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Chest pain rib cage: 6 possible causes of rib cage pain

6 possible causes of rib cage pain

Rib cage pain is a common complaint that can result from many factors, ranging from a fractured rib to lung cancer. The pain may be sudden and sharp or dull and aching.

Many cases of rib cage pain are not linked to serious conditions and resolve on their own or with minimal treatment. Others, however, are medical emergencies requiring immediate intervention.

There are many possible causes of rib cage pain. A doctor will diagnose the underlying cause by a physical examination and imaging scans.

Common reasons for rib cage pain include:

1. Injury

Injury to the chest from falls, traffic collisions, and sports-related contact is the most common cause of rib cage pain. Types of injury include:

  • broken ribs
  • bruised ribs
  • fractured ribs
  • pulled muscle

Rib cage pain that begins following injury is typically diagnosed with an X-ray to highlight bone breaks and fractures. MRIs and other scans can detect soft tissue damage.

2. Costochondritis

Costochondritis or Tietze’s syndrome is another common cause of rib cage pain.

This condition is characterized by inflammation of the cartilage in the rib cage. It usually occurs in the cartilage that joins the upper ribs to the sternum, an area called the costosternal joint.

Rib cage pain due to costochondritis ranges from mild to severe. Symptoms include tenderness and pain when touching the chest area. Severe cases can lead to pain that radiates down the limbs, or pain that interferes with daily life.

Some cases of costochondritis resolve without treatment, while others require medical intervention.

3. Pleurisy

Pleurisy, also known as pleuritis, is an inflammatory condition that affects the linings of the lungs and chest.

The pleura are thin tissues that line the wall of the chest and the lungs. In their healthy state, they smoothly slide across one another. However, inflammation causes them to rub, leading to significant pain.

Since the advent of antibiotics, pleurisy is much less common than it was. Even when it does occur, it is often a mild condition that resolves on its own. Pleurisy usually lasts from a few days to 2 weeks.

Other inflammatory conditions of the lungs, such as bronchitis, may also cause pain around the rib cage.

4. Cancer

Lung cancer is the second most common cancer in the United States.

One of the symptoms of lung cancer is rib cage pain or chest pain that gets worse upon breathing deeply, coughing, or laughing. Other symptoms to look out for include coughing up blood or phlegm, shortness of breath, and wheezing.

The outlook for lung cancer is poorer than other forms of cancer and is the leading cause of cancer death among both men and women. People with early-stage lung cancer have a better chance of being cured, highlighting the importance of early intervention.

Metastatic lung cancer, or cancer that begins in one area and spreads to the lungs, is a life-threatening condition. It will also cause pain in the rib cage or chest.

5. Fibromyalgia

This is a chronic condition, causing pain throughout the body. Fibromyalgia is estimated by the American College of Rheumatology to affect between 2-4 percent of people, up to 90 percent of whom are women.

The pain associated with fibromyalgia may be burning, throbbing, stabbing, or aching. These pains are commonly felt in the rib cage, although any part of the body can be affected.

Some research suggests that non-specific chest pain, including rib cage pain, is the most common co-existing condition that leads to hospital admission in people with fibromyalgia.

6. Pulmonary embolism

A pulmonary embolism (PE) is when an artery going into the lungs becomes blocked. The blockage is often caused by a blood clot that has traveled up from one of the legs.

As well as rib cage pain, PE can cause the following symptoms:

  • shortness of breath
  • rapid breathing
  • coughing, including coughing up blood
  • anxiety
  • lightheadedness
  • sweating
  • irregular heartbeat

PE is a serious condition that can damage the lungs and other organs due to reduced oxygen in the blood. Anyone who experiences the symptoms of PE should see a doctor.

The National Heart, Lung, and Blood Institute estimate that 30 percent of people who develop PE will die if they do not receive treatment. Fortunately, a quick diagnosis and treatment can prevent complications.

The rib cage consists of 24 ribs, 12 on either side, and it shields the organs of the chest, including the heart and the lungs, from damage.

The ribs are attached to the breastbone, which is the long bone that runs down the center of the chest. They are attached at the front, by cartilage, which is a firm yet flexible tissue. At the back, they are attached to the spine.

The liver is located at the lower end of the rib cage on the right and the spleen is on the left. Both are given some protection by the rib bones. The gallbladder and kidneys lie just below the rib cage.

If any of the components of the rib cage, including the bones or cartilage, or the organs nearby are affected by injury or illness, a person will have pain in or near the rib cage.

