What are the symptoms of costochondritis and slipping rib syndrome. How do these conditions affect back pain. What causes rib cage disorders and how are they treated. What is the recovery time for rib-related back pain.

Understanding Rib Cage Anatomy and Its Relation to Back Pain

The human rib cage is a complex structure that plays a crucial role in protecting vital organs and facilitating breathing. To comprehend how rib-related disorders can cause back pain, it’s essential to understand the basic anatomy of the rib cage.

The rib cage consists of 12 pairs of ribs, each connected to the thoracic spine. The first seven pairs, known as true ribs, are directly attached to the sternum (breastbone) via costal cartilage. The next three pairs, called false ribs, are indirectly connected to the sternum through the cartilage of the ribs above them. The last two pairs, referred to as floating ribs, are not connected to the sternum at all.

This intricate structure is held together by various ligaments and muscles, allowing for flexibility during breathing and movement. However, this complexity also makes the rib cage susceptible to various disorders that can cause back pain.

The Role of Costal Cartilage in Rib Cage Flexibility

Costal cartilage plays a vital role in the flexibility of the rib cage. This elastic tissue allows the rib cage to expand and contract during breathing, accommodating changes in lung volume. When this cartilage becomes inflamed or damaged, it can lead to conditions such as costochondritis or slipping rib syndrome, both of which can cause significant discomfort and back pain.

Costochondritis: A Common Cause of Chest Wall and Back Pain

Costochondritis is an inflammation of the cartilage that connects the ribs to the sternum. This condition can cause sharp, stabbing pain in the chest wall, which may radiate to the back, mimicking other more serious conditions such as heart attacks or lung problems.

Symptoms of Costochondritis

• Sharp, aching pain in the chest wall
• Pain that may worsen with deep breathing or coughing
• Tenderness when pressing on the affected area
• Pain that may radiate to the back or abdomen
• Increased pain with certain movements or positions

Can costochondritis be confused with other conditions? Yes, the symptoms of costochondritis can often be mistaken for those of more serious conditions, such as heart attacks or lung disorders. This is why it’s crucial to seek medical attention if you experience persistent chest pain.

Slipping Rib Syndrome: An Often Overlooked Cause of Back Pain

Slipping rib syndrome, also known as clicking rib syndrome or Tietze syndrome, is a condition where the lower ribs slip and move excessively. This can cause pain in the lower chest or upper abdomen, which may also radiate to the back.

Characteristics of Slipping Rib Syndrome

1. Pain typically affects the lower ribs, particularly the 8th, 9th, and 10th ribs
2. A clicking or popping sensation in the rib area
3. Pain that may worsen with certain movements or positions
4. Tenderness along the affected rib margins
5. Potential difficulty in breathing deeply

Why is slipping rib syndrome often misdiagnosed? The symptoms of slipping rib syndrome can mimic those of other conditions, such as gallbladder problems or abdominal disorders. This can lead to misdiagnosis and delayed treatment, highlighting the importance of a thorough examination by a healthcare professional.

Causes and Risk Factors for Rib-Related Back Pain

Both costochondritis and slipping rib syndrome can contribute to back pain, but what causes these conditions in the first place? While the exact causes are not always clear, several factors have been identified as potential contributors:

• Physical trauma or injury to the chest wall
• Repetitive strain from activities such as rowing or heavy lifting
• Respiratory infections or chronic coughing
• Certain inflammatory conditions, such as rheumatoid arthritis
• Poor posture or muscular imbalances
• Genetic predisposition to cartilage weakness

Are some people more at risk for developing these conditions? While anyone can develop costochondritis or slipping rib syndrome, certain factors may increase the risk. These include participation in contact sports, occupations involving repetitive upper body movements, and a history of respiratory conditions.

Diagnosing Rib-Related Back Pain: Challenges and Approaches

Diagnosing conditions like costochondritis and slipping rib syndrome can be challenging due to their similarity to other, more serious conditions. Healthcare providers typically use a combination of methods to reach a diagnosis:

Diagnostic Methods for Rib-Related Back Pain

1. Physical examination and medical history review
2. Palpation of the affected area to identify tender spots
3. Hooking maneuver test for slipping rib syndrome
4. Imaging studies such as X-rays or CT scans to rule out other conditions
5. In some cases, local anesthetic injection for diagnostic confirmation

How can patients help in the diagnostic process? Keeping a detailed record of symptoms, including when they occur, what triggers them, and what provides relief, can be invaluable in helping healthcare providers reach an accurate diagnosis.

Treatment Options for Costochondritis and Slipping Rib Syndrome

Once diagnosed, the treatment of rib-related back pain focuses on managing symptoms and addressing the underlying cause. Treatment approaches may include:

• Rest and activity modification to avoid aggravating movements
• Application of heat or cold therapy to the affected area
• Over-the-counter pain relievers and anti-inflammatory medications
• Physical therapy to improve posture and strengthen supporting muscles
• In some cases, corticosteroid injections for severe inflammation
• For slipping rib syndrome, manual manipulation techniques
• In rare cases, surgical intervention for persistent or severe cases

What role does physical therapy play in treating these conditions? Physical therapy can be crucial in managing rib-related back pain. Therapists can provide exercises to strengthen the muscles supporting the rib cage, improve posture, and teach techniques to manage pain and prevent recurrence.

