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Rib sternum pain: Costochondritis – Symptoms and causes

Causes and when to see a doctor

Sternum pain is pain or discomfort in the area of the chest that contains the sternum and the cartilage connecting it to the ribs. The sternum is located near the heart, so many people experiencing sternum pain may confuse it with more general chest pain.

Some people experiencing sternum pain worry they may be having a heart attack. However, in most cases, sternum pain is unrelated to the heart and caused primarily due to problems with the sternum itself or the nearby cartilage.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

The sternum is sometimes known as the breastbone. This flat bone sits at the front of the chest and connects to the ribs with cartilage.

The sternum is part of the rib cage, a series of bones that protects the heart and lungs from injuries.

Share on PinterestThe sternum is located at the front of the chest and is connected to the ribs.

Sternum pain is usually caused by problems with the muscles and bones near the sternum and not the sternum itself.

Pain felt just behind or below the sternum is called substernal pain and is sometimes caused by gastrointestinal problems.

Some of the most common causes of sternum and substernal pain are:

Costochondritis

Costochondritis is the most common cause of sternum pain and occurs when the cartilage between the sternum and ribs becomes inflamed and irritated.

Costochondritis can sometimes occur as the result of osteoarthritis but may also happen for no apparent reason.

The symptoms of costochondritis include:

  • sharp pain on the side of the sternum area
  • pain that worsens with a deep breath or a cough
  • discomfort in the ribs

Costochondritis is usually not a cause for concern. However, people experiencing symptoms of costochondritis may want to consult a doctor if their symptoms worsen or do not go away.

Sternoclavicular joint injury

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

  • mild pain or swelling in the upper chest area
  • difficulty or pain when moving the shoulder
  • popping or clicking around the joint

Collarbone injuries

Share on PinterestCollarbone injuries may lead to long-lasting pain or limited movement in the shoulder and upper chest.

While the collarbone itself is not part of the sternum, it is connected to the sternum by cartilage. Injuries to the collarbone may cause pain in the sternum area.

Collarbone injuries are often the result of trauma, such as a car accident or sports injury, although infections or arthritis can also cause them.

Symptoms of a collarbone injury include:

  • severe pain when raising the arm
  • bruising or swelling in the upper chest area
  • abnormal positioning or sagging of the shoulder
  • clicking and grinding in the shoulder joint

Hernia

Hernias may not be an obvious cause of pain near the chest. However, a hiatal hernia may cause substernal pain.

A hiatal hernia happens when the stomach moves out of its normal position up past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

  • frequent burping
  • heartburn
  • vomiting blood
  • a feeling of fullness
  • trouble swallowing

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Sternum fracture

Like a fracture in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention, as the heart and lungs may also be injured.

Symptoms of a sternum fracture include:

  • pain during inhaling or coughing
  • swelling over the sternum
  • difficulty breathing

Acid reflux or GERD

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest and is generally accompanied by a burning feeling.

Pain in this region can also be caused by inflammation or a spasm of the windpipe. People with GERD should talk to their doctor about how to prevent further damage to this area.

Muscular strain or bruise

The sternum and ribs have many muscles attached to them. These muscles can be pulled or strained by severe coughing or strenuous activity involving the arms or torso.

Injuries or trauma can result in bruising to these muscles, which may cause them to ache.

Share on PinterestSternum pain is usually caused by muscles or bones surrounding the sternum.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.

Other associated symptoms may include:

  • pain or discomfort in the ribs
  • pain that worsens during deep breathing or coughing
  • mild, aching pain in the upper chest
  • swelling in the upper chest
  • stiffness in the shoulder joints
  • severe pain when raising the arms
  • signs of collarbone trauma, such as bruising or swelling
  • difficulty breathing
  • grinding or popping sensation in joints near the sternum
  • frequent belching
  • heartburn
  • feeling too full
  • throwing up blood

Sternum pain vs.

heart attack

People experiencing any kind of chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain.

People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.