Rib cage pain may occur in the chest, below the ribs, or above the naval. As there are several different causes of rib cage pain, the symptoms can vary. As a result, the pain may be:

  • sharp
  • dull
  • aching
  • sudden
  • slow to develop
  • constant
  • intermittent
  • worse when breathing in or moving

Other symptoms affecting the rib cage can include:

  • bruising
  • tenderness
  • difficulty breathing

Rib cage pain can be attributed to many underlying injuries or medical conditions. A person should always consult a doctor in any case of unexplained rib cage pain.

If the pain or pressure in the chest is severe and breathing becomes difficult, a person should seek emergency medical treatment, as these symptoms could indicate a heart attack.

Back rib pain: Causes and treatment

Pain in the back ribs can happen for many reasons. It can result from an injury, such as muscle strain or fractured rib, but it can also be a sign of a more serious condition, such as osteoporosis, gallstones, or a lung condition.

The pain may be sharp or dull and mild or severe. Often, the pain resolves without intervention, but it can sometimes indicate a more serious medical condition that requires specialist care. This is more likely if the pain is intense or there are other symptoms.

This article looks at some common causes of pain in the back of the ribs, as well as the associated symptoms and typical treatments.

Injuries can cause back rib pain. Common rib-related injuries include:

  • bruised ribs
  • pulled muscles
  • fractures
  • broken ribs

If pain after an injury is lasting or severe, the cause may be a broken rib. To diagnose this injury, a doctor may use an X-ray or MRI.

Treatment options vary. Many people with broken ribs just need rest and pain relief medication. Surgical intervention is sometimes necessary, but only in severe cases.

An intercostal muscle strain is an injury to the muscles between the ribs. A strain occurs when these muscles tear, often due to strenuous physical activity.

Common symptoms of an intercostal muscle strain include:

  • sharp, severe pain in the upper back or ribs
  • stiffness and tension in the upper back muscles
  • spasms in the intercostal muscles

To treat this type of strain, doctors often recommend pain medication and physical therapy.

Costochondritis is inflammation of the cartilage that holds the ribs together. It is a common condition, particularly in adults aged 40–50, and it causes pain in the chest wall, sometimes at the back of the ribs.

The pain may be strong and sharp, and it may get worse when the person takes a deep breath. It may also worsen with movement.

Treatment may involve:

  • heat therapy
  • local or oral pain medications
  • capsaicin cream
  • physical therapy

For many people with costochondritis, the issue improves in a few weeks. However, because the symptoms can be similar to those of a heart condition, it is vital to speak with a doctor.

Preexisting conditions, such as osteoporosis, can weaken the ribs so that they break more easily, often during less intensive activities.

Osteoporosis causes the bones to lose the minerals that they need to stay strong. With a low mineral density, bones can fracture spontaneously or when the person is coughing. It is a common condition in older adults, especially in females.

The Centers for Disease Control and Prevention (CDC) report that 12.6% of adults over 50 had osteoporosis in 2017–2018. The figure for females only was 19.6%.

The symptoms of osteoporosis include soreness and pain. Healthcare professionals often diagnose the issue with X-rays. They may also test a person’s kidney and thyroid function.

Some treatment options for osteoporosis include:

  • doing gentle strength training
  • reducing alcohol consumption and cigarette smoking, if applicable
  • taking calcium and vitamin D3 supplements
  • taking medications that reduce the risk of fractures

Fibromyalgia causes widespread pain in the muscles and bones. People may also have specific tender points. Researchers are unsure what causes it, but it is more common in females than in males.

Beyond the pain, fibromyalgia often occurs with:

  • fatigue
  • headaches
  • paresthesia, which is a numb or burning sensation, usually in the extremities
  • depression
  • anxiety
  • cognitive disturbances, such as problems processing and remembering information

Because fibromyalgia has such diverse symptoms, doctors may recommend a variety of interventions, including:

  • improving sleep quality
  • practicing relaxation techniques
  • starting cognitive behavioral therapy
  • getting regular cardiovascular exercise
  • taking medications, including antidepressants and anticonvulsants

Gallstones are hardened deposits in the gallbladder. They sometimes cause no symptoms, but they can also move and block the ducts of the gallbladder, leading to problems.

Gallstones can cause pain, especially when they block ducts. The classic presentation is pain in the upper right part of the stomach, under or around the ribs. Some people also feel the pain in their back, such as between their shoulder blades.