Recovery Time and Long-Term Management of Rib-Related Back Pain

The recovery time for costochondritis and slipping rib syndrome can vary significantly depending on the severity of the condition and the individual’s response to treatment. In many cases, symptoms may improve within a few weeks with appropriate care. However, some individuals may experience persistent or recurring symptoms that require ongoing management.

Factors Affecting Recovery Time

1. Severity of the initial inflammation or displacement
2. Promptness of diagnosis and treatment initiation
3. Adherence to treatment recommendations
4. Individual factors such as age and overall health
5. Presence of underlying conditions or contributing factors

How can patients promote faster recovery? Patients can support their recovery by following their healthcare provider’s recommendations, maintaining good posture, avoiding activities that exacerbate symptoms, and engaging in prescribed exercises or physical therapy.

Preventing Recurrence and Managing Chronic Rib-Related Back Pain

While not all cases of costochondritis or slipping rib syndrome can be prevented, there are steps individuals can take to reduce their risk of recurrence or manage chronic symptoms:

• Maintain good posture during daily activities
• Practice proper lifting techniques to avoid strain on the rib cage
• Engage in regular, low-impact exercise to strengthen supporting muscles
• Avoid activities that consistently trigger symptoms
• Manage underlying conditions that may contribute to inflammation
• Use ergonomic equipment and techniques in the workplace
• Practice stress-reduction techniques to minimize muscle tension

Can lifestyle changes help in managing chronic rib-related back pain? Absolutely. Adopting a healthy lifestyle that includes regular exercise, proper nutrition, stress management, and good sleep habits can significantly improve the management of chronic rib-related back pain and overall well-being.

When to Seek Medical Attention for Rib-Related Back Pain

While many cases of rib-related back pain can be managed at home, there are situations where medical attention should be sought promptly:

Warning Signs Requiring Medical Evaluation

• Severe or worsening pain that doesn’t respond to over-the-counter treatments
• Difficulty breathing or shortness of breath
• Fever or signs of infection
• Pain that spreads to the arm, jaw, or neck
• Unexplained weight loss or fatigue accompanying the pain
• History of cancer or other serious medical conditions

Why is it important not to ignore persistent rib-related back pain? While conditions like costochondritis and slipping rib syndrome are generally benign, persistent pain could be a sign of a more serious underlying condition. Seeking medical evaluation can ensure proper diagnosis and treatment, potentially preventing complications or addressing more severe issues early on.

In conclusion, understanding the complexities of rib-related back pain, including conditions like costochondritis and slipping rib syndrome, is crucial for effective management and treatment. By recognizing the symptoms, seeking appropriate medical care, and following recommended treatment plans, individuals can effectively manage these conditions and improve their quality of life. Remember, while these conditions can be painful and disruptive, with proper care and attention, most people can find relief and return to their normal activities.

Back Pain and Slipped Rib

Key anatomical structures of the human body’s rib cage related to slipped rib are illustrated. Photo Source: 123RF.com.

If you’ve ever read up on back pain, you probably know that your lower back and your neck, which are very mobile, are much more prone to injury than your mid- and upper back (thoracic spine). But that doesn’t help you much when your upper back is a morass of pain.

But what if it wasn’t even your back? If not your back, then what? Could be a rib.

Slipping rib syndrome is a rare disorder known by several alternative names. If you’ve heard terms such as floating rib syndrome, lost rib syndrome, costal chondritis, or costochondritis, they each refer to slipping rib syndrome. In addition, slipping rib syndrome is often called Tietze syndrome, as German surgeon Alexander Tietze discovered the condition.

What Is Slipping Rib Syndrome?

Slipping rib syndrome is characterized by inflammation of the rib’s cartilage. The inflammation typically causes chest pain in the upper rib area. This benign condition usually affects people under 40 years of age, including some children.

The name “slipping rib syndrome” would seem unlikely to involve your spine. However, this condition can cause severe back pain in your thoracic spine. You feel the pain when one of your ribs shifts out of normal position. For some patients, chest wall pain is their first introduction to slipping rib syndrome.

Anatomy of Slipping Rib Syndrome

To learn about the workings of any medical condition, a quick review of the related anatomy is useful. To understand how slipping rib syndrome develops, an explanation of your body’s rib structures is a good starting point.

First, everyone has 12 pairs of ribs, with one set on each side of your body. Starting at the top, the first set of ribs attaches to the first thoracic vertebra (referred to as T1). The remaining ribs make attachments down to the T11 vertebra. Costovertebral ligaments attach the ribs to the thoracic vertebrae.

The first seven rib sets are connected to the thoracic vertebrae in your back and the sternum (or breastbone). In the front of the rib cage, and between the ribs, are the costochondral joints and costal cartilage. These ribs are referred to as true ribs.

The costal cartilage has considerable elasticity, allowing for expansion of the rib cage. When you take a deep breath, for example, the cartilage allows your rib cage to expand to accommodate the extra volume of air.

False Ribs and Floating Ribs

The remaining five ribs are “false ribs.” This unusual term results from the fact that ribs 8-10 are not actually connected to the sternum. Instead, these ribs are connected by a fibrocartilaginous band from the rib above.