A heart attack also occurs with the following symptoms:

  • pressure, squeezing, or fullness in the center of the chest
  • sweating
  • nausea
  • shortness of breath
  • lightheadedness

However, anyone who thinks they are having a heart attack should seek immediate medical attention.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

  • started as a result of direct trauma
  • is accompanied by heart attack symptoms
  • is persistent and does not improve over time
  • is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Read the article in Spanish.

Causes and when to see a doctor

Sternum pain is pain or discomfort in the area of the chest that contains the sternum and the cartilage connecting it to the ribs. The sternum is located near the heart, so many people experiencing sternum pain may confuse it with more general chest pain.

Some people experiencing sternum pain worry they may be having a heart attack. However, in most cases, sternum pain is unrelated to the heart and caused primarily due to problems with the sternum itself or the nearby cartilage.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

The sternum is sometimes known as the breastbone. This flat bone sits at the front of the chest and connects to the ribs with cartilage.

The sternum is part of the rib cage, a series of bones that protects the heart and lungs from injuries.

Share on PinterestThe sternum is located at the front of the chest and is connected to the ribs.

Sternum pain is usually caused by problems with the muscles and bones near the sternum and not the sternum itself.

Pain felt just behind or below the sternum is called substernal pain and is sometimes caused by gastrointestinal problems.

Some of the most common causes of sternum and substernal pain are:

Costochondritis

Costochondritis is the most common cause of sternum pain and occurs when the cartilage between the sternum and ribs becomes inflamed and irritated.

Costochondritis can sometimes occur as the result of osteoarthritis but may also happen for no apparent reason.

The symptoms of costochondritis include:

  • sharp pain on the side of the sternum area
  • pain that worsens with a deep breath or a cough
  • discomfort in the ribs

Costochondritis is usually not a cause for concern. However, people experiencing symptoms of costochondritis may want to consult a doctor if their symptoms worsen or do not go away.

Sternoclavicular joint injury

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

  • mild pain or swelling in the upper chest area
  • difficulty or pain when moving the shoulder
  • popping or clicking around the joint

Collarbone injuries

Share on PinterestCollarbone injuries may lead to long-lasting pain or limited movement in the shoulder and upper chest.

While the collarbone itself is not part of the sternum, it is connected to the sternum by cartilage. Injuries to the collarbone may cause pain in the sternum area.

Collarbone injuries are often the result of trauma, such as a car accident or sports injury, although infections or arthritis can also cause them.

Symptoms of a collarbone injury include:

  • severe pain when raising the arm
  • bruising or swelling in the upper chest area
  • abnormal positioning or sagging of the shoulder
  • clicking and grinding in the shoulder joint

Hernia

Hernias may not be an obvious cause of pain near the chest. However, a hiatal hernia may cause substernal pain.

A hiatal hernia happens when the stomach moves out of its normal position up past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

  • frequent burping
  • heartburn
  • vomiting blood
  • a feeling of fullness
  • trouble swallowing

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Sternum fracture

Like a fracture in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention, as the heart and lungs may also be injured.

Symptoms of a sternum fracture include:

  • pain during inhaling or coughing
  • swelling over the sternum
  • difficulty breathing

Acid reflux or GERD

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest and is generally accompanied by a burning feeling.

Pain in this region can also be caused by inflammation or a spasm of the windpipe. People with GERD should talk to their doctor about how to prevent further damage to this area.

Muscular strain or bruise

The sternum and ribs have many muscles attached to them. These muscles can be pulled or strained by severe coughing or strenuous activity involving the arms or torso.

Injuries or trauma can result in bruising to these muscles, which may cause them to ache.

Share on PinterestSternum pain is usually caused by muscles or bones surrounding the sternum.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.

Other associated symptoms may include:

  • pain or discomfort in the ribs
  • pain that worsens during deep breathing or coughing
  • mild, aching pain in the upper chest
  • swelling in the upper chest
  • stiffness in the shoulder joints
  • severe pain when raising the arms
  • signs of collarbone trauma, such as bruising or swelling
  • difficulty breathing
  • grinding or popping sensation in joints near the sternum
  • frequent belching
  • heartburn
  • feeling too full
  • throwing up blood

Sternum pain vs.

heart attack

People experiencing any kind of chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain.

