Rib pain occurring in the chest area can be due to a variety of causes. A distinction must also be made between pain that occurs for a short period of time and longer-lasting, chronic rib pain.
What is rib pain?
Infographic on pain regions, progression and development of pain, and intensity levels in pain sensation. Click image to enlarge. Rib pain is called chronic if it lasts more than six months or if the patient complains of regularly recurring pain. About one-third of patients with rib pain suffer from a chronic condition. In contrast to acute rib pain, chronic complaints often do not have a special warning function with regard to another disease, but represent a disease in their own right. According to the source of rib pain, two subgroups are distinguished: Pain originating directly from the rib area can be triggered by bruises or rib fractures, for example. Pain can originate from all twelve pairs of ribs and thoracic vertebrae as well as from the sternum. The second group includes rib pain that is due to diseases of organs located in the chest or tissues located near the ribs.
Causes
Rib fractures or rib contusions are most often caused by violent bumps or falls. However, an inflammatory change is also possible. In so-called Tietze syndrome, the rib or sternum cartilages are noticeably swollen and trigger the rib pain. Furthermore, there is a possibility of ossification of the rib joints, which can lead not only to rib pain but also to shortness of breath. The rather rare thoretic outlet syndrome (TOS) describes rib pain that is often caused by a congenital, unilateral or bilateral abnormality of the cervical rib. This abnormality can cause rib pain during movements of the arms, for example. However, rib pain can also be due to osteoarthritis (joint wear and tear), rheumatic disease (a chronic inflammatory disease due to a malfunction of the immune system), or scoliosis. Scoliosis is when the spine is bent laterally and vertebrae are twisted at the same time.
Diseases with this symptom
- Osteoarthritis
- Tietze syndrome
- Rheumatism
- Rib contusion
- Scoliosis
- Rib fracture
Diagnosis and course
At the beginning of any treatment for rib pain, it is first necessary to make a detailed analysis of the cause, which includes a thorough examination of the body and a precise determination of the duration and nature of the pain. Most acute rib pain will pass on its own without further intervention after a few days. However, if the pain persists for more than a week, the doctor will perform a closer examination. A rib fracture can often be diagnosed by simple palpation. An X-ray or ultrasound examination, a computer or magnetic resonance tomography and, in individual cases, a so-called bone scintigraphy, which can be used to examine the metabolism of a bone, can also be considered. The course of rib pain depends largely on the individual disease. Bruises, for example, lead to very severe rib pain that does not last very long. However, rib fractures can lead to secondary pain if a rib injures internal organs such as the spleen or lungs.
Complications
Body tissue that swells due to fractures or bruises can lead to lasting and intense pain. Affected individuals find themselves severely limited in their ability to perform as well as mobility. A detailed examination must quickly determine the exact cause if the condition persists. Superficial injuries are not always the reason for intense discomfort. A rupture or injury to the organs themselves can trigger lasting complications. The liver, spleen as well as the lungs and the upper section of the stomach are then impaired in their function. Depending on the localization, patients develop fears of dangerous but non-existent diseases. Last but not least, the increased heartbeat and shallow breathing to avoid pain fuel the fear of a heart attack. As inflammatory foci progress, water retention accumulates in the tissue between the lung and the pleura.At the same time, the swollen tissue exerts additional pressure on the surrounding organs and permanently increases the level of suffering. If the symptoms are not due to a mechanical effect from outside, fever, loss of appetite, and nausea are frequently observed as typical companions. In addition to the risk of manifestation of neurosis, the patient’s sleep quality may suffer in the long term. Even small movements in bed intensively revive pain. As a consequence, unnatural postures are adopted to protect the body. In the long run, these put a strain on back health and lead to further distortions or blockages of the musculoskeletal system. Bacterial infections can spread to the entire body without proper treatment and threaten the patient’s life.
Treatment and therapy
The diagnosis made on the basis of rib pain then determines the therapy in the further course. If there is no possibility of eliminating the cause of the pain, treatment will be limited to pain therapy. For this purpose, pain-relieving drugs can be used or, in individual cases, local anesthesia of the painful rib area can be performed, which, as a side effect, can also improve blood circulation and thus reduce inflammation. Rib pain caused solely by a contusion is usually treated with painkillers only. In contrast to the procedure for other bone fractures, a rib fracture does not require fixation, e.g., with a plaster cast. All other causes of rib pain are addressed by therapy of the underlying disease in question. In some diseases (such as scoliosis), physiotherapeutic treatment is considered. In the case of TOS, too, treatment is usually initially conservative with targeted physiotherapy. Only if physiotherapeutic efforts are unsuccessful may a rather complicated operation be performed, involving removal of ligaments and/or cervical ribs. Tietze syndrome, if severe rib pain is present, is treated with analgesic medications. In the case of osteoarthritis, in addition to pure pain therapy and physiotherapeutic measures, for example, a simple measure such as cooling the affected area of the chest, but in some circumstances the administration of cortisone preparations for the rib pain may also be considered.
Prevention
The possibility of preventive measures for rib pain depends on the nature of the underlying conditions. For example, in hazardous occupations or sports, it is possible to wear protective clothing that prevents impact or fall injuries. If rib pain is due to a specific disease, at least worsening of the pain can be counteracted by treating that disease. Early evaluation of prolonged rib pain allows prompt diagnosis, based on which complications that might otherwise be imminent can be avoided.
