Table of ContentsView AllTable of ContentsCommon CausesLess Common CausesNon-Musculoskeletal CausesSymptomsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Common Causes
Less Common Causes
Non-Musculoskeletal Causes
Symptoms
Diagnosis
Treatment
Rib pain may feel like it hurts when touched, when you breathe in, or constantly. The quality of pain symptoms (dull pain, sharp pain, radiating pain) may depend on the cause. Your healthcare provider may need to have images taken and bloodwork done to properly diagnose your rib pain.
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Some of the more common musculoskeletal causes of rib cage pain are as follows.
Injuries
Muscle strains may occur with an injury or even coughing or bending.Rib fracturesare relatively common and can sometimes cause intense pain. Ribs can also be bruised (bone bruise) without a fracture.
The sternum is infrequently fractured, but chest trauma can result in a number of abnormalities ranging from single fractures to flail chest, in which three or more ribs have two or more fractures each.Withosteoporosis, rib fractures can sometimes occur with very little trauma.
With fractures, tenderness is usually very localized. Your ribs may hurt when touched on or near the injured area. Symptoms may include swelling along with pain.
Inflammation
Costochondritisis an inflammatory condition that involves the cartilage that connects the ribs to the sternum. The condition is common and the pain can sometimes mimic the pain felt in a heart attack.
With costochondritis, pain is most commonly noted when touching the ribs left of the sternum in a very localized region.
Fibromyalgia
Fibromyalgiais a relatively common cause of rib cage pain but it can be challenging to both diagnose and treat because it’s primarily a diagnosis of exclusion. People with fibromyalgia can experience pain from even a very slight touch.
Along with pain and morning stiffness, people with the condition often experience mental fog, fatigue, and other symptoms.
Rheumatoid Conditions
Common rheumatoid conditions that can cause rib cage pain includerheumatoid arthritis(RA) andpsoriatic arthritis.Because RA is a chronic condition, it can contribute to thinning of bones, including the ribs. So can steroid drugs used to treat it.
If your healthcare provider suspects a rheumatoid condition, they may order laboratory tests to look for markers of these conditions.
Intercostal Neuralgia
Intercostal neuralgiais a condition in which nerve pain (neuropathic pain) arises from an injury, shingles, nerve impingement, and other causes. It can be challenging to diagnose and treat.
With intercostal neuralgia, pain may be felt over the whole chest or along one rib. You may feel a sharp pain when your healthcare provider presses on the area between the ribs.
Slipping Rib Syndrome
Slipping rib syndrome (also called lower rib pain syndrome, rib tip syndrome, or 12th rib syndrome) is thought to be underdiagnosed and can cause significant pain in the lower ribs (the floating ribs).
In this condition, it’s believed that overly mobile floating ribs slip under the ribs above and pinch the intercostal nerves, nerves that supply the muscles that run between the ribs.Your ribs may hurt when touched.
Other Causes
Other relatively common musculoskeletal causes can include:
Rib Cage Pain in Pregnancy
Much less commonly, and after the 20th week of gestation, pain on the right side felt under the lower ribs is sometimes a sign ofpreeclampsiaorHELLP syndrome, a medical emergency.
Some less common but still significant musculoskeletal causes of rib cage pain are as follows:
Rib Stress Fractures
Rib stress fracturesare an overuse injury commonly seen with activities such as backpacking or rowing.These injuries can cause pain or tenderness with touch.
Rib stress fractures can be challenging to diagnose, so it is important to let your healthcare provider know what type of exercises and sports you participate in.
Tietze Syndrome
Tietzesyndrome is similar to costochondritis but less common. Unlike costochondritis, there is swelling that accompanies the inflammation of the cartilage connecting the ribs to the sternum.
With Tietze syndrome, the pain occurs in the chest area and can be especially pronounced when touching the ribs or applying pressure to them.
Cancer
A number of cancers can lead to rib cage pain.Both lung cancer and breast cancer, for example, commonly spread (metastasize) to bones, including those of the rib cage.
Pain may be due to the presence of the tumor in bone (bone metastases) or due to fractures that result in weakened bones (pathologic fractures). In some cases, rib cage pain may be the first symptom of cancer.
These tumors may also grow directly into the rib cage and cause pain.Multiple myelomais a blood-related cancer that may occur in the bone marrow of the rib cage and other bones and can also cause rib cage pain.
