Rib Pain or chest pain is most often caused by chest wall injury following automobile accident, contact sports, work injury or domestic fall. Sports injury causing direct trauma to chest wall results in rib contusion or fracture. Rib contusion or fracture causes severe chest wall pain. Chest pain is also observed in patients diagnosed of Osteochondritis or Osteochondritis Dissecans. It affects mostly larger joints of body such as the hips, ankles etc.; however, it is even found to cause pain in the ribs. In this article, we will discuss about how Osteochondritis Dissecans causes pain in the ribs, its symptoms, and various forms of treatment.
What Is Osteochondritis or Osteochondritis Dissecans?
Osteochondritis or Osteochondritis Dissecans is a disease caused by avascular (lack of blood supply) necrosis of the cartilage lining the joint. Necrosis of cartilage results in separation of tiny piece of cartilage from underlying bone. Loss of cartilage eventually results in exposure of subchondral bone and joints become bone on bone. Osteochondritis is rare disease mostly found in young population. Injury causes the damage of blood vessels that results in inadequate blood supply to cartilages of the joints. The chest wall pain caused by Osteochondritis Dissecans disease is usually found in people who are actively involved in sports and are prone to rib injuries. It causes pain in the ribcage near the breastbone as shown in the picture above.
Self Recovery for Osteochondritis or Osteochondritis Dissecans
Osteochondritis Dissecans of chest in adolescent is a self-limiting disease. The blood supply is restored in growing adolescent from surrounding normal tissue. The osteoblast and osteoclast bone cells within growing bones are actively functioning to repair and remove dead cartilages and bones until the growth is completed, which results in self recovery.
Causes of Osteochondritis or Osteochondritis Dissecans
- Contact Sports- Osteochondritis Dissecans is caused by repetitive stress or injury to the ribs. The injury is mostly directed to the joint blood vessels around joint cartilages. Injury triggers avascular necrosis of the cartilage following diminished or complete lack of blood supply to the cartilages. Young adults involved in contact sports are mostly prone to sustain a joint injury. Thus Osteochondritis Dissecans is more common disease among younger population even though it is rare disease. Contact sports that may trigger joint injuries are football, basketball, wrestling and soccer.
- Motor Vehicle Accident- Osteochondritis Dissecans is also observed in older patient following motor vehicle accidents. Vascular injury is triggered by the seat belt being tight around chest wall following accident and direct impact to chest wall. Trauma results in stress injury to the ribs at Costocondral joint near sternum.
- Work Injury- Osteochondritis Dissecans is not known to develop as a result of a single blow to chest while operating heavy equipment. Vibrating heavy equipment over a period of time involving repeated mobility of the rib joint may follow damage of the blood vessels resulting in avascular necrosis of rib cartilages.
- Genetic Avascular Necrosis of the Cartilages- Published research suggests a genetic predisposition for rapid wear and tear of rib cartilages resulting in Osteochondritis Dissecans.
Symptoms of Osteochondritis or Osteochondritis Dissecans
- Chest Pain- Osteochondritis or Osteochondritis Dissecans may cause only symptom of chest wall pain or rib pain. Usually, the pain is situated where the ribs and sternum meet. The rib pain becomes significant following exercise or deep breathing.
- Shortness of Breath- Patient may complaint of difficulties in breathing or having shortness of breath. Symptom is observed during advanced stage of the disease. Movement of breathing like inspiration and expiration causes pain with rib movements.
- Tenderness Over Chest Wall- Palpation or light touch of the Costocondral junction near sternum induces severe pain, which is often diagnostic test.
- Swelling of Costocondral Junction- Rib cartilage is attached to sternum and rib. Tender swelling is observed on one or both side of the sternum.
Diagnosis of Osteochondritis or Osteochondritis Dissecans
Individual with severe rib pain must consult the physician at the earliest possible time. The physician will conduct a detailed physical examination of the involved anatomical area of pain and come up with a clinical diagnosis after ruling out other causes of rib pain. Physician may advise chest and rib X-Ray, CT scan or MRI to rule out any other cause of chest wall or rib pain. Early treatment of Osteochondritis Dissecans prevents worsening of the symptoms. The main goal of the treatment is to restore normal breathing by treating pain aggressively and improving breathing.
Treatment for Osteochondritis or Osteochondritis Dissecans
There are numerous treatments available for treating Osteochondritis or Osteochondritis Dissecans and their results vary from individual to individual. The physician may suggest some of the following treatments:
- Give time to the ribs to rest and heal and avoid activities that may strain the ribs.
- Immobilization of chest movement to prevent acute and severe pain is not advised as a treatment of Osteochondritis Dissecans.
- Avoid strenuous activities, which may result in hyperventilation (deep and rapid breathing).
- NSAIDs can be used for relief of pain.
- Physical therapy is advised under supervision of physical therapist. Physical therapy exercises trains breathing muscles and also directs activities, which would not trigger the pain.
Rib pain resulting from Osteochondritis Dissecans during early phase generally resolves in a few months if further injuries are prevented. Early diagnosis of Osteochondritis Dissecans is essential to prevent repeated injuries, which prevents rapid healing and permanent avascular necrosis. Patient with early symptoms and diagnosis of it should follow instructions of the physician diligently.