The last two ribs have no connection at the front of the body. For this reason, these ribs are sometimes called floating ribs. Because these lower ribs are not completely connected, they are most often involved in slipping rib syndrome.

The thoracic spine’s facet joints are another relevant anatomical feature. Your body contains 24 of these facet joints (12 on either side at the back of each thoracic vertebrae). When a rib slips at T10 or T11, there is an opportunity for facet joint involvement. If this occurs, you can experience considerable pain.

Slipping Rib Syndrome: Causes and Risk Factors

Slipping rib syndrome has several possible causes, but no definitive source has been established. Certain individuals may have an inherited risk for this condition.

In addition, researchers have stated their belief that slipping rib syndrome results from small rib injuries. Following are several potential sources of injury:

• Traumatic rib cage injury (from an auto accident or a fall)

• Fall or collision during contact sports

• Repetitive or demanding physical activities

• Upper respiratory tract infections, including sinusitis or laryngitis

• Respiratory conditions such as asthma or bronchitis

• Excessive or violent coughing episodes

• Severe vomiting episodes

Symptoms of Slipping Rib Syndrome

Back pain is a common slipping rib syndrome symptom. The back pain results from abnormal rib movement, which irritates surrounding nerves and muscles. In turn, this triggers inflammation and subsequent pain.

Characteristics of the Inflammation

Pain in the specific area results from inflammation of the affected rib’s cartilage. The inflammation can lead to swelling that can become hard and spindle-shaped. The area may look red or swollen, and it may feel warm and tender.

Patients with slipping rib syndrome also report these symptoms:

• Initially intense abdominal pain (eventually subsides to an ache)

• A “clicking” or “popping” sensation in the rib cage area

• Difficulty breathing or coughing

• Pain with bending or other activities that move the rib cage

Slipping Rib Syndrome: Potential Complications

Some slipping rib syndrome patients may experience severe pain, making it challenging to perform their daily activities. For example, wearing a bra or turning over in bed can lead to excruciating pain. Breathing difficulties are another potential complication.

If a patient receives an injection during a treatment procedure, an injury could cause a pneumothorax. This term refers to a partially or completely collapsed lung. This can result from an air leakage into the space between the lung and chest wall.

Major Complications Are Uncommon

Salman Zaheer, MBBS, a cardiothoracic surgeon at Loma Linda University Health, states that slipping rib syndrome alone does not produce major complications. In addition, the condition does not cause damage to internal organs.

When to See Your Doctor

Slipping rib syndrome symptoms can be uncomfortable and painful. They can also be life threatening.

If you have difficulty breathing, or you are experiencing chest pain, this may indicate a serious medical emergency. Seek immediate medical care, including emergency room treatment if necessary.

If your pain shows no signs of subsiding, and/or if symptoms are interfering with your ability to perform daily tasks, see your doctor as soon as possible. By getting a proper diagnosis and treatment, you’ll be on the path to pain relief.

Getting a Slipping Rib Syndrome Diagnosis

Slipping rib syndrome’s symptoms mimic those of many other medical conditions. This makes it difficult to make an accurate diagnosis. To begin the process, your doctor or spine specialist will carefully review your medical history.

Next, the physician will ask you to describe your symptoms and note their severity and duration. Your doctor will also want to know what worsens or eases these symptoms.

Diagnostic Tests

Because so many other conditions have similar symptoms, the doctor may order tests that will help to eliminate potentially serious causes. These tests may include:

• Blood tests (to detect signs of a heart attack or other conditions)

• Bone scan (to check your bone health and for the presence of osteoporosis or osteopenia)

• Chest MRI (to more closely review cartilage abnormalities)

• Chest X-ray (to rule out broke ribs or other fractures)

• Electrocardiogram (or EKG) (to evaluate heart function)

• Ultrasound imaging (to look for rib cartilage inflammation)

Physical Examination

Your doctor will conduct a targeted physical examination, which will reveal whether a rib is not properly positioned compared to your other ribs. If your doctor finds a rib out of alignment, he or she may perform the “hooking” or “hook” maneuver. Here, the doctor gently moves the misaligned rib to determine if the movement causes pain. They will also listen for a clicking sound.

Next, your doctor may order imaging tests. The test results may enable the physician to rule out other conditions. In certain cases, the hooking maneuver may be sufficient to confirm a slipping rib syndrome diagnosis.

Slipped Rib Syndrome Differential Diagnosis

Varied medical conditions have similar signs or symptoms. Making a differential diagnosis refers to the process of differentiating between multiple conditions that feel largely the same to the patient. Slipping rib syndrome’s differential diagnosis includes these medical conditions:

• Appendicitis

• Asthma

• Bone metastases

• Bronchitis

• Cholecystitis

• Esophagitis

• Gastric ulcer disease

• Heart conditions

• Muscle tears

• Myocardial infarction (heart attack)

• Pancreatitis

• Pleuritic chest pain

• Pulmonary embolism

• Stress fractures

A Thoracic Surgeon’s Perspective

Dr. Zaheer states that slipping rib syndrome presents with lower chest and/or upper abdominal pain. The differential diagnosis for this symptom is extensive. Potential cardiovascular system causes are of major significance.