The pain may be intense, though it is mild for some people. It usually develops shortly after a meal and lasts for a few hours. A person may also have nausea and vomiting or jaundice. This yellowing of the eyes and skin signals that the gallstones are affecting the liver. It may also cause dark urine.

A blocked gallbladder duct can become a medical emergency. Anyone with gallstones should receive prompt medical attention for any intense abdominal pain, especially if there is jaundice.

A pulmonary embolism occurs when a blood vessel in a lung is blocked, often by a blood clot. A person may initially notice pain and swelling in one leg when the clot blocks a blood vessel there. If the clot breaks loose, it can travel to the lungs.

Pulmonary embolisms are serious and relatively common. Research shows that they are responsible for around 100,000 deaths per year in the United States, and this figure is rising.

Aside from pain in the back of the ribs, a pulmonary embolism can cause the following symptoms:

  • coughing, which may bring up blood
  • sweating
  • headaches and lightheadedness
  • shortness of breath
  • rapid breathing
  • anxiety
  • an irregular heartbeat

A pulmonary embolism is a life threatening emergency that requires immediate treatment.

Typically, treatment involves blood thinning medication, which makes it harder for clots to form. A person who cannot tolerate this approach receives a different medication that prevents the blood from clotting.

Certain health conditions that affect the lungs can also cause back rib pain.

For example, pleurisy, or inflammation of the lining of the lungs, can cause pain in the chest, shoulders, and back ribs. Researchers know that several underlying issues can cause pleurisy. For this reason, the treatments are varied.

Lung cancer can also cause pain in the chest and ribs. It is life threatening and a leading cause of cancer-related death in the U.S.

Other symptoms of lung cancer include coughing, which may bring up blood, and shortness of breath.

The best course of treatment depends on the cancer’s type and stage, as well as factors specific to each individual. A person may need to undergo surgery, chemotherapy, and radiation therapy.

A person should contact a doctor about back rib pain if:

  • The pain worsens.
  • It remains after a few days of home treatment.
  • It limits the ability to move.
  • It occurs with a fever, chills, vomiting, nausea, or other symptoms.

People who think that they may have gallstones should call a healthcare professional and ask if their symptoms are signs of an emergency. But anyone with intense gallstone pain should go to an emergency room.

In general, seek emergency treatment if:

  • The pain is so severe that it limits the ability to function.
  • It occurs with jaundice.
  • It occurs with trouble breathing, shortness of breath, or chest pain.
  • The person feels very sick.
  • Any symptoms rapidly worsen over several hours.

Minor injuries can cause pain in the back ribs. These injuries are not usually dangerous, and they often heal on their own.

However, this pain can also stem from a more serious health condition. This is especially likely if the pain is very intense, comes on suddenly, with no clear cause, or occurs with other symptoms. Prompt treatment can prevent serious complications and death.

Anyone with persistent or severe back rib pain should contact a healthcare professional.

Tactics of behavior in case of chest pain and risk factors for myocardial infarction – Prevention of diseases and healthy lifestyle – Budgetary institution of the Khanty-Mansiysk Autonomous Okrug – Yugra

The most common cause of chest pain is angina pectoris or “angina pectoris”.

Angina pectoris is a form of coronary heart disease (CHD), the obvious signs of which are considered to be pain in the heart and shortness of breath. This pathology occurs against the background of a violation of the supply of the heart with a sufficient amount of blood, which is a consequence of the defeat of the coronary arteries by atherosclerosis.

Since this pathology is one of the forms of coronary artery disease, if it is present, there is an obstruction in one or both coronary arteries, which prevents the blood from circulating normally. This condition is accompanied by attacks of myocardial ischemia, that is, a lack of oxygen in the heart muscle.

The most obvious sign indicating the development of angina pectoris is considered to be the so-called imbalance between the need of the heart muscle for oxygen and the supply of oxygen to the region of the heart. To put it simply, the patient’s heart receives much less amount of blood than he needs.

Lack of oxygen makes itself felt at the moment of physical activity – that is why in patients with this pathology attacks develop during physical work or under the influence of a stressful situation.

Painful sensations resemble seizures. Pain during such attacks is simply unbearable – it seems to burn, press and compress, it arises in the area behind the sternum and radiates to the left shoulder or to the whole arm. Very common pain is also accompanied by strong anxiety, and fear : a person is trying to find a place for himself, he is holding on to his left chest and cannot fully understand what is happening.

