Rib Pain: Classification, Types, Pathophysiology, Causes, Signs, Symptoms, Tests, Treatment

If an individual has any type of pain or discomfort that occurs in the ribs it is called as rib pain. These are the long, slender bones that curve around the chest to form the rib cage. A typical human rib cage consists of 24 ribs. The top ten ribs, on both sides of the body, are connected to the thoracic spine and breastbone (sternum) through joints and ligaments. The bottom two ribs are attached to the spine, but not to the breastbone, and these are called the “floating” ribs. The rib cage helps in supporting the complete skeleton and also contains and protects the thoracic cavity i.e. the chest and its contents like lungs, heart and other vital structures of the respiratory and cardiovascular system. Other than this, the rib cage also protects organs and structures of other systems, such as digestive, nervous and lymphatic systems.

Rib pain may occur at any age or in any population. Rib pain is described as stabbing, tearing, or aching pain. The pain is presented as a symptom of various diseases, disorders, and conditions that may be mild or it can be serious. Most reasons for rib pains are inflammation or injury of the muscles, ligaments, or cartilages in the rib cage or the middle spine area. Even little conditions like straining of the rib cage due to coughing with normal cold or muscle strain can cause this pain. This may be fairly easy to treat. Rib pain can also represent more serious conditions such as broken ribs, osteoporosis, bone cancer, heart attack, collapsed lung or pleurisy. Cause of the rib pain can be determined through a complete medical evaluation. Immediate medical care should be sought if you have unexplained pain in the rib cage, chest pain, a crushing feeling or pressure in the chest, shortness of breath or change in the consciousness level.

• Joint Pain: As the ribs form a joint with the sternum as well as two separate joints with the vertebrae, rib pain can also be due to subluxations of these joints. This pain can be situated in the front or back of the rib cage. Usually it is a localized pain, which is achy or sharp, painful to the touch and is relieved by rest. Usually there is swelling over the area of the joint irritation. Postural alterations often result in rib subluxations. Other conditions like rounded shoulders and tension in the postural muscles can push or pull the ribs out of their normal, relaxed position causing rib pain. Taking a deep breath often accelerates the pain because the ribs expand with the lungs.
• Traumatic Rib Pain: Accidents or trauma to the ribs can result in fractures, dislocations, contusions, sprains or strains to the rib cage structure. Icing the injured area and rest helps inflammation to subside. Supportive measures are taken in case of rib fracture or surgery.
• Nerve Pain: Nerves traveling between the ribs are called intercostal nerves. These nerves originate from the spine and cross the entire circumference of the rib cage and end at the sternum. Anything irritating these nerves causes pain between the ribs. Subluxed costovertebral joints and shingles are the two most common causes of nerve irritation. Outbreak of shingles appears as small blister-like bumps on the skin. Treatment includes anti-viral medications.
• Organ Pain: Rib cage pain can be due conditions in other organs. The most common cause for rib pain is angina or heart pain. The pain is usually located near the sternum, towards the left, and may radiate into the left arm, the jaw or the back. Pressure and/or heaviness over the rib cage is the main symptom. Patient should seek prompt medical care if the pain is not relieved by rest and is aggravated by physical exertion.
• Another life threatening cause for rib cage pain is pulmonary embolism, triggered by a blood clot (thrombosis) originating in the leg. If the patient has sudden shortness of breath and chest pain following a long trip by plane or car it indicates pulmonary embolism and medical attention should be sought immediately. Other causes for rib cage pain include pneumonia or pleurisy in the lungs; stomach ulceration; heartburn or other esophageal conditions like cancer; gall bladder stones/inflammation.

The chest wall protects the structures within it with hard osseous bones such as ribs, clavicles, sternum, and scapula. For normal respirations to occur, it is important for the chest wall to be intact. One of the reasons where respiration may become compromised is fracture of the rib. Rib fracture causes pain resulting in atelectasis and pneumonia. Numerous adjoining rib fractures disturb the normal costovertebral and diaphragmatic muscle excursion leading to ventilatory insufficiency. Pieces of fractured rib may penetrate the pleural cavity causing formation of hemothorax or pneumothorax. Generally, the ribs get fractured at the point of impact or at the posterior angle which is the weakest area structurally. The most common ribs to get injured are ribs 4 through 9. The groove for the subclavian artery is the thinnest and weakest portion of the first rib. Violent contraction of the scalene muscles brought on by the sudden forward movement of the head and neck causes first-rib injury in motor vehicle accidents.

