General
Pain in the ribs can therefore originate either from the ribs or their cartilaginous part. The cause of rib pain can therefore come from the joints and the ligaments there or be triggered by nerves that run very close to the ribs. However, since pain is usually very uncharacteristic, inflammatory or other diseases may also be a possible cause in addition to the orthopedic causes. Indications of non-orthopedic causes of rib pain are further symptoms.
Causes of rib pain
The most common disorder and cause of rib pain is rib fracture (rib fracture). The rib fracture is a common injury in the area of the chest. One or more rib bones are injured.
A serial rib fracture is when more than three ribs are broken. In most cases, a rib fracture is caused by a fall event with direct impact. Typical symptoms are pain over the affected rib, which increases when breathing in and out deeply, coughing and moving.
In addition to rib pain, skin emphysema over the fracture is often present and occasionally a crunching sound can be heard when pressure is applied to the fracture. However, similar symptoms can also be caused by a contusion of the ribs (rib contusion), which in most cases is more likely caused by blunt trauma. Simple rib fractures are usually treated purely conservatively and heal without complications.
The diaphragm is a respiratory muscle and anatomically separates the thorax from the abdomen. A diaphragmatic hernia (diaphragmatic hernia) results in an enlarged opening in the diaphragm through which abdominal organs push into the thorax, depending on the location of the hernia. The most common location of a diaphragmatic hernia is where the esophagus leads into the abdominal cavity or stomach.
This is where there is an opening by nature. If this widens, the stomach, for example, if it is very full, can slide through the enlarged opening into the chest. Since the stomach lies below the left costal arch, a diaphragmatic hernia in this area can cause pain if the stomach is trapped in the gap.
Depending on the size of the hernia and the proportion of abdominal organs in the thorax, the lung may be displaced, so that symptoms such as shortness of breath may occur in addition to pressure and rib pain. Surgery for a diaphragmatic hernia is only performed if it causes significant discomfort. You can read more information on this topic here: Diaphragmatic herniaDuring pregnancy, the abdominal muscles that attach to the ribs are stretched further and further due to the increasing space requirements of the unborn child.
This stretching exerts a permanent, increasing pull on the ribs, especially in the area of the costal arch. The pain that develops in this way usually occurs suddenly and repeatedly throughout the day. From about the eighth month of pregnancy onwards, the uppermost pole of the uterus is often in the region of the costal arch, exerting pressure on the rib cage which can cause pain in the ribs.
When coughing, air is expelled explosively from the lungs to remove foreign bodies or mucus from the airways, for example. During this process, the muscles of the chest wall are used to “squeeze” the chest and thus the lungs. Since a cough is the fastest movement a person can perform, many different muscle groups of the thorax are involved.
The muscle groups involved have to perform a great deal of effort to achieve the necessary speed of tension. Patients with a chronic or prolonged cough, which can occur, for example, as part of bronchitis, often experience chest pain because the muscles of the thoracic wall are overloaded by the constant coughing. This muscular pain can easily be confused with rib pain, because the muscle fibres used for coughing run between the ribs.
Other muscle groups, such as the chest muscles or the back muscles, are also needed for coughing and are sometimes attached to the ribs. It is difficult to make a clear distinction between rib pain and muscle pain at the point where the muscle attaches to the rib. In rare cases, in patients with osteoporosis or cancer patients with metastases in the ribs, a severe cough can also lead to a broken rib.There are some malignant tumors that can cause bone metastases through the metastasis of cancer cells.
Examples are breast cancer, prostate cancer, the bronchial carcinoma and renal cell carcinoma. In addition to other bones, the tumor cells can also attack the ribs and lead to changes in the bone structure there. Bone metastases in the ribs cause various symptoms, especially pain.
Those affected often describe the rib pain as deep-drilling. The pain is typically permanent and does not improve at rest. This leads to a significant reduction in quality of life. Furthermore, bone metastases can cause pathological fractures, i.e. the formation of fractures without violent impact on the bones. Metastases in the ribs often cause great suffering to the patient, so that adequate pain therapy is urgently indicated to alleviate the symptoms as much as possible.