People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.

A heart attack also occurs with the following symptoms:

  • pressure, squeezing, or fullness in the center of the chest
  • sweating
  • nausea
  • shortness of breath
  • lightheadedness

However, anyone who thinks they are having a heart attack should seek immediate medical attention.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

  • started as a result of direct trauma
  • is accompanied by heart attack symptoms
  • is persistent and does not improve over time
  • is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Read the article in Spanish.

Causes and when to see a doctor

Sternum pain is pain or discomfort in the area of the chest that contains the sternum and the cartilage connecting it to the ribs. The sternum is located near the heart, so many people experiencing sternum pain may confuse it with more general chest pain.

Some people experiencing sternum pain worry they may be having a heart attack. However, in most cases, sternum pain is unrelated to the heart and caused primarily due to problems with the sternum itself or the nearby cartilage.

In this article, learn about the causes of sternum pain and the differences between sternum pain and heart problems.

The sternum is sometimes known as the breastbone. This flat bone sits at the front of the chest and connects to the ribs with cartilage.

The sternum is part of the rib cage, a series of bones that protects the heart and lungs from injuries.

Share on PinterestThe sternum is located at the front of the chest and is connected to the ribs.

Sternum pain is usually caused by problems with the muscles and bones near the sternum and not the sternum itself.

Pain felt just behind or below the sternum is called substernal pain and is sometimes caused by gastrointestinal problems.

Some of the most common causes of sternum and substernal pain are:

Costochondritis

Costochondritis is the most common cause of sternum pain and occurs when the cartilage between the sternum and ribs becomes inflamed and irritated.

Costochondritis can sometimes occur as the result of osteoarthritis but may also happen for no apparent reason.

The symptoms of costochondritis include:

  • sharp pain on the side of the sternum area
  • pain that worsens with a deep breath or a cough
  • discomfort in the ribs

Costochondritis is usually not a cause for concern. However, people experiencing symptoms of costochondritis may want to consult a doctor if their symptoms worsen or do not go away.

Sternoclavicular joint injury

The sternoclavicular joint connects the top of the sternum to the collarbone. Injuries to this joint generally cause pain and discomfort at the top of the sternum in the upper chest area.

People experiencing sternum pain due to a sternoclavicular joint injury will often experience the following:

  • mild pain or swelling in the upper chest area
  • difficulty or pain when moving the shoulder
  • popping or clicking around the joint

Collarbone injuries

Share on PinterestCollarbone injuries may lead to long-lasting pain or limited movement in the shoulder and upper chest.

While the collarbone itself is not part of the sternum, it is connected to the sternum by cartilage. Injuries to the collarbone may cause pain in the sternum area.

Collarbone injuries are often the result of trauma, such as a car accident or sports injury, although infections or arthritis can also cause them.

Symptoms of a collarbone injury include:

  • severe pain when raising the arm
  • bruising or swelling in the upper chest area
  • abnormal positioning or sagging of the shoulder
  • clicking and grinding in the shoulder joint

Hernia

Hernias may not be an obvious cause of pain near the chest. However, a hiatal hernia may cause substernal pain.

A hiatal hernia happens when the stomach moves out of its normal position up past the diaphragm and into the chest. Symptoms of a hiatal hernia include:

  • frequent burping
  • heartburn
  • vomiting blood
  • a feeling of fullness
  • trouble swallowing

People with substernal pain and symptoms of a hiatal hernia should see a doctor for prompt treatment.

Sternum fracture

Like a fracture in other parts of the body, sternum fractures can cause a lot of pain. Sternum fractures usually occur as a direct result of trauma, such as a car accident or sports injury.

People who believe they may have a sternum fracture should seek immediate medical attention, as the heart and lungs may also be injured.

Symptoms of a sternum fracture include:

  • pain during inhaling or coughing
  • swelling over the sternum
  • difficulty breathing

Acid reflux or GERD

Acid reflux happens when stomach acid wears away the lining of the windpipe (esophagus). This happens primarily in people with gastroesophageal reflux disease (GERD).

