Pain in the rib area

Pain in the rib area can be a signal of many diseases. The term "pain in the region" of the ribs or "pain in the ribs" denotes discomfort sensations directly in the tissue of paired arcuate bones, that is, in the walls of the chest.

The bone or cartilaginous tissue of the ribs, fascia and muscles, surrounding ribs, intercostal nerve endings can ache. The nature of pain is like cardiac pain - pulling, aching or sharp, stitching, so only the doctor, usually a narrow specialist - traumatologist, orthopedist, thoracic surgeon, neurologist, should differentiate symptoms and diagnose.

The causes that can provoke pain in the rib area are: 

• Injuries, fractures of ribs or ribs.
• Malignant tumors of the ribs.
• Osteoporosis.
• Syndrome Titz.
• Osteochondrosis.
• Pathology of the intercostal muscles, nerves.
• Herniated discs of the thoracic spine.
• Intercostal neuralgia.
• Fibromyalgia.
• Pathological inflammation of the pleura.
• Pleurisy (acute, dry).
• Neoplasms of the pleura.
• Psychoemotional pain.
• Pain related to pregnancy.

[1], [2], [3]

Description of diseases in which pain in the rib area is manifested

[4]

Injuries, fractures and bruises

Injuries and fractures, which can be the result of a strong impact, a fall. The nature of the pain depends on the severity of injury and the type of injury. 

A bruise provokes a sharp but not intense pain in the place where the muscle tissue surrounding the ribs is damaged. Among the most common symptoms are swelling in the place of impact, a hematoma, to which it is painful to touch. The pain subsides a little and becomes dull, aching. The appearance of the injury does not allow differentiating the injury from the fracture, so an X-ray is required. 

Pain in the rib area may be a consequence of fracture of the rib or ribs. This is a more serious injury, which signals itself with pain during inspiration, change of posture, while moving. Fracture is characterized by acute pain, spreading to the entire chest, painful sensations persist for a long time, even after the bone tissue is fused.

Fractures in turn are divided into three groups - cracks, subperiosteal fracture, complete and complex fracture, as well as comminuted fractures. Pain in the rib area during a fracture is the easiest trauma in a group of fractures, since the rib retains its integrity and coalesces quickly enough. Subperiosteal fracture, in which the rib is injured, but the periosteum remains intact, also heals quickly. A complete fracture is dangerous with its fragments, which can disrupt the integrity of the structure of the lungs, and a complex fracture is also considered a serious trauma, in which several rib archs are injured at once. In addition to the fact that fractures are accompanied by painful sensations, they can provoke a typical cough with blood, a violation of the respiratory and heart rhythm up to the shock state. Any fracture, from a crack to a comminuted injury, is considered a complicated case, requiring not only a medical examination, but also a sufficiently long treatment.

Titze syndrome is a disease of unclear etiology, in which it develops a pathological inflammation of the cartilaginous tissue. Pain in the rib area of Tietze syndrome is very acute, intense, often moving behind the sternum, resembling cardiac symptoms. Quite often pains associated with inflammation of the cartilaginous tissue of the ribs are confused with angina pectoris, especially if a person tries to diagnose himself and start treatment himself. Indeed, the symptom of pain, giving for the sternum, under the scapula, in the arm or in the neck, growing and intense, is similar to an attack of angina pectoris, however, it is not capable of removing cardiac preparations. A differential sign that will help visually distinguish the Tietze syndrome is a small swelling, a swelling in the site of the inflammation, in addition, the pain in the rib area can increase with pressure on the bone, which is quite uncharacteristic for angina pectoris. Diagnose the syndrome with examination, orthopedic tests, palpation and X-ray.

Oncological process of bone tissue

Malignant tumors that can cause pain in the rib area are osteosarcomas that affect people regardless of age. Symptoms of the malignant process are manifested by constant pulling pains, which are aggravated at night, when a person takes a horizontal position. Sometimes the tumor develops asymptomatically and begins to manifest itself after the bruise of the sternum, which provokes the proliferation of pathological formation. If the bruise is not checked by the X-ray, it is treated as a simple household injury, often warming up, which aggravates the oncological process. A large tumor can be seen with a visual examination: there is a swelling at the site of its localization. The main way to confirm or exclude a rib tumor is a biopsy.

