The rib cage supports and protects vital organs in the thoracic cavity, chest and in the abdominal region. The area around the thoracic cavity or the rib cage is a common location for pain due to various reasons. This area is also more prone to injuries and can have varying degrees of discomfort.
Abdominal Causes Of Pain Under Left Rib Cage
The rib cage on the left covers a wide area of the upper abdomen. Several diseases of the organs that lies in upper left quadrant of abdomen causes pain under left rib cage. Following diseases of the visceral that lies in upper left quadrant of abdomen results in frequent left rib cage pain.
- Irritable bowel syndrome
- Food intolerances
- Post-surgical adhesions
- Pancreatic cancer.
Gas in Colon (Splenic Flexure Syndrome) – Excessive amount of gas formed and trapped in the colon can cause pain in the upper left side of the abdomen and this area is felt below the left rib cage. Pain and discomfort under left rib cage may be experienced after consumption of food. There may be associated symptoms like distended stomach, indigestion and relief after passage of gas. Megacolon is a rare disease and gas distribution causes distension of transverse colon as well as splenic flexure that results in severe left lower rib cage pain.1
Spleen Irritation – Sometimes, the spleen, located under the left rib cage, can get irritated due to physical activities like long distance running or walking. The constant irritation of spleen may causes spleen rupture. The irritation or rupture of spleen causes upper abdominal and lower chest pain on left side. Such pain is also referred to left shoulder. Under normal circumstances the pain caused by irritation of spleen subsides after rest and stopping of physical activity. In cases of spleen rupture, immediate evaluation is required. Irritation and rupture of spleen is also caused by diseases like endocarditis or infectious mononucleosis.2
Acid Reflux – Over consumption of foods or drinks causing hyperacidity, can cause acid to regurgitate into the food pipe located under the rib cage. This may cause pain under the left rib side and may be associated with burning sensation and abdominal bloating.
Gastritis and Gastric Ulcer – Sometimes, long standing acid reflux or irritation of the stomach lining can cause gastritis or even ulcers in the stomach. This can cause sharp pain over upper abdomen, under the left rib cage and back of the ribs.3 Pain intensity increases especially after consumption of food. It may extend to the left shoulder or under the breastbone.
Other Causes – Other gastrointestinal causes that lead to gas formation, irritation of organs and pain under left rib cage include irritable bowel syndrome, food intolerances, trauma, post surgical adhesions, pancreatitis, and pancreatic cancer.
Musculoskeletal Causes Of Pain Under Left Rib Cage
The left side pain under rib cage is also caused by diseases of rib as well as intercostal nerve. Following diseases frequently causes rib pain on left side.
- Fractured Rib
- Nerve Irritation
Costochondritis – The cartilages that join the ribs to the breastbone can get inflamed causing pain and discomfort in the ribs.4 It could be due to injury, infection or fibromyalgia and can cause severe pain, especially on touching the affected area.
Fractured Rib – An injury leading to broken rib on the left side can cause excruciating or sharp pain under the left rib cage and needs immediate medical attention.
Nerve Irritation – Sometimes a trapped or irritated left side intercostal nerve causes severe under left rib cage pain. The cause of irritation of nerve in spinal canal and epidural space are spondylitis, bulging disc, vertebral arthritic conditions and severe foraminal stenosis caused by disc degeneration. The intercostal nerve is also injured following blunt or penetrating trauma of chest that often results in fracture of rib. The ligation of intercostal nerve during chest surgery can cause severe chest wall pain.5 Certain infections like herpes or shingles caused by chicken pox viruses cause post-herpetic intercostal neuralgia and severe chest wall pain.
Respiratory Causes Of Pain Under Left Rib Cage
Lungs and surrounding structures of the respiratory system too can be a potential cause of pain and discomfort under left rib cage. Inflammation of the lining of lungs and other structures or infections can cause such pain. These conditions are often accompanied with respiratory symptoms like cough, fever and chest pain, which is usually worsened by coughing. Following respiratory diseases causes left side rib cage pain.
Cardiac Causes Of Pain Under Left Rib Cage
- Angina Pectoris
- Heart attack
Sudden sharp or stabbing pain in the left rib cage area can also be due to a heart attack or angina pectoris, which may occur in other heart disorders and need immediate medical attention.
Other Causes Of Pain Under Left Rib Cage
Some other causes of pain under left rib cage include, muscle spasm or strained muscle, trauma to the chest cavity or abdomen, disorders or inflammation of the blood vessels; particularly aorta and some kidney disorders like renal or left ureteric stones.
Diagnosis Of Pain Under Left Rib Cage
Any pain arising in the left side or under the left rib cage can be due to minor reasons while some can be a medical emergency. While it is not necessary that every pain is serious, it is worth performing a thorough medical assessment. Any pain under left rib cage needs proper evaluation and clinical examination to detect the exact cause.
Investigations Depend On The Suspected Cause And May Include:
- Laboratory tests to detect infection and related parameters
- Imaging studies like X-ray, CT scan to detect structural abnormality, injury, fracture, etc, MRI to note structural growth or any specific changes
- Gastric studies may be ordered to detect gastrointestinal causes.
Treatment Of Pain Under Left Rib Cage
Proper identification of the cause for pain under left rib cage can help in determining the severity of the condition and appropriate treatment can be decided. Treatment depends on the underlying cause and may include:
- Rest, immobility and painkillers are helpful for musculoskeletal or physical causes of pain under left rib cage like muscle spasm, trauma or fracture.
- Gastric causes of pain under left rib cage may be treated with medications for hyperacidity, indigestion and proper bowel movement.
- Respiratory infections causing pain under left rib cage may need more specific treatment like antibiotics or chest tube insertion in more severe cases.
- Colonic gas distribution in toxic megacolon. Kramer P, Wittenberg J., Gastroenterology. 1981 Mar;80(3):433-7.
- Rupture of the spleen in infectious mononucleosis: a critical review. Rutkow IM., Arch Surg. 1978 Jun;113(6):718-20.
- Peptic ulcer disease in children and adolescents. El Mouzan MI1, Abdullah AM., J Trop Pediatr. 2004 Dec;50(6):328-30.
- Costochondritis. Schumann JA1, Parente JJ2., StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019-. 2018 Dec 6.
- Clinical course of pain in a patient with neuropathic pain induced by ligation of an intercostalnerve. Kato J1, Gokan D, Hirose N, Baba M, Ehara T, Ogawa S., J Clin Anesth. 2010 Feb;22(1):50-1. doi: 10.1016/j.jclinane.2009.01.009.
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