Acid reflux may cause substernal pain and discomfort in the chest and is generally accompanied by a burning feeling.

Pain in this region can also be caused by inflammation or a spasm of the windpipe. People with GERD should talk to their doctor about how to prevent further damage to this area.

Muscular strain or bruise

The sternum and ribs have many muscles attached to them. These muscles can be pulled or strained by severe coughing or strenuous activity involving the arms or torso.

Injuries or trauma can result in bruising to these muscles, which may cause them to ache.

Share on PinterestSternum pain is usually caused by muscles or bones surrounding the sternum.

Symptoms of sternum pain vary depending on the cause. The most common symptom is discomfort and pain in the center of the chest, which is the location of the sternum.

Other associated symptoms may include:

  • pain or discomfort in the ribs
  • pain that worsens during deep breathing or coughing
  • mild, aching pain in the upper chest
  • swelling in the upper chest
  • stiffness in the shoulder joints
  • severe pain when raising the arms
  • signs of collarbone trauma, such as bruising or swelling
  • difficulty breathing
  • grinding or popping sensation in joints near the sternum
  • frequent belching
  • heartburn
  • feeling too full
  • throwing up blood

Sternum pain vs.

heart attack

People experiencing any kind of chest pain may worry they are having a heart attack. However, sternum pain differs from heart attack pain.

People who are having a heart attack experience specific signs before the heart attack itself, whereas most sternum pain starts suddenly.

A heart attack also occurs with the following symptoms:

  • pressure, squeezing, or fullness in the center of the chest
  • sweating
  • nausea
  • shortness of breath
  • lightheadedness

However, anyone who thinks they are having a heart attack should seek immediate medical attention.

While sternum pain is not usually serious, there are some causes of sternum pain that require immediate medical attention.

A person should seek emergency medical attention if the pain:

  • started as a result of direct trauma
  • is accompanied by heart attack symptoms
  • is persistent and does not improve over time
  • is accompanied by intense vomiting or vomiting blood

A person should also speak to a doctor if the pain in their sternum gets worse or does not improve over time.

Read the article in Spanish.

Rheumatoid Arthritis and Costochondritis: What to Know About Chest Pain

Costochondritis is caused by inflammation of the cartilage that connects your breastbone, also known as your sternum, to your ribs. The pain associated with this condition can closely mimic a heart attack or other cardiac problems, but a report published in January 2017 in the German journal Der Internist suggests that as many as 50 percent of all chest pains are caused by musculoskeletal disorders.

Common Causes of Costochondritis

There are rubbery segments of cartilage — called costosternal joints — that attach the ribs to the breastbone, and chest pain can occur when the cartilage in those joints gets inflamed. “Costochondritis is typically a result of some sort of mechanical stress, like you coughed too hard or you reached too far and pulled something,” says Harry L. Gewanter, MD, a pediatric rheumatologist in Richmond, Virginia. For example, chest pain symptoms could occur after you physically strain yourself moving furniture. While these symptoms can be extremely painful, the condition is not life-threatening.

RELATED: Don’t miss these lifestyle tips from people who have RA. Find answers on Tippi.

Costochondritis Symptoms Can Be Scary

The hallmark symptom of costochondritis is pain in the chest wall of varying intensity, and it tends to be described as “sharp,” “aching,” or “pressure-like,” according to research published in September 2009 in the journal American Family Physician. The pain can become even worse with upper body movement or by breathing deeply, since it involves joints that flex when you inhale. Although the second to fifth costochondral joints of the ribs are most frequently affected — and especially ribs three and four — it can impact any of the seven rib junctions. Pain can take place in multiple sites, but it’s most frequently unilateral, which means it takes place on only one side of the body. “It can feel like someone stuck a knife in you, and it can take your breath away,” says Dr. Gewanter.

Naturally, intense symptoms can be scary, as Kelly Young describes in her blog, Rheumatoid Arthritis Warrior. This is especially the case if you don’t understand the cause or haven’t experienced it before. But there’s a good chance that the cause behind the pain isn’t serious.

