Diseases of the ribs | Ribs

Diseases of the ribs

Pain in the costal arch is a non-specific symptom and can have various causes. First, the pain should be characterized more precisely by the patient. For example, is it a pressure pain or rather a stabbing pain stimulus?

Does the pain become stronger under stress or also when breathing in? With this information, the treating physician can better assess the symptoms and the possible cause. A possible cause could be a contusion of the ribs, for example.

A previous fall and bruises in this area are indications of this. In this case, there is usually not only pain in the ribs, but also tension and bruising (haematomas) in the rib area. Especially in older patients or in cases of particularly bad falls, it should be remembered that the ribs can also break.In this case, a doctor should be consulted immediately, as the ribs are located above the heart and lungs and should therefore not be injured under any circumstances!

A further reason for pain at the costal arch can be pleurisy (inflammation of the pleura). This is an inflammation of the pleura, which can be caused by bacteria or a virus. Characteristic for this disease is the increase in pain during inhalation.

In addition, it should always be considered whether the pain at the costal arch may also have organic causes. The liver, gallbladder and stomach are examples of possible causes. These organs are located in the immediate vicinity of the costal arch, so that the symptoms can be felt as far as the costal arch.

Furthermore, muscular problems such as pulled muscles or torn muscle fibers can also cause pain. If there is tension or muscle soreness in the area of these ribs (for example, Musculi intercostali or Musculus serratus), the patient may have the subjective feeling that the pain comes from the ribs themselves. If the pain comes from the muscles surrounding the ribs, it is sufficient to wait two days, as the pain will then disappear on its own.

However, there is also the possibility that the pain in the ribs is projected pain from the individual organs. Pain in the area of the left costal arch may be associated with pain in the stomach, which is located directly below the lower left costal arch. Since the spleen is also located in the area of the lower left ribs, spleen complaints can also cause pain in the area of the left ribs, but this is rather rare.

However, it is important to characterize the pain precisely. If the pain is sudden and severe and if, in addition to the pain in the (left) ribs, there is also pain and tingling in the left arm, a heart attack should always be considered! The emergency doctor must be called immediately.

Pain in the right ribs may be due to problems with the liver or gall bladder. In this case, the rib pain is accompanied by nausea or bloating. If the rib pain occurs when coughing, it may be caused by pleurisy (inflammation of the pleura).

The duration of pleurisy can vary greatly. Patients with pre-existing lung disease in particular can be affected. Other rare causes of pain in the ribs are

  • Intercostal neuralgia
  • Tietze syndrome
  • Bechterew’s disease

Intercostal neuralgia, also known as intercostal neuralgia, is a razor-sharp pain, especially between the ribs, which is often caused by pinching of the “rib nerves” in the area of the thoracic spine.

The Tietze syndrome is mainly characterized by pain in the area between the ribs and the sternum. This leads to inflammation of the cartilaginous joints that connect the ribs to the sternum (sternocostal joints). Ankylosing spondylitis is a rheumatic disease that is accompanied by inflammation, ossification and thus pain in the area of the spine and ribs.

The ribs (costae) form the outer shape of the thorax and are usually well palpable and visible externally. Due to this unprotected position directly under the skin (or fatty tissue), broken ribs (rib fracture) are not uncommon. If the ribs are broken, this can usually also be easily seen externally.

Especially in the case of falls or strong blows in the area of the chest, ribs can be broken. Before a rib fracture occurs, the ribs usually spring out of the joints that connect the ribs and the sternum (breastbone) (Articulationes sternocostales). Depending on the injury, not only one rib is broken, but several ribs at once.

In addition, a rib can break easily, i.e. only once, or it can be broken several times. In this case, it is called a rib line fracture. In general, a rib is fractured by strong external force.

If a rib fracture occurs spontaneously, one should immediately think of bone diseases such as osteoporosis. The detection of a broken rib can usually already be done by means of an inspection, during which the doctor only looks at the patient and can therefore already detect the protruding rib. In addition, the doctor can palpate the rib to locate the fracture more precisely.If the findings are unclear, an additional X-ray can be taken.

It is always important to consider the surrounding structures in the case of a broken rib. A broken rib is usually not problematic in itself. However, it is fatal if, for example, in a traffic accident, the broken rib damages the pleura, causing air to enter the pleural gap.

This phenomenon is called pneumothorax and is accompanied by a collapse of the affected lung. This causes chest pain and breathing difficulties. A broken rib is also feared to cause damage to the spleen or the pericardium.

In most cases, however, a broken rib is not problematic and the broken rib does not need to be plastered, nor does a plate or a screw have to serve as a stabilizer. Instead, conservative treatment with a three-week period of rest is sufficient. In the event of external traumatic influences (for example, a severe blow to the rib cage or a fall), the superficial position of the ribs can easily lead to a contusion of the ribs (rib contusion).

It is important that a contusion does not exceed the elasticity of the rib bone. As soon as the elasticity is exceeded, a rib fracture (fracture) occurs instead of a rib contusion. Since blood vessels and the intercostal nerves run directly underneath the ribs, it is possible that the small vessels may burst open in addition to the contusion of the ribs.

This then leads to an outflow of blood, which can be superficially recognized as redness. In addition, a sensory disturbance on the skin in the area of the rib contusion can occur (loss of sensitivity). These sensory disturbances are caused by the fact that superficial nerves have been injured or damaged and are no longer able to adequately transmit their information to the brain through touch on the skin.