Osteoporosis

Osteoporosis, which occurs most often in female patients, can also be a cause of rib pain. This disease is associated with a pathologically low level of calcium in bone tissue and their destruction. The causes of osteoporosis are diverse, but most often explained by physiological age changes - endocrine (climax), metabolic (violation of calcium absorption, vitamin D). Osteoporosis develops asymptomatically, so a person does not feel the slightest symptoms of this destructive process. Pain in the rib area in osteoporosis indicates a significant change in the structure of bone tissue, small fissures and irritation of the periosteum that retains bone. It is the periosteum that signals with pain the problem, because it contains a large number of neural pain receptors. A strong, sharp pain in osteoporosis can indicate a pathological fracture, which provokes a normal load for a healthy person. Bone tissue is so fragile that it can collapse from a banal tilt or a sharp turn of the body. Simultaneously with the destruction of the costal bones, the integrity of the spine and the bone system of the organism as a whole is impaired. Osteoporosis is diagnosed with a standardized complex of examinations, which includes x-rays, laboratory blood tests.

Osteochondrosis

Osteochondrosis, which is a systemic degenerative inflammatory process developing in intervertebral discs. When squeezing the nerve bundles, pain appears, which is most often localized in the back. However, a neglected disease, especially if the deformity of the vertebrae occurs in the thoracic spine, can cause pain in the rib area. Symptoms have the character of chronic, aching pains, which are accompanied by a feeling of "cola in the chest". The pain changes its intensity depending on the posture, physical activity, thermal regime (drafts, hypothermia). Osteochondrosis is characterized by a sensation of numbness of limbs, muscle weakness. Often the pain in the rib area on the left is confused with cardiac pain. The disease is diagnosed by a neurologist, who also prescribes a set of therapeutic measures that can last a long time.

Hernia

Intervertebral discs of the thoracic spine are not considered vulnerable, most often the hernia develops in the lumbar spine. However, pain in the rib area sometimes indicates a hernia, which is a pathological complication of degenerative changes in the thoracic vertebrae. The pain develops gradually, intensifies and becomes unbearable until it becomes unconscious. The pain symptom often radiates to the neck or arm. The diagnosis of a hernia is confirmed or eliminated using an X-ray or CT scan, which is a more accurate and specific examination method. The hernia of the thoracic spine is treated in a conservative way.

Intercostal neuralgia

It is a frequent cause of pain in the ribs.

In the intervals between the ribs there are quite a lot of muscle and nerve tissue, the structure of which includes pain receptors. Any irritation or squeezing of the nerve bundles provokes a pain symptom of varying degrees of intensity. The causes of intercostal neuralgia are so diverse that they require a separate detailed description. The nature of neurologic pain in the rib area is quite typical - it is acute, there is a sense of "puncture", lumbago. Pain can catch a person at any time of the day and is greatly enhanced by changing the posture, movements, slopes, corners of the body and even when inhaling, coughing or sneezing. For intercostal neuralgia is also characterized by the presence of two points - in the middle of the chest and in the spine. Pain can cause squeezing of the intercostal muscles when deforming the ribs, stretching the muscles, with excessive physical exertion. Pain in the rib area caused by neuralgia often goes away on its own and does not involve any serious treatment other than rest, simple rubbing or warming. More serious cases, when pain in the ribs does not last for a long time, should be dealt with by a neurologist who will determine the diagnosis and prescribe medication, perhaps - massage, a course of therapeutic gymnastics.