Diagnosing Costochondritis

X-rays don’t show soft tissue well and there’s not a blood test for it, so costochondritis is typically diagnosed by a doctor through a physical exam. Older adults experiencing these symptoms may need to get an EKG to rule out the possibility of cardiac problems.

The Costochondritis–Rheumatoid Arthritis Connection

Costochondritis isn’t directly related to RA, but inflammation from RA can be a reason for damage to the rib cartilage. “Costochondritis also happens in people with rheumatic diseases because their joints aren’t working properly, so they can move the wrong way and tweak their bodies even further,” says Gewanter. “It’s a biomechanical issue, and it can become a house of cards.”

While the chest pain may be related to an inflammatory disease, such as rheumatoid arthritis or ankylosing spondylitis, it can also be partially caused by noninflammatory conditions, such as fibromyalgia.

It’s Not the Same as Tietze’s Syndrome

Costochondritis is often confused with Tietze’s syndrome, a similar but less common disorder that typically involves swelling of the second or third rib that can last for months. According to the American Family Physican review, Tietze’s syndrome typically affects people who are younger than 40, while costochondritis is more common in people older than that. Local swelling is typically present with Tietze’s, while it is not with costochondritis. Tietze’s syndrome can subside without treatment, but over-the-counter pain medication may be used.

How to Treat Costochondritis

Treatment typically takes the form of oral pain relievers — typically either Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen). The American Family Physician report notes that heating pads can help, as can minimizing activities that provoke your symptoms. Cough suppressants can also help reduce discomfort, and sometimes physical therapy is used to help diminish soreness. “But there really is no great way to treat it, outside of time,” says Gewanter. There’s also no real way of knowing how long the pain will last, and it can go away on its own without any treatment.

Costochondritis | Chest Pain | Symptoms and Treatment

What is costochondritis?

Costochondritis is a condition of the chest wall that causes pain. People who get chest pain are often frightened they have a heart or lung problem. Fortunately, if the pain is due to costochondritis, there is no need to panic, as it is not a life-threatening condition. It usually gets better on its own with time.

The pain you get if you have costochondritis comes from the protective cage formed by your ribs, and not from the heart or lungs or blood vessels inside your chest. More specifically, it comes from one or more of the joints between your ribs and your breastbone (sternum). These joints have become inflamed if you have costochondritis.

See the bottom of this leaflet for information on how the chest wall works.

Costochondritis symptoms

  • Costochondritis causes chest pain, felt at the front of the chest.
  • Typically, it is sharp and stabbing in nature and can be quite severe.
  • The pain is worse with movement, exertion and deep breathing.
  • Pressure over the affected area also causes sharp pain.
  • Some people may feel an aching pain.
  • The pain is usually confined (localised) to a small area but it can spread (radiate) to a wider area.
  • The pain tends to wax and wane and it can settle with a change of position and quiet, shallow breathing.

The most common sites of pain are close to the breastbone (sternum), at the level of the 4th, 5th and 6th ribs.

Note: without tenderness, the cause of the chest pain is unlikely to be costochondritis. Remember to seek medical advice if you are unsure of the cause of your symptoms (see the section on ‘when to see a doctor’).

Tietze’s syndrome causes similar symptoms to costochondritis. However, it also tends to cause swelling at certain tender points on your chest wall. If you have costochondritis, there is nothing there to actually see.

Bornholm disease is another similar condition but it often leads to muscle aches and pains, as well as chest pain. See the separate leaflet called Bornholm Disease for more details.

How common is it?

It is hard to be sure exactly how common it is, as lots of people probably have it but don’t bother to go to their doctor. It seems to be quite common. Of the people with chest pain going to see their GP, about 1 in 5 have a cause related to the muscles, ribs and joints in their chest wall.

What are the common causes of costochondritis?

The basic problem is inflammation but the cause of this is unknown for most people. There are some situations that are associated with inflammation and they include:

  • Chest infections of varying types.
  • Large physical efforts, like lifting heavy objects or repeated bouts of coughing.
  • Accidents which hit the chest, like falls or car accidents.
  • Some types of arthritis.

Who develops costochondritis?