Rib pain can be caused due to mild or serious disorders, diseases or conditions. Some of which are:

• Chest or rib injury like broken ribs or a bruised chest.
• Costochondritis.
• Fibromyalgia.
• Multiple sclerosis.
• Neuritis.
• RA (rheumatoid arthritis) and/or OA (osteoarthritis).
• Osteoporosis.
• Pulled or strained muscle in the shoulders, back, arm, or chest wall.
• Infection in the ribs.
• Scoliosis and kyphosis also known as spinal alignment disorders.

• Asthma.
• Bronchitis.
• Flail chest (multiple broken ribs causing part of the chest wall to move independently with breathing).
• Pleural effusion.
• Pleurisy (inflammation of the lung lining).
• Pneumonia.
• Pneumothorax or hemothorax (collapsed lung or blood around the lung).
• Pulmonary edema.
• Pulmonary embolism.
• Pulmonary hypertension.
• Tuberculosis.

• Aortic dissection.
• Congenital cardiac abnormalities, disorders, and birth defects.
• Congestive heart failure.
• Coronary artery disease like angina or coronary artery spasm due to atherosclerosis.
• Heart attack or myocardial infarction.

• Bone cancer.
• Lung cancer.
• Multiple myeloma.
• Cancer of bone marrow.
• Digestive system causes of rib pain.
• Esophageal spasm.
• Gallbladder conditions, such as cholecystitis and gallstones.
• Gastritis.
• Heartburn or GERD (Gastroesophageal Reflux Disease).
• Hiatus hernia.
• Pancreatitis.
• Peptic ulcer.

Complications of rib pain if left untreated are: Cardiac arrest, cardiac arrhythmias, high carbon dioxide levels and acidosis, injury to organs and structures in the chest such as arteries, lungs, kidneys, liver and spleen, low oxygen levels, pneumonia, respiratory failure and respiratory arrest, sepsis and shock.

Rib pain can occur along with other symptoms. These symptoms depend on the underlying disease, disorder or condition. Infections such as pneumonia cause symptoms such as fever and body aches.

• Abdominal pain.
• Body aches.
• Cough (dry or productive with phlegm).
• Fever.
• Pain in the arm, shoulders or back.
• Pain when twisting or bending the torso.
• Limited mobility of the shoulders or back.

• Breathing or coughing causing chest pain.
• Chest pain radiating to the left arm, jaw, shoulder or back.
• Chest pressure, tightness, or a sensation of tearing in the chest.
• Cyanosis.
• Cold and clammy skin.
• Confusion or altered/change in level of consciousness or alertness.
• Coughing up yellow-green phlegm (mucus).
• Palpitations.
• High fever (higher than 101 degrees Fahrenheit).
• Breathing discomfort such as shortness of breath, labored breathing, wheezing or choking.
• Noisy or harsh sound when breathing.
• Acute abdominal pain.
• Primary lung cancers can cause symptoms like coughing up blood, chest or rib pain, hemoptysis, shortness of breath, bone pain, joint pain and swelling.
• Pneumonia causes symptoms such as shortness of breath, chest pain, when breathing in, coughing; shallow and rapid breathing; fever and chills.

• Physical examination of the patient.
• Blood tests: CBC, rheumatoid factor, etc.
• Chest x-ray.
• CT scan.
• Sputum cytology.

• Mild rib sprain is usually treated with RICE therapy (rest, ice, compression and elevation).
• Taking NSAIDs, over the counter, like ibuprofen or aspirin.
• Rest along with discontinuing sports and other physical activities.
• Using compression bandage helps in reducing the swelling. Compression bandaging should be done by a trained professional only.
• Elevating the upper body by adding more pillows helps in reducing the swelling.
• Injection with local anesthetic helps in decreasing the pain.
• Progressive exercises can be done after sufficient healing of the injury has taken place. This improves flexibility and strength.
• Anti-inflammatory medications, hot compress and chiropractic manipulation helps in reducing muscular pain and pain from costochondritis.
• Moderate and severe rib sprain should be treated promptly by a qualified health care provider for proper diagnosis and treatment.
• A supportive rib jacket is beneficial for bone and soft tissue injuries. It helps in reducing pressure over the area.
• Shingles is treated with anti-viral medication.
• The main aim of treatment is to decrease inflammation and pain.

Also Read:

• Slipping Rib Syndrome: Causes, Symptoms, Treatment, Recovery Period
• Sprained Rib: Causes, Symptoms, Treatment, Exercises
• Rib Fracture or Broken Rib: Causes, Symptoms, Treatment- Ice, NSAIDs
• Bruised Ribs or Sportsmens Chest Pain: Causes, Risk Factors, Symptoms, Treatment, Exercises