrasound of the abdomen in order to rule out symptoms of the abdominal organs. In addition, a blood test in combination with an EKG can clarify whether a heart attack is present. Shingles is a visual diagnosis that the doctor determines during the examination.

treatment

The treatment depends heavily on the cause of the symptoms. If no cause for intercostal neuralgia is found, only the symptoms are treated. To do this, you use pain medication and, under certain circumstances, manual therapy or physiotherapy. If the pain is severe, a local anesthetic can also be injected into the affected area. Medicines that relax the muscles can also be used.

Pleurisy is also treated to relieve pain, and if there is an effusion, it can be drained.

A rib fracture usually does not have to be surgically straightened because the ribs are sufficiently stabilized by muscles and ligaments. However, if there are multiple fractures of the ribs, surgery may be necessary as the chest is otherwise too unstable. Physical rest is recommended in any case.

A blockage in the ribs can be treated with heat and the pain can be relieved with medication. In addition, taking muscle relaxants can help if the blockage is accompanied by severely tense muscles. Furthermore, a trained doctor can try to resolve the blockage using manual therapy.

If the pain is of organic origin, appropriate therapy is initiated. It can e.g. the removal of gallstones or taking tablets to reduce stomach acid in gastric ulcers.

Duration of symptoms

The duration of the complaint depends entirely on the cause. If it is an inflammation and it is consistently treated anti-inflammatory, the symptoms can disappear within a few days. However, if the cause persists, e.g.if the rib is broken, the symptoms will persist until the bone heals. By exercising and avoiding bad posture, muscular tension can also disappear in the long term.