Your healthcare provider may want to order imaging tests to help rule out a malignancy. Bone scans can show bone metastases, and a PET scan may be used to find other types of cancer. Abronchoscopyand/or a CT scan of the chest can help diagnose lung cancer.
Other potential causes of rib pain that occur less often include:
It can sometimes be very difficult to know whether pain that is felt in the rib cage is related to the rib cage itself, or to underlying structures. Some potential non-musculoskeletal causes of rib cage pain include the following.
Shingles
Shinglesis a condition in which the chickenpox virus (which remains in the body after the initial infection) reactivates.
Symptoms include fever, chills, and rash distributed on one side of the body. However, pain, sometimes around the rib cage (which can be severe), often occurs before these other symptoms, making shingles difficult to diagnose. The pain can feel like burning and can occur even with a very slight touch.
Heart Disease
Heart disease may cause pain that is felt in the rib cage.
The possibility of a heart attack should always be considered in a person who has any form of chest-related pain.Pericarditis, an inflammation of the membrane that lines the heart, is also a potential cause.
If your healthcare provider suspects heart disease, they may order tests such as an electrocardiogram (ECG) or an echocardiogram (ultrasound of the heart).
Enlargement of the Aorta
Enlargement of the large artery (aorta) in the chest may cause rib cage pain. Risk factors include the condition Marfan’s syndrome as well as cardiovascular disease. Sleep apnea may also play a role.
Lung Conditions
Lung conditions such aslung cancermay cause rib cage pain.Lung cancer, in particular, may irritate nerves that lead to pain that feels like it originates in the rib cage.
Pulmonary emboli, or blood clots in the legs (deep venous thromboses) that break off and travel to the lungs are a serious cause of rib cage pain. Pneumonia can also be a cause.
If you have a lung condition, you may have breath sounds (like wheezes) that will help your healthcare provider diagnose your condition.
Pleural Conditions
Inflammation of the pleura (pleurisy) or the build-up of fluid between the two layers of the pleura can cause rib cage pain.This may cause pain when touched or with a deep breath. Certain positions may be more painful than others.
A pleural friction rub is a breath sound that may be heard with inflammation of the lining of the lungs (the pleura).
Enlargement of the Spleen
Spleen enlargement, such as with some blood-related conditions or cancers, may cause rib cage pain and pain or tenderness with touch.The spleen may also become enlarged (and sometimes rupture with mild trauma) with infectious mononucleosis.
Liver Conditions
Inflammation or scarring of the liver, such as with hepatitis or cirrhosis, may cause pain just below the ribs.
Digestive System Conditions
Gastroesophageal reflux disease(GERD) often causes heartburn, but can also cause other types of chest pain.Peptic ulcer disease or gastritis are other potential causes.
Referred Pain From Outside of the Rib Cage
Organs outside of the rib cage may also cause pain that feels like it arises in the rib cage. Some of the organs that can be associated with rib cage pain include:
If you are experiencing rib cage pain that does not have an obvious explanation, it’s important to make an appointment to see your healthcare provider.
Symptoms that should alert you to call 911 include:
You also should let your healthcare provider know if you experience nausea, have trouble swallowing, or cough up blood.
In order to determine the cause or causes of rib cage pain, your healthcare provider will ask you about your medical history, the history of your pain, where it hurts, and what the pain feels like. They will also ask if there’s anything that makes your pain worse or better.
On physical examination, your healthcare provider will look for pain and signs of swelling or rash. they may also ask you to do a range of motion tests. Additional lab or imaging tests may be necessary if they suspect that there is a cause unrelated to your muscles or bones.
The treatment of rib cage pain will depend on the underlying cause. Sometimes this simply requires reassurance and advice to avoid activities and movements that aggravate the pain. You may try some at-home measures to stop your ribs from hurting, including:
For muscle or bone-related causes, your healthcare provider may consider pain medication (including steroid injections). Exercise and physical therapy, as well as complementary practices such as massage or acupuncture, also may help.
Rib fractures cause pain that persists for several weeks. Healthcare providers often opt for conservative treatments such as wrapping the rib cage, but surgery to stabilize the rib cage also may be needed.
If an underlying problem or disease is the cause of rib pain, it will need to be treated.
Summary
Rib cage pain can signal a number of possible musculoskeletal conditions as well as non-musculoskeletal conditions within or outside of the chest. A diagnosis is usually based on your history and symptoms, a physical exam, and sometimes imaging scans or other tests.
Depending on the cause, healthcare providers have a wide array of options to choose from in order to identify the cause of the pain and lead to an appropriate treatment plan.
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