Your doctor will go down a list much like the one above (which is non-exhaustive), checking off what conditions aren’t causing your symptoms, one by one. Then, slipping rib syndrome is usually a diagnosis of exclusion—the last condition standing.

Treatment Regimen

To resolve your slipping rib syndrome symptoms, your physician may use a combination of treatments. Each therapy is designed to address a different component of the condition.

Nonsurgical Treatments for Slipping Rib Syndrome

If your slipping rib syndrome is considered mild or moderate, conservative treatment may be sufficient to relieve pain. Your doctor may recommend one or more of these nonsurgical treatments:

• Rest

• Cold and heat therapy

• Avoidance of strenuous activities

• Gentle stretches and rotation exercises

• Rib stabilization with a chest binder

To complement the above therapies, your physician may prescribe the following pain relief measures:

• Epidural corticosteroid injection or intercostal nerve block (to relieve inflammation and pain)

• Botulinum toxin therapy (or Botox) (to relieve muscle pain)

• Prolotherapy (to strengthen weak ligaments)

• Ultrasound therapy (to reduce muscle inflammation)

• Massage (to work out any muscle spasms)

Medication Management

Your physician may recommend medication that will help to relieve pain and inflammation. If you are experiencing mild pain, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may provide relief. Commonly used NSAIDs include:

• Aspirin

• Ibuprofen (Advil or Motrin)

• Naproxen (Aleve or Naprosyn)

Physical Therapy and Exercise

Maybe you currently have slipping rib syndrome, and you want to exercise to maintain your fitness level. Know that many types of exercises can worsen your symptoms and sabotage the healing process. If you overdo your workouts, you may develop a chronic problem that requires pain injections or surgery to resolve.

Exercises to Avoid

Avoid exercises that place direct pressure on your chest. In addition, avoid exercises that involve throwing or pitching motions (such as pushups or throwing a baseball or softball). Until you are completely healed, stay away from sports in which you are likely to contact other athletes (such as basketball or football).

Suggested Exercises

During your recovery, your physician may recommend specific types of gentle exercise. Obtain his or her approval before engaging in any exercise program. Working with a physical therapist may also be beneficial.

Early-Stage Exercises

At the beginning, you’ll need to take it slow—very slow. Your physical therapist or recovery specialist can show you some breathing exercises, which is about as vigorous as you’ll want to go at first. Focus on segmental breathing, which will help to provide you with more rib mobility.

Expansion Exercises

To further improve your rib joint mobility, engage in thoracic extension and flexion exercises. Seated rotation exercises may also be useful. A physical therapist can also guide you through these exercises.

Surgery for Slipping Rib Syndrome

If you are experiencing severe chest wall and mid-back pain, and it has not responded to nonsurgical treatments, slipping rib syndrome surgery may help. The medical name for this procedure is costal cartilage resection or excision, which Dr. Zaheer says can be very effective.

During the procedure, the surgeon will remove the slipped rib and the connecting costal cartilage. Afterward, the surgeon will advise you if follow-up treatment is necessary.

Slipping Rib Syndrome Patient Outlook

Slipping rib syndrome patients’ outlooks can vary. In some cases, the condition may gradually resolve on its own without any treatment. Other patients achieve complete pain relief with one or more therapies. For certain patients, slipping rib syndrome discomfort can evolve into chronic pain.

In especially severe cases, patients may achieve permanent relief with a single intercostal nerve block. Surgery may be an option for debilitating or persistent pain.

Fortunately, slipping rib syndrome does not lead to long-term damage. In addition, the condition does not appear to negatively affect internal organs.

Life with Slipping Rib Syndrome

Slipping rib syndrome affects each patient differently. Some people may be impacted more than others, and each person will experience their own healing journey.

One subgroup may be especially prone to slipping rib syndrome and its varying levels of severity. In Dr. Zaheer’s experience, slipping rib syndrome mostly occurs in athletes and people involved in vigorous physical activity.

“This condition results in significant pain and sometimes the sensation of ‘clicking’ at the injury site. This can make the person unable to perform at the same level as before. In the worst cases, the person is not able to perform at all,” he explains.

Minimizing Slipping Rib Syndrome Pain

Dr. Zaheer recommends several strategies that will help to minimize slipping rib syndrome pain. Because healing may take time, the patient should implement this approach under the direction of their physician.

• Physical therapy

• Reduction of the displaced rib (via at-home maneuvers)

• Avoidance of rigorous activity (can take up to three months)

• Analgesics (particularly NSAIDs)

A Timely Diagnosis is Important

As with other medical conditions, quickly getting an accurate diagnosis plays a key role in your treatment program’s success. If you are experiencing severe middle back or chest pain, see your personal physician or spine specialist without delay. Varied treatments and therapies can help with pain relief, enabling you to enjoy a better quality of life.

Notes: This article was originally published February 15, 2018 and most recently updated January 21, 2022.

