The diagnosis
In order to make a diagnosis, it is first and foremost necessary to differentiate and limit the pain through targeted questioning. In the majority of cases, musculoskeletal diseases (diseases of the muscles, tendons, ligaments or bones) are present. These are often based on a cause, for example a broken rib as a result of a fall.
The pain can often be made worse by pressure, movement or breathing. In the case of a fracture, it is possible to palpate a fracture site externally. An x-ray of the chest is useful for further clarification.
In some cases, organic damage can also be seen on this x-ray. An injury to the pleura with collapse of the lung can be detected on it, as can problems of the large pulmonary and cardiac vessels. Individual diseases, such as diaphragmatic hernias (points of passage through the diaphragm) and other diseases of the gastrointestinal tract can also be detected on the X-ray image.
These can be examined in more detail by endoscopic examinations, for example a gastroscopy. For special organic diseases, CT and MRI images can also be used. Diseases of the coronary vessels, which often lead to pain under the ribs, can be diagnosed with the aid of a so-called “heart catheter”.
In the case of mild, initial symptoms, potential causes should first be narrowed down on the basis of the pain and the exact medical history. If an underlying disease is suspected, the physician will refer the patient to an appropriate specialist. Numerous further diagnostic steps are available to these specialists.
The Therapy
The treatment of pain under the ribs varies greatly with the underlying causes. Complaints of the ribs, muscles and nerves can be easily treated in most cases; in the case of organic complaints, the treatment depends strongly on the disease. Broken ribs are among the fractures that are difficult to treat.
If the fractures are straight in relation to each other, neither an operation nor a cast or bandage needs to be applied. As with bruises, the treatment here is based on waiting for healing and, if necessary, on medication to relieve the pain.Drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs), for example diclofenac and ibuprofen, are also possible. In the case of severe pain, which even hinders breathing, morphine-like drugs can be used to relieve pain.
Tension and constriction of the muscles and nerves between the ribs heal by themselves in most cases. Again, the symptoms can be relieved with NSAIDs or opiates. Under certain circumstances, drugs to relax the muscles or anesthetics for the nerves can also be administered.
If there is an organic disease, comprehensive causal therapies must be carried out. In acute cases, intensive care measures may become necessary, consisting of ventilation and circulatory stabilization. For diseases of the upper abdomen, endoscopic and surgical interventions are often used.