There is no particular person more at risk of costochondritis than any other. It does tend to affect younger people, especially teenagers and young adults. It can affect children. People performing repetitive movements that strain the chest wall, particularly if they are not used to it, as above, might be more at risk of getting this condition. Some studies suggest women tend to be affected more commonly than men.

People with fibromyalgia tend to develop costochondritis more often than others. Fibromyalgia is a long-term (chronic) condition that causes widespread body pains and fatigue. See the separate leaflet called Fibromyalgia for more details.

When should I see a doctor?

It can be very difficult to know if your pain is due to costochondritis or whether – and how urgently – to see a doctor. With chest pain, it makes sense to err on the side of caution if you are unsure.

If you feel unwell, breathless, dizzy, or sweaty, or if your chest pain is very severe or spreading to your jaw or left arm then treat it as an emergency. Call 999/112/911 for an emergency ambulance.

It is more likely that you have costochondritis if:

  • You are young and otherwise healthy.
  • You feel generally well in yourself and have no other symptoms.
  • You have pain which is worse when you move your chest wall or press on it.
  • The pain is relieved with simple painkillers such as paracetamol or ibuprofen.

If you have other symptoms in addition to the pain then consult a doctor. This would include if you have:

  • A cough.
  • A high temperature (fever).
  • Breathlessness.
  • Blood in the mucus you cough up (sputum).
  • Pain which spreads to other parts of the body.
  • A rash.
  • A feeling of having a ‘thumping heart’ (palpitations).
  • Dizziness.
  • Difficulty swallowing.
  • Started to get heartburn or indigestion.

Also consult your doctor if the pain gets worse as you exert yourself (for example, on walking up a hill) rather than as you twist your chest around. Pain on exertion is more likely to be due to angina.

See the separate leaflet called Chest Pain for more information about the different causes of chest pain.

Costochondritis treatment

Treatment options for costochondritis include:

  • No treatment. Sometimes it helps just to be reassured there is no serious cause for the chest pain.
  • Relaxation techniques. Worry can make the pain worse. (Indeed, anxiety is a common cause of chest pain.)
  • Simple painkillers such as paracetamol or ibuprofen.
  • Injections of steroids or local anaesthetic medicines if pain is severe and other treatments have not worked.

Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:

With or without treatment, most people with costochondritis get better gradually over time.

In extreme cases, an intercostal nerve block can be performed (usually by a doctor specialising in acute pain and/or anaesthetics). This involves injection of a local anaesthetic medicine around the painful ribs This blocks the nearby intercostal nerve and temporarily disrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In repeated, severe cases of costochondritis, a series of these injections can be given to permanently destroy the nerve causing the pain.

What is the outlook?

The outlook (prognosis) for costochondritis is generally very good. Most cases are mild and settle reasonably quickly. This happens with or without simple medications. In nearly all cases, the condition has completely gone within a year. Occasionally, if you are unlucky, it lasts longer. Costochondritis may return; however, this is unlikely.

How does the chest wall work?

To understand costochondritis, you need to know a bit about the way the rib cage is put together. The rib cage is a bony structure that protects the lungs. Bones are hard and solid and they can’t bend or move much. Your lungs, however, need to move, so that you can breathe.

When you take a deep breath in, your rib cage expands. (Try it! You will feel and see your rib cage moving.) In order for the ribs to expand, they need something to allow movement. Cartilage allows this. Cartilage is a softer, flexible (but very strong) material found in joints around the body.

Cartilages attach the ribs to the breastbone (sternum) and the breastbone to the collarbones (clavicles). The joints between the ribs and the cartilages are called the costochondral joints. Those between the cartilages and the breastbone are called costosternal joints. Those between the breastbone and the collarbones are called the sternoclavicular joints.

The prefix ‘costo’ simply means related to the ribs. ‘Chondr-‘ means related to the cartilage and ‘-itis’ means inflammation. So, in costochondritis, there is inflammation in either the costochondral, costosternal or sternoclavicular joints (or a combination). This causes pain, which tends to be worse when you move, or when you press down on the affected part.

‘Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.’