• Gray H. Gray’s Anatomy. 15th Ed. Pick TP, Howden R eds. Barnes & Noble Books, Inc., New York, NY.
• van Delft EA, van Pul KM, Bloemers W. The slipping rib syndrome: A case report. International Journal of Surgery Case Reports. 2016;23:23-24. https://www.sciencedirect.com/science/article/pii/S2210261216300670 Last accessed January 9, 2020.
• Knaap S. Tietze Syndrome. National Organization for Rare Disorders (NORD). https://rarediseases.org/rare-diseases/tietze-syndrome/. Last accessed January 9, 2020.
• University of California San Francisco. (n.d.) “Slipping Rib Syndrome.” https://www.ucsfhealth.org/medical-tests/slipping-rib-syndrome
• Physiopedia. (n.d.) “Slipping Rib Syndrome.” https://www.physio-pedia.com/Slipping_Rib_Syndrome
• Mayo Clinic. (n.d.) “Pneumothorax.” https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367.
• Mobile Physiotherapy Clinic. (n.d.) “Slipping Rib Syndrome and Physiotherapy Management.” https://mobilephysiotherapyclinic.in/slipping-rib-syndrome-and-physiotherapy-management/

Our Review Process

Pain Around Ribs and Back Symptoms

In this article we describe all the possible causes of pain around the ribs and back symptoms and the most effective ways to treat it.

Our body has been designed to perform several important functions. There are vital functions such as protection of the vital organs, repairing and healing the worn-out cells and other body parts, storage of compounds only to be utilized later, and excretion of the toxic and harmful substances so that they do not harm the body. 

At the end of the day, all functions serve to protect our body and keep it in its optimal shape and condition. However, sometimes, due to malfunctions or diseases, the body becomes compromised and is unable to work as effectively as it normally did. 

Body aches and pains are one such unwelcome and uncomfortable condition that can greatly impact the working and functioning of an otherwise healthy and happy human being. 

While body pain may vary from person to person, when we speak generally, backache is undoubtedly one of those body pains that affect almost every other person at least more than once in their lifetime. The most common cause of backache is a poor sitting or sleeping posture. If left untreated, this pain can easily assume a chronic pain condition in your body. [1]

This characteristic pain may affect any part of the back, with the lower back being the most affected region. However, the middle or upper back may be involved just as commonly. In the case of the upper-middle back, the rib cage and chest area also get involved, leading to chest pain later in the course of the pain.  

The Relation Between The Ribs And Upper-Middle Back Region

It is essential to realize the relation between the rib cage and the back muscles if we need to dive deeper into the mechanism of pain occurring between these two regions. 

Contrary to popular belief, both these regions are not just connected by pain but also through muscles. The intercostal muscles, or the ‘intercostals,’ are sets of muscles between two adjacent ribs in the ‘intercostal’ spaces. These muscles work to set up the chest wall and also help connect the ribs. [2]

Therefore, all the pain that occurs in the upper back area or around the rib cage itself is due to problems within the intercostal muscles. 

Common Causes Of Pain Around The Ribs And Back Symptoms

There could be several underlying causes that lead to the development of pain around the ribs and back. It is important to rule out all the possible causes before beginning any treatment because, in some cases, the underlying cause could be a life-threatening one for the affected person, so medical attention could be needed.  

The common causes of back and rib cage pain include: 

Costochondritis

Costochondritis, also known as ‘Tietze’s Syndrome,’ is a condition that occurs due to the inflammation of the cartilage that is holding the ribs together. [3]

Since this type of inflammation causes unexpected, sharp pain, the affected people often visit the emergency room (ER) as soon as possible, for they mistake it to be something related to the heart, most commonly a heart attack. 

The pain usually makes the affected person develop difficulty breathing, usually when deep breaths are involved, experiencing the characteristic ‘stabbing’ sensation. [4]

Costochondritis is a common condition that affects people in their middle ages. However, it is still recommended for the people suffering from this disease to get their cardiac workup done, for it is always better to be safe than sorry, especially in patients who already have a history of cardiovascular diseases. 

Warm compresses and over-the-counter pain relief anti-inflammatory medications (Ibuprofen, Naproxen) usually help resolve the pain in no time. [5]

COVID19

As surprising as it may sound, COVID19 has also been responsible for some rib and back pain cases. However, the pain occurring in and around the breast bone region could have various reasons while remaining in the context of COVID19. 

Some people experience this pain due to the coughing episodes that are a part of the COVID19 symptoms, whereas some develop it as part of the COVID19 infection itself due to the shortness of breath and chest pain that is both, again, considered to be a part of COVID19 symptoms. [6]

Muscle Strain as a cause of pain around the ribs and back symptoms

Just like every other body muscle, the intercostal muscles can get strained too. Now, this condition could occur due to numerous causes. But, usually, it happens when a person suddenly lifts a very heavy weight or performs a strenuous physical activity that they usually do not perform. [7]

It could also occur due to any muscle tears or injury to the intercostals, which have other primary causes leading to the development of pain in this region.  

The pain that occurs due to intercostal muscle strain also has a sharp and severe intensity and sometimes can cause stiffness in the entire back and ribs. 

The treatment of this muscle strain is the same as that for any other musculoskeletal pain. It involves taking the appropriate painkillers. In the majority of the cases, NSAIDs are enough. For people with persistent pain, physical therapy may also be recommended. [8]

Lung Conditions

Apart from the usual muscle and ligament tears and sprains, several other serious conditions and pathologies might also simultaneously contribute to developing back and chest pain. 