In the case of the initial forms of the development of the disease, pain recedes within one to five minutes after taking the drug. If the pain does not disappear after this period of time, then this is a signal that the disease has acquired a more severe course, and, therefore, the chances of developing a myocardial infarction are high.

In most cases, just one tablet of Nitroglycerin helps to forget about the pain. If one tablet is not enough to get rid of pain, it means that the risk of developing myocardial infarction is increased.

At the first manifestations of retrosternal pain, you should immediately consult a doctor. It should not be thought that young age excludes the possibility of angina pectoris, or that burning behind the sternum when running or walking quickly uphill cannot be a sign of “angina pectoris” in a person involved in sports.

During an attack, the following measures are recommended for immediate relief of pain:

  • create physical and psycho-emotional rest for the patient: lie down, sit down, or stop if chest pains appear during exercise;
  • urgently needs to take 1 tablet of nitroglycerin under the tongue. The analgesic effect of nitroglycerin usually occurs within 1-5 minutes. To stop an attack, 1-2 tablets of nitroglycerin are enough.
  • if the attack is prolonged (lasts 15-20 minutes) and repeated doses of nitroglycerin are ineffective, you should immediately call an ambulance.

Do not self-medicate. If you do not promptly consult a doctor and do not start the prescribed treatment, the disease progresses.

Under conditions of “oxygen starvation” in case of pain, myocardial cells can live for 20-30 minutes . Then they die. This is a heart attack, a site of necrosis in the tissue of the heart. A scar remains on the affected area.

There are risk factors for myocardial infarction , the elimination of which significantly reduces the risk of its development: smoking, high levels of low-density lipoprotein cholesterol and hypercholesterolemia, arterial hypertension.

For the first time chest pain or shortness of breath on previously well tolerated exertion, an urgent need to consult a cardiologist. The District Cardiological Dispensary has the whole range of diagnostic procedures necessary in this case: all currently known methods for diagnosing coronary heart disease, both performed on an outpatient basis and in a hospital.

Experienced cardiologists of the District Cardiology Dispensary evaluate the patient’s condition and decide where to conduct examinations. In some cases of severe manifestation of the disease or ineffectiveness of medical treatment, cardiologists organize the hospitalization of patients in a specialized department, also located in the cardio center. Thus, patients receive the whole range of diagnostic and therapeutic measures in one center, which is an exclusive offer in the city of Surgut.

A.A. Seitov, cardiologist, head of the emergency cardiology department of the KhMAO-Yugra OKD “CD and SSH”

Chest pain: causes, symptoms, diagnosis, treatment

Feelings of pain in the chest are as common as headaches and abdominal pain. It has been found that up to 40% of people have experienced chest pain at some point in their lives. There are vital organs in the chest, chest pains are often the main symptom of a number of life-threatening diseases, which necessitates the differential diagnosis of dangerous and non-dangerous conditions and their adequate correction. As doctors have noticed in the past, if an attack of pain occurs for no apparent reason and stops on its own, most likely it is functional. According to modern concepts, when examining patients with chest pain, it is advisable for a doctor to evaluate possible options for the causes of pain, as well as determine the need for intervention and choose the most optimal ones among a large array of treatment and diagnostic methods. Diagnosis of such conditions is further complicated by the fact that chest pain can be an integral part of pathological, psychological and psychosocial factors.

Treatment of diseases of the spine in the Center “Meddiagnostics” is carried out

Gongalsky Vladimir Vladimirovich

Doctor of Medical Sciences, orthopedist-traumatologist, neurologist, vertebroneurologist

Kopyl Evgeny Gennadievich

Maksimov Grigory Alexandrovich

Doctor neurologist , Candidate of Medical Sciences

The most common causes of chest pain are:

  1. Musculoskeletal diseases (osteochondrosis, costal chondritis, rib fractures).
  2. Diseases of the cardiovascular system (ischemic heart disease, angina pectoris, mitral valve prolapse, arrhythmias, pericarditis).
  3. Problems with the digestive organs (reflux gastroesophageal, achalasia of the cardia, gastric and duodenal ulcers).
  4. Panic disorders, anxiety, stress.
  5. Pathology of the bronchi and lungs (bronchitis, pleurodynia, pneumonia).
  6. Atypical chest pain.

