Chest wall or Rib Pain is an annoying pain, which is quite common following intercostal muscle spasm or muscle sprain. An individual can sprain any muscle of the body, including those in the chest area resulting in severe pain. Intercostal muscle sprain results in severe spasmodic shooting pain. In this article, we will discuss the symptoms and treatment of Intercostal Muscle Sprain. Intercostal Muscles facilitate breathing. The muscles between the ribs are known as intercostal Muscles. Intercostal Muscles have a very vital role to play when it comes to movement of the ribs like while breathing.
Description of Intercostal Muscles
The 11 groups of intercostal muscles lie on right and left side. Three layers of intercostal muscles are attached to upper and lower rib known as intercostal space.1 The three layers of intercostal muscles are outer layer known as external oblique, middle layer known as transverse intercostal muscles and inner layer known as internal oblique intercostal muscles. The function of the intercostal muscle is to stabilize the structure of the chest wall. The intercostal muscles also join the ribs together. The external and internal intercostal muscles fibers run in opposite oblique direction. Middle muscle layer runs in horizontal direction.
Causes of Intercostal Muscle Sprain
- Upper Body Twist- A sudden twist of the chest area may cause an Intercostal Muscle Sprain.
- Stretching- Stretching of arm or rotational movement of upper body while playing tennis or participation in contact sports results in rupture of the Intercostal Muscles.2
- Forceful Twist Of Upper Body- Injuries caused by forceful twist stretches the intercostal space. Stretched intercostal space pulls intercostal muscles and results in intercostal muscle sprain. A forceful activity, which exerts a tremendous amount of pressure on the rib cage can result in Intercostal Muscle sprain.
- Forceful Swing Of The Arm- Upper arm swing pulls the rib cage towards the swinging arm. Twist of lower body in opposite direction while upper arm is swinging results in intercostal muscle tear or twist. The intercostal nerve is often trapped in the spasmodic muscles and causes severe intercostal neuralgic pain. Injury is observed in individuals participating in tennis, golf and badminton games at professional level.
- Direct Chest Wall Impact- Direct chest wall impact is observed following, automobile accident, work injury or sport injury.
Symptoms of Intercostal Muscle Sprain
Sudden Acute Intense Pain
- Pain is localized over the sprained muscles.
- Pain intensity is severe, sharp and intense pain.
- Pain is associated with tenderness. Patient feels severe pain with palpation or examination of the area of the chest with sprain intercostal muscles.
- The main symptom of an Intercostal Muscle sprain is severe and constant pain in the chest wall area.
- If left untreated, after some time the pain may start occurring with movement or activities like breathing, coughing, sneezing etc.
- It is a self-limiting medical condition and usually resolves on its own after a few days.
- Pain at the injury site.
Swelling and Tenderness
- Swelling is observed over the sprained intercostal muscles.
- Swelling is secondary to subcutaneous hematoma or inflammation of the muscles.
Shortness of Breath or Dyspnea
- Patient complaints of shortness of breath also known as dyspnea.
- Shortness of breath is secondary to increase of pain intensity during inhalation.
- Patient stops taking deep breath when pain become severe and act of breathing results in short of completing of inspiration.
Chest Wall Stiffness
- Patient complaints of the chest wall stiffness.
- Patient prefers to take shallow breath.
- Stiffness is localized around the tender chest wall area.
Diagnosis of Intercostal Muscle Sprain
Diagnosis of Intercostal Muscle Sprain Includes Following Findings-
- Detailed physical examination.
- X-Ray and MRI examination of the chest.
- Rule out rib fracture
- Rule out rib dislocation
- Rule out lung pathology as a cause of the pain
- Intercostal hematoma
- Intercostal muscle damage
- Thoracic disc bulge or herniation
- Thoracic spinal or foraminal stenosis.
- Ultrasound Studies- Rule out hematoma, fracture and dislocation as cause of pain.
Treatment for Intercostal Muscle Sprain
As stated above, Intercostal Muscle Sprain is a self-limiting medical condition and resolves itself within a few weeks. There may be steps taken to calm down the pain and inflammation that a person experiences with Intercostal Muscle sprain. Conservative treatment helps a long way in relieving symptoms.
Conservative Treatment for Intercostal Muscle Sprain
- Adequate rest
- Apply ice to the affected area
- Cold compresses
- Limited stretching exercises
Medications for Intercostal Muscle Sprain
- Non Steroidal anti-inflammatory medications (NSAIDs)- like ibuprofen or Advil helps to calm down the pain.
- Muscle Relaxants is prescribed for muscle spasm and muscle ache. Most common muscle relaxants used are Robaxine and Flexeril.
Interventional Therapy for Intercostal Muscle Sprain
- Intercostal nerve block (INB)- INB or intercostal nerve block is performed under X-Ray guidance. Local anesthesia and corticosteroid are injected at most painful area. Treatment helps to relieve pain and treat inflammation. Initial series of 3 injections are performed with 2 weeks interval. Later one injection is repeated every 8 to 12 weeks.
One must make sure to avoid strenuous activities during the healing phase.
Recovery From Intercostal Muscle Sprain
Intercostal Muscle Sprains can be categorized as mild, moderate, or severe. Mild form of sprains can heal in two to three weeks. The moderate form of sprain takes around six to seven weeks to heal. The severe forms of sprains where there may be complete rupture of the muscles usually takes a little bit more time, but generally six weeks is the time by when complete healing takes place.
1. Mechanics of intercostal space and actions of external and internal intercostal muscles.
De Troyer A, Kelly S, Macklem PT, Zin WA.
J Clin Invest. 1985 Mar;75(3):850-7.
2. Effect of intercostal muscle and costovertebral joint material properties on human ribcage stiffness and kinematics.
Kindig M1, Li Z, Kent R, Subit D.
Comput Methods Biomech Biomed Engin. 2013 Aug 15. [Epub ahead of print]
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