Here, it is important to mention that lung-related conditions are one of the prevalent causes of pain in this region. Pathologies such as pulmonary embolism, pleurisy, and lung cancer contribute to the development of rib pain. [9]

For this pain category, it is important to seek medical advice and get the primary condition or the underlying cause treated first.  

Surgery, chemotherapy, or radiotherapy follow the treatment of choice for this back rib pain. 

Visceral (Referred) Pain: 

Sometimes, pain around the shoulder or upper-mid back area can also be present for unexpected reasons. Some of the popular medical conditions that cause this type of pain include cholelithiasis (stones in the gallbladder) or pancreatitis. [10]

In both these conditions, the pain gets referred from the point of origin to the back area, either between the shoulder blades or all the way around the ribs. This pain is also sharp and stabbing in nature, causing difficulty breathing to develop and only gets relieved if the patient makes an effort to bend forward. 

The treatment plan for either of these conditions is the same as that involving lung conditions – the underlying cause needs to be treated first. 

How Is Pain Around The Ribs And Back and Back Symptoms Diagnosed? 

Diagnosis of pain conditions involving the ribs and back area could be quite tricky. The reason for this uncertainty is the proximity of the heart to this region. With any painful situation that arises over here, a heart attack or other angina-related pain is usually the first suspicion for anyone. 

Visiting a doctor should be your first resort. A doctor will take a detailed history and perform a proper physical examination to help rule out any visible or possible causes of rib and back pain. 

Along with that, in all such cases, it is best to get an X-ray done. It will help visualize all the inner details from a broken bone to any muscle-related problem (by showing that every other structure is intact) that will ultimately lead to a doctor leading their list of exclusions in the case. [11]

Conditions such as a broken rib, a blood clot due to pulmonary embolism, COVID19, and bruised ribs might all become life-threatening in the long run. They might also start compromising the health and vitality of the other structures around them, which might turn into a complicated series of events out of nowhere.  

The treatment for all back and rib pain cases can be effectively treated with over-the-counter painkillers, analgesic or anti-inflammatory balms, or physiotherapy for chronic pain. The earlier the condition gets diagnosed, the better it is for it to get evaluated and treated. 

Summary of pain around ribs and back symptoms

A common scenario is a condition that causes pain to develop around the rib cage or back area. Even though it might be nothing serious to worry about, it is best if people get it evaluated as soon as it starts, for in some cases, it might also turn out to be an alarm for a possible medical emergency – a heart attack might just be around the corner, and you will have no idea! 

The diagnosis and treatment of rib and back pain are simple and easy to follow. Therefore, many people experience the resolution of their symptoms in no time when they opt for rapid treatment.

Frequently Asked Questions 

1. Does COVID19 Cause Your Ribs To Hurt?

The COVID19 infection can indeed cause the ribs to hurt. Sometimes, it is due to the cough that accompanies the infection; sometimes, it is due to the chest pain that leads you to develop shortness of breath during the infection – so yes, it is completely normal to experience rib pain during COVID19. 

1. When Should I Be Concerned About Rib Pain?

Rib pain is usually serious when it does not resolve after taking a strong painkiller. Apart from this, if you develop difficulty breathing while moving in a particular direction or while sneezing or taking deep breaths, you need to visit a doctor right away as it might be something serious that is causing these muscle strains.  

1. Does Pancreatitis Cause Rib Pain?

Yes, pancreatitis can lead some patients to develop visceral or ‘referred’ pain between their shoulder blades and around the rib cage. This referred pain usually occurs in cases of chronic pancreatitis because the patients find their relief in bending forward and so do not consult their doctor for definitive treatment.  

1. Is Costochondritis A Symptom Of COVID19?

Costochondritis was found to occur in patients who were severely attacked with COVID19 infection. In other mild to moderate cases, costochondritis usually does not take place. 

1. What Causes Rib Pain Without Injury?

Several medical conditions can cause rib pain without any significant injury. Pulmonary embolism, pleurisy, lung cancer, pancreatitis, and gallstones are some possible causes of the rib pain. 

References 

1. Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/
2. Tang A, Bordoni B. Anatomy, Thorax, Muscles. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www. ncbi.nlm.nih.gov/books/NBK538321/
3. Schumann JA, Sood T, Parente JJ. Costochondritis. [Updated 2021 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532931/
4. Proulx, A. M., & Zryd, T. W. (2009). Costochondritis: diagnosis and treatment. American family physician, 80(6), 617-620.
5. Mott, T., Jones, G., & Roman, K. (2021). Costochondritis: Rapid Evidence Review. American Family Physician, 104(1), 73-78.
6. Kucuk, A., Cumhur Cure, M., & Cure, E. (2020). Can COVID-19 cause myalgia with a completely different mechanism? A hypothesis. Clinical rheumatology, 39(7), 2103-2104.
7. Ayloo, A., Cvengros, T., & Marella, S. (2013). Evaluation and treatment of musculoskeletal chest pain. Primary Care: Clinics in Office Practice, 40(4), 863-887.
8. Fabricant, L., Ham, B. , Mullins, R., & Mayberry, J. (2013). Prolonged pain and disability are common after rib fractures. The American Journal of Surgery, 205(5), 511-516.
9. Jany, B. (2017). Pulmonary causes of chest pain. Der Internist, 58(1), 22-28.
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costochondritis: symptoms, causes, dangers and treatment

Introduction

Costochondritis is an inflammation of the costal cartilages that causes chest pain. In particular, the bone-sternal joints (where the ribs connect to the sternum) are susceptible to inflammation.