Correlation of chest pain by sex and age:


  • 18-24 years old – gastroesophageal reflux, muscle pain in the chest wall;
  • 25-44 years – gastroesophageal reflux, muscle pain in the chest wall, costal chondritis;
  • 45-64 years old – angina pectoris, myocardial infarction, muscle pain in the chest wall, atypical pain;
  • over 65 years of age – muscle pain in the chest wall, atypical pain, diseases of the heart and blood vessels;


  • 18-24 years old – costal chondritis, anxiety or stress conditions;
  • 25-44 years – muscle pain, costal chondritis, atypical pain, gastroesophageal reflux:
  • 45-64 years old – angina pectoris, myocardial infarction, atypical pain, muscle pain in the chest wall;
  • over 65 years old – angina pectoris, unstable angina pectoris, myocardial infarction, muscle pain in the chest wall, atypical pain, costal chondritis.

Chest pain classifications include:

  1. Anginal (coronary, non-coronary) and non-anginal (cardialgia) pain, as well as pain in a number of vascular diseases (aorta, pulmonary artery).
  2. Pain associated with the pathology of the respiratory system (with pneumonia, lung abscess, neoplasms of the bronchi and lungs, pleurisy).
  3. Pain in the cervical and thoracic spine, in the muscles of the humeroscapular region, in the anterior chest wall.
  4. Pain caused by psychovegetative disorders.
  5. Pain in diseases of organs located in the mediastinum (esophageal spasm, reflux esophagitis, diverticula, tumors, mediastinitis).
  6. Pain in diseases of the gastrointestinal tract (stomach and duodenal ulcer, chronic cholecystitis, etc.) and diaphragm (hernia, diaphragmatic pleurisy).

Coronary pains are life-threatening; pain accompanying pulmonary embolism, aortic aneurysm, pneumothorax. Life-threatening pain is accompanied by a serious condition of the patient, severe disorders of cardiac function and respiration, which makes it possible to quickly judge the nature of the pathology. According to modern concepts, overdiagnosis is preferable to underdiagnosis. Thus, in the USA, 6-8% of patients with chest pain who were not hospitalized after going to the hospital are mistakenly released. Differential diagnosis of this type of pain involves determining: localization, irradiation, nature, intensity of pain, conditions for its onset and cessation, duration, frequency of attacks. A significant number of adverse outcomes in chest pain is associated with an incorrect assessment by the patient of his condition as not serious enough to seek medical help.

Physician’s tactics when referring a patient with chest pain:

  • history taking; physical examination;
  • electrocardiogram;
  • stress tests;
  • if necessary – nitroglycerin test, anaprilin test;
  • blood tests;
  • fluorography of the lungs;
  • x-ray of the spine for suspected spondylogenic (associated with the spine) pain
  • other studies: echocardiography, radiography, examination of the gastrointestinal tract, fibrogastroduodenoscopy, psychological consultation.

Algorithm for diagnosing chest pain (according to G.I. Lysenko and V.I. Tkachenko, 2007)

After conducting the necessary research and establishing the causes of chest pain, appropriate treatment of the identified pathology is carried out.

The diseases listed below may be the cause of your complaints

  • diseases of the muscles of the chest and spine ;
  • diseases of the spinal joints ;
  • spinal osteoarthritis ;
  • spinal osteochondrosis ;
  • spondyloarthritis ;
  • spondyloarthropathy ;
  • thoracic radiculopathy ;
  • referred pain from the cervical spine (transition to “pain in the neck”) ;
  • diseases of the costovertebral joints ;
  • diseases of the ribs ;
  • osteoporosis ;
  • broken ribs ;
  • exertional angina ;
  • myocardial infarction;
  • atherosclerosis;
  • dissecting aortic aneurysm ;
  • pulmonary embolism ;
  • lung cancer ;
  • tumors of the spinal cord ;
  • pleurisy ;
  • pneumonia ;
  • mediastinitis ;
  • pericarditis ;
  • pneumothorax ;
  • mitral valve prolapse ;
  • esophagospasm ;
  • reflux esophagitis ;
  • herpes zoster ;
  • cough fracture of ribs ;
  • epidemic myalgia (pleurodynia) ;
  • cocaine use ;
  • diabetes mellitus ;
  • side effects of drugs and intoxication ;
  • diseases of the thyroid gland ;
  • Urinary tract infection ;
  • mental disorders ;
  • depression ;
  • anxiety disorders ;
  • neurocirculatory dystonia;
  • arterial hypertension;
  • hypertrophic cardiomyopathy;
  • myocarditis;
  • aortic orifice stenosis.