3 Similar Types of Chest Pain: Costochondritis, Tietze syndrome, and Intercostal Neuralgia

Costochondritis occurs when the cartilage in the rib cage (where the upper ribs attach to the sternum) becomes inflamed. This area is called the sternocostal joint, and the pain associated with costochondritis ranges from mild to severe. This particular type of pain is often described as feeling like a heart attack. The pain is more commonly felt in the left side of the chest between the fourth to sixth ribs and sometimes radiates to the back or abdomen. Pain usually increases with movement and/or deep breathing and decreases when idle. Costochondritis tends to be more prevalent in women than in men.

Genetics, injuries, surgery to the sternum area, arthritis, joint infections, tumors, and viruses are the most common causes of costochondritis, but infectious diseases can also cause the condition. Pressing on the affected area causes pain, and without this tenderness, a diagnosis of costochondritis is unlikely. Although it can last for several weeks, costochondritis is usually harmless and goes away on its own.

Health professionals usually deem it necessary to rule out other conditions before making a diagnosis of costochondritis. A physical exam (pressing on the breastbone, moving the rib cage and arms in an effort to re-create the pain, and ensuring that no swelling is present) is typically performed before making the diagnosis of costochondritis. No specific test exists that can confirm costochondritis is present.

Treatment for costochondritis includes taking anti-inflammatory medications such as ibuprofen or naproxen, alternating heat and ice to the affected area, stretching exercises, and avoiding activities that make the symptoms worse usually help ease the pain. If the pain is severe, a physician may prescribe anti-seizure medication, anti-depressants, or narcotics.

Costochondritis and Tietze syndrome pain are very similar; however, if swelling accompanies the pain, Tietze syndrome is typically diagnosed. Tietze syndrome is rare and comes on suddenly. The affected area is normally between the second and third ribs. Although swelling is the distinguishing symptom of Tietze syndrome, redness, tenderness, and warmth to the area may also be present. Tietze syndrome pain can last up to several months and may be confused with the pain of a heart attack (as with costochondritis). Determining a diagnosis involves a physical exam as performed for costochondritis; however, in order to make a specific diagnosis of Tietze syndrome, blood tests are usually ordered to determine if inflammation is present. Treatment of Tietze syndrome and costochondritis is the same.

Intercostal neuralgia is caused when the intercostal nerves (nerves that originate from the spinal cord and lie between the twelve ribs) become inflamed or damaged. Intercostal neuralgia pain presents in the upper trunk and chest wall and may radiate to the shoulder blade(s) and/or lower pelvis. A sharp, shooting, and/or burning pain around the ribs, in the upper chest, and/or upper back is the most common symptom. Tingling, numbness, or a squeezing sensation may also be present. Pain typically intensifies when deep breathing, stretching, laughing, sneezing, or coughing. In severe cases, muscle twitching, loss of appetite, muscle atrophy and/or shrinkage, and/or intensified pain develops.

Intercostal neuralgia is often caused by the shingles virus, trauma to the chest, nerve pressure, or injury from surgery to the affected area. A diagnosis of intercoastal neuralgia involves a healthcare professional performing a physical examination and ruling out other conditions. During the physical exam, the physician presses between the area of the ribs while the patient is taking a deep breath. If a pain is felt during this physical exam, and other possible diagnoses are eliminated, intercostal neuralgia may be diagnosed.

Although no cure exists for intercostal neuralgia, various treatment options are available to manage the pain. Lidocaine patches and capsaicin creams often offer temporary relief. Antidepressants and/or anticonvulsants are sometimes prescribed for long-term pain management. Opioids may be also be prescribed, but due to the many side effects, they are usually a last resort. In addition to topical and oral medications, nerve blocks can be done to help with the inflammation and pain. Another option includes a thoracic epidural injection of anti-inflammatory medication into the affected area. Also, pulsed radiofrequency, a minimally-invasive procedure, can be effective in managing the pain. Other treatments that may help include, but are not limited to, physical therapy, relaxation therapy, and cognitive therapy.

Costochondritis & Chest Wall Pain

Most Common Less Common
As