Also called osteosternal syndrome or costal chondritis, the main causes can be:

• chest trauma,
• excessive physical effort,
• infections,
• rheumatological diseases (ankylosing spondylitis, rheumatoid arthritis, …),
• certain types of cancer,
• fibromyalgia.

The most common symptoms of costochondritis are:

• chest pain, widespread or localized, aggravated by movement or pressure on the chest,
• pain radiating to the back or abdomen leading to pain in the back and abdomen,
• functional restriction of the chest in movements,
• constant feeling of tension.

If you experience chest pain, seek immediate medical attention to rule out the possibility of a heart attack; after ruling out heart problems or other serious pathologies (such as pulmonary embolism or pleurisy), using the history, physical examination, and some instrumental tests, the diagnosis of costochondritis can be made by exclusion.

Given that in most cases costochondritis resolves spontaneously within a few days, symptomatic treatment is based on rest and the use of anti-inflammatory and analgesic drugs.

The condition responds positively to physical therapy and some physical rehabilitation procedures (such as TENS and others).

Causes

This problem mainly affects women and adolescents, although anyone at any age can suffer from costochondritis; a large percentage of people suffer from costochondritis without a specific cause (idiopathic), while known precipitating factors include:

• Chest injury: any kind of injury to the ribs and sternum can be a precursor to costochondritis. The most common traumatic events are sports injuries (eg, football, rugby, American football, hockey, combat sports), physical assault, and car accidents.
• Excessive exercise: this refers to excessive sports activity in untrained subjects, lifting excessive weights, only in rare cases chronic and continuous cough.
• Infections: may be bacterial, viral or fungal, including:
  • syphilis,
  • tuberculosis,
  • aspergillosis,
  • candidiasis,
  • Staphylococcus aureus,
  • viral respiratory infections
• Rheumatological diseases, such as:
  • Ankylosing spondylitis,
  • Rheumatoid arthritis,
  • osteoarthritis
  • and various forms of arthritis (juvenile idiopathic arthritis, Reiter’s arthritis, psoriatic arthritis)
• Tumors: Several types of tumors can cause costochondritis, including:
  • lung cancer,
  • breast cancer,
  • bone metastases
• Fibromyalgia: a chronic disease of still unknown cause characterized by chronic muscle pain that is difficult to relieve, as well as stiffness and functional impotence. It often presents with pain at specific points, called trigger points, which are also present in the chest.

Symptoms

The main symptom of costochondritis is chest pain, which has several characteristics:

• It may be diffuse throughout the chest or localized at certain points at the level of the sternum or more laterally at the level of the ribs.
• Tends to be aggravated by chest movements (including coughing) or pressure on certain points.
• Tends to radiate to the back and abdomen, resulting in back and abdominal pain.
• May have a limited duration or remain fixed for some time.

May be associated with other symptoms such as

• constant feeling of muscle tension in the chest,
• functional limitation of certain chest movements.

Diagnosis

If you experience chest pain, it is recommended that you seek immediate medical attention to rule out the possibility of a heart attack.

After ruling out more serious problems such as heart problems, the diagnosis can be made on the basis of

• history,
• physical examination,
• instrumental examination.

Anamnesis consists in the fact that the doctor formulates a series of questions in order to study and reconstruct the patient’s entire medical history. In this case, it is important to understand:

• when the pain occurred and what characteristics it has,
• if it could be due to injury or overexertion,
• whether it is aggravated by movement or pressure on certain trigger points.

At the end of this phase, the doctor is often already able to suspect possible costochondritis, but an objective examination can recognize all the symptoms reported by the patient and objective clinical signs, excluding, in particular, the presence of swelling at the level of the costal cartilage, characteristic of Tietze’s syndrome.

From an instrumental point of view, the following can be done:

These examinations are important to exclude

• heart or lung disease,
• rib fractures.

Costochondritis is not recognized on any instrumental examination, requiring a clinical (ie, symptom-based) diagnosis of exclusion.

Differential diagnosis

Costochondritis is included in the differential diagnosis with a number of other pathologies, the most important of which are:

• Rib fracture : in this case there is actual bone damage; in history – a serious injury to the chest, the pain is very intense and prolonged. In older people, due to osteoporosis, it can occur without noticeable chest trauma.
• Myocardial infarction : The pain is intense (less pronounced in diabetic neuropathy) and radiates to the shoulder and left arm. Before thinking about costochondritis, myocardial infarction must always be ruled out.
• Tietze’s Syndrome: This is a benign pain syndrome, manifested by chest pain localized in the region of the first 4-5 ribs. It is now recognized as a severe form of chronic costochondritis. A significant distinguishing factor from costochondritis is the presence of swelling and edema of the articular cartilage, which are absent in costochondritis, as well as the localization of pain:
  • Costochondritis usually affects the third, fourth and fifth costosternal joints,
  • Tietze’s syndrome usually affects the second or third costosternal joint.