Fibromyalgia

The disease, which recently began to occur more often, although previously fibromyalgia was not a separate nosological unit in the classification guide. According to statistics, every 25th person suffers from one or another form of fibromyalgia. The etiology of the polyfactor syndrome has not yet been clarified, but the symptomatology has been thoroughly studied and described. One of the typical signs of fibromyalgia is pain in the rib area, especially when fibrous degeneration is exposed to the muscle tissue of the thoracic region. Provokes an acute painful form of a hidden course of the disease, stress, psycho-emotional trauma. Fibromyalgia is the simultaneous defeat of many muscle groups, including intercostal muscles. Pain in the ribs with fibromyalgia is characterized as bilateral, sensitive to weather conditions. The patient has a feeling of stiffness in the chest, there is a periodic headache, the process of falling asleep, and then the sleep as a whole, suffers from coordination and the quality of life is significantly reduced. Diagnosis of fibromyalgia is always difficult, because the symptoms are extremely extensive and not specific. Pain in the rib area is not the main symptom, but it should be noted if it has a permanent, chest-covering character. Fibromyalgic intercostal pains are diagnosed by elimination, followed by a comprehensive examination, in addition, there is an approved diagnostic table with the parameters of the disease. Treatment of fibromyalgia is also diverse, it depends on the individual properties of the patient's body and the nature of pain in the ribs. Sometimes it is enough to stop the pain symptom and prescribe a course of physiotherapy, but sometimes the therapy can take a longer time.

[5], [6], [7]

Diseases of the pleura

Pleural diseases can also be a factor that provokes pain in the rib area. Pleura covers the lungs with a thin, outer layer of connective tissue and the entire sternum from the inside. The pleura contains a huge number of pain receptors, the slightest irritation of which provokes enough severe pain. Especially painful is dry pleurisy in acute form. Symptoms of dry pleurisy are as follows: 

• Unilateral pain in the rib area.
• Change in the intensity of pain with deep breathing, sneezing and coughing, sharp bends of the body, with defecation.
• Subfebrile body temperature, with jumps to 38-39 degrees.
• Transient feverish condition in the evening.
• Excessive sweating.
• Dry, frequent, unproductive cough.
• Preference for lateral posture in a horizontal position.
• Rapid, shallow breathing.
• Dyspnea.

Diagnosis of dry pleurisy should the therapist, and then pulmonologist with a comprehensive survey, the decisive method in which will be radiography. Treatment involves the appointment of antibiotics, anesthetics and anti-inflammatory drugs.

Tumor process in the pleura can also be accompanied by pain in the rib area.

The oncological pleural process, fortunately, is rare, but even those few cases are worth describing. Painful sensations in tumors of the pleura are permanent, pains are aching, long, but not sharp, tolerant. The localization of pain depends on the place of development of the tumor, if the formation reaches a large size, dyspnea appears, cyanosis of the skin. A tumor that causes pain in the rib area can be benign or malignant, this is determined by a biopsy.

[8], [9], [10], [11], [12], [13],

Psychoemotional pain in the rib area

Can be common and affect not only the pain in the ribs, but also headaches, digestive discomfort. Neurosis, prolonged depression, neurasthenia, hypochondriacal disease is accompanied by muscle spasms, pain in the rib area can develop. Anxiety, in principle, mobilizes many resources of the human body, but a prolonged state of anxiety, constant stress begins to act on organs and systems pathologically destructive. Functional or organic lesions with psychoemotional factor causing rib pain, do not reveal, however, treatment is necessary.

Therapeutic strategy should be built by a neuropathologist or psychiatrist.

Pain in the ribs during pregnancy

These are typical feelings of the third trimester, especially if a woman had an asthenic physique before pregnancy. No pathologies in the organs and systems of the future mother with such pains do not exist, as a rule, the pain symptom is caused by the following reasons: 

• A significant increase in the uterus in size, the uterus moves up and presses on the lower ribs.
• Intrauterine activity of the baby, which moves too intensively.
• The position of the fetus is upside down, when the baby rests against the upper cavity of the uterus and the ribs.

Symptomatics is not menacing, but with constant, disturbing pains, a woman still needs to see a doctor and undergo an additional examination. Usually, the recommendations that relate to pain in the ribs do not present difficulties in performing: 

• A pregnant woman should remember the correct posture and try to keep her back straight, straighten her shoulders.
• Clothes should not be tight and fettering the movement and the body as a whole, especially in the chest area.
• Pain in the ribs can be removed by raising your hands up in a deep breath. His hands are exhaling.
• With excessive intra-uterine activity of the baby, a woman needs to take a horizontal position, lie on her side.

Pain in the rib area is a nonspecific symptom that can indicate various internal pathologies and functional disorders. If the pain symptom lasts more than a day, you should consult a doctor, even if there is a tolerable pain.