Like the rib contusion and the hematoma, this sensory disturbance is unpleasant but disappears again. However, the consequences of a rib contusion can also manifest themselves in the form of coughing, shortness of breath (dyspnoea) or more severe pain in the area of the ribs or even in the entire upper abdomen. Particularly if there is more pressure in the area of the bruise (for example, the seat belt in a car), increased pain can occur.

If the pain becomes too strong, the patient can take painkillers. This is especially important if the patient feels that his breathing is altered due to the pain or that he is taking relieving postures that will be a strain on his back in the long run. However, it is also important to always have a rib fracture clarified by a doctor.

Older patients in particular easily confuse a rib fracture with a rib contusion. Other measures to reduce the pain caused by a rib fracture are, on the one hand, an adequate relieving posture and, on the other hand, the patient can reach for cooling compresses. These have the positive concomitant effect of causing the blood vessels to contract (vasoconstriction).

This reduces the leakage of blood and prevents the formation of a large hematoma in the area of the rib fracture. Of course, this effect only occurs if the cooling compresses are applied to the corresponding area immediately after the rib contusion. In case of severe rib contusion, an additional X-ray examination is recommended.

If the physician is unsure whether soft tissues have been injured, he can also request an additional sonography. Inflammation of the costal pleura, also known as pleuritis, is an inflammation of the pleura. The pleura covers both lungs and the chest from the inside.

This creates the so-called pleural space, which contains approximately 5 ml of pleural fluid. This ensures that breathing can take place with as little friction as possible. In pleurisy, an inflammatory reaction occurs, which can have various causes.

On the one hand, viruses, bacteria or even fungi can cause pleuritis. These pathogens are usually absorbed via the respiratory tract and reach the pleura via the lungs. On the other hand, pleurisy is a concomitant disease (comorbidity) in various clinical pictures.

The most notable of these are pneumonia, pulmonary embolism and pancreatitis (inflammation of the pancreas). Characteristic for pleurisy is respiratory pain in the area of the ribs. A distinction can also be made between dry and wet pleuritis.In dry pleuritis, only the pleura is inflamed, so the patient feels very strong pain when breathing in.

In contrast, a wet pleurisy causes additional breathing problems for the patient. These are caused by the increased production of pleural fluid, which accumulates in the pleural gap. This compresses the lung and makes it harder for the patient to breathe.

  • Pleurisy
  • Duration of pleurisy

A contusion or bruise of the ribs can be the result of a trauma such as a collision or a traffic accident. A severe impact or a violent fall crushes the soft tissue. Soft tissue includes the muscles that surround the ribs and the lungs themselves.

The crush injures small blood vessels, causing small bleedings into the tissue. Similar to a bruise (hematoma), this injury is harmless, although it can be very painful. Often a rib contusion manifests itself by a bluish discoloration in the area of the pain.

By means of an x-ray, the attending physician can rule out a broken rib. In most cases, the rib bruise heals on its own after a few days. The patient should take it easy for a few weeks and should refrain from physical activities such as soccer or martial arts for a few weeks.

If the rib bruises are particularly severe, physiotherapy can be carried out to support the patient. The ribs (costae) form the outer shape of the thorax and are important bones to support breathing. There is no inflammation of the ribs themselves.

However, the joint that connects the ribs to the sternum can become inflamed. This is called Tietze syndrome, in which the rib cartilage that attaches to the sternum is inflamed. This leads to severe pain in the area of the ribcage.

The causes of Tietze syndrome and the associated inflammation of the ribs are not yet known exactly. However, since only the first 7 ribs are “real” ribs (costae verae) and are connected to the sternum by cartilage, the inflammation also occurs only in the first 7 rib joints (sternocostal joints). However, inflammation most frequently occurs in the area of the 2nd -5th rib.

In addition to inflammation of the rib cartilage, pain in the rib area can also occur after inflammation caused by herpes zoster (shingles). The reason for this is an irritation of the nerves (neuralgia) in the area of the ribs caused by the inflammation. In this case, however, the ribs are not directly affected by the inflammation, but rather the rib nerves (= intercostal nerves, i.e. intercostal neuralgia) are irritated by the inflammation with the virus.

Together with the spinal column and the sternum, the ribs form the bony security for our upper body (thorax) and enclose the heart, both lungs, spleen and the kidneys. Sportsmen and women in particular often have the problem that they “dislocate” their ribs when they move incorrectly. This involves shifts in the area of the costal vertebral joints, which can then lead to severe pain and possibly even shortness of breath.

It is now important not to try to dislocate the ribs yourself. On the one hand, you can only make the situation worse without knowing it, on the other hand a dislocated rib is painful enough. It is therefore not desirable to put the rib back in yourself without expert knowledge.

Osteopaths, physiotherapists and in some mild cases the family doctor are recommended. In order to counteract a renewed dislocation of the ribs, one should also pay more attention to sports activities (especially back muscle training). Massages are not beneficial.

Since athletes in particular often suffer from shifts in the area of the costal vertebral joints, they can ask their osteopath or physiotherapist to show them how they can put their ribs back in place. One exercise, which must be discussed with the respective physiotherapist beforehand, is that the patient lies down on the side that does not hurt, clamps a towel under the lying side at the level of the painful rib and breathes slowly deeper and deeper against the pain. During this exercise the ribs should be mobilized more.However, if the pain gets worse, you should not continue the exercise and consult a physiotherapist again so that he can set the rib professionally.