In most cases, costochondritis resolves spontaneously within a few days.

Medical therapy is therefore symptomatic, i.e. associated with the elimination of symptoms, and is based on:

• absolute rest for several days,
• use of anti-inflammatory drugs (such as NSAIDs) and pain relievers (traditional such as paracetamol or opioid-derived for more severe pain),
• physical therapy and physical rehabilitation procedures such as TENS. The latter is a modern method used in pain therapy, which is especially effective in the treatment of chronic pain in the musculoskeletal system. It is based on the use of small electrical discharges that stimulate the nerves through the skin, reducing the sensation of pain;
• antibiotics for costochondritis secondary to bacterial infection.

Patients complaining of persistent discomfort not responding to traditional oral medications can be treated with cortisone infiltration (mesotherapy).

Natural remedies

Since pain can be aggravated by any activity that puts some strain on the chest area (physical activity, extensor movements to lift an object, sleeping pressure on the abdomen, …), it is in the patient’s interest to avoid any activity that may cause pain.

Some patients find it helpful to apply hot water (to relax the muscles) or cold water (to reduce inflammation) to painful areas.

Costochondritis: symptoms, causes, risk factors and treatment

Photo: pixabay com

Costochondritis is also known as costosternal chondrodynia, costosternal syndrome, or chest wall pain syndrome. This is a condition associated with inflammation/swelling of the cartilage that connects the rib to the sternum or sternum. However, the inflammation is accompanied by a sharp pain in the left half of the sternum, which radiates to the shoulder and arm.

Because the pain of costochondritis is in the chest area, you may mistake it for a heart attack.

The condition is harmless and usually resolves without any treatment. But for severe pain, the treatment strategy is symptomatic and based on pain relief.

Symptoms of costochondritis

• Chest pain associated with costochondritis usually occurs after exercise, injury or respiratory infections.
• Sharp pain in the chest, usually on the left, at the junction of the ribs with the sternum.
• Pain when coughing or taking a deep breath.
• Pain on pressure on costal joints.
• If costochondritis is due to a postoperative infection, there will be redness, swelling, and purulent discharge at the surgical site.
• Your doctor will examine you for tenderness or swelling along your breastbone. He/she may ask you to move your arms or chest in a certain way to cause costochondritic pain.

There are no specific or confirmatory laboratory or imaging tests for costochondritis. But to rule out other serious chest, lung, and airway conditions, your doctor may order certain tests, such as a chest x-ray and an echocardiogram (ECG).

If you have had a history of chest surgery or are at risk for heart disease, your doctor may recommend testing to determine if infection at the surgery site is causing the pain. They will search:

• Redness, swelling and purulent discharge at the surgical site.
• Check white blood cells (white blood cell count) to confirm infection.
• Recommend chest scan with gallium.
• Recommend a chest x-ray to rule out pneumonia.

Causes of costochondritis

While the exact causes of costochondritis are unknown, the following conditions can cause costochondritis pain:

• Vigorous arm exercise
• Repeated or multiple minor chest injuries
• Arthritis. Costochondritis may be the initial sign of arthritis, rheumatoid arthritis, or ankylosing spondylitis.
• A tumor that has moved from the joints and settled in the chest.
• Virus-mediated respiratory infections.
• Upper chest wall surgery

Risk factors for costochondritis

Chest pain associated with costochondritis is commonly seen in children and adolescents. About 10-30% of chest pain in children is caused by costochondritis. It can be seen that 12-14 years is the peak age for this condition.

Women over 40 are also more prone to costochondritis.

Treatment of costochondritis

It is important to see a doctor if you experience chest pain. In order to find the optimal treatment, it is necessary to make the correct diagnosis.

Your doctor may first prescribe over-the-counter (OTC) medicines to relieve chest pain and swelling. These medications include NSAIDs such as ibuprofen, naproxen, and acetaminophen.

If NSAIDs are not sufficient to relieve pain, local anesthesia and steroid injection at the site of pain may be given.
For extremely unbearable pain, drugs such as hydrocodone or oxycodone can help.

If these medicines do not help with pain, your doctor may give you an injection of corticosteroids at the site of pain.
Other drugs such as the tricyclic antidepressants amitriptyline and antiepileptic drugs such as gabapentin may also help treat costochondritis pain. However, they also have other side effects.

Infectious costochondritis is treated with intravenous antibiotics.

Home remedies for costochondritis

Once you’ve been diagnosed with costochondritis by your doctor, you can also manage costochondritis-related chest pain at home:

• Taking over-the-counter painkillers.
• Get enough sleep and rest your arms and ribs.
• Avoid excessive exercise and heavy lifting.
• Apply an ice pack to your chest at the site of pain.
• Apply a heating pad to the area of ​​chest pain.
• Chest pain is a scary symptom. If you have severe chest pain, then you should see a doctor to find out the cause.

There is no need to panic if it is costochondritis. Costochondritis is swelling of the cartilage and is usually a short term condition. There are various treatment options for pain relief.

Frequently asked questions

What are the symptoms of costochondritis?
The main symptom of costochondritis is a sharp pain that starts on the left side of the chest and radiates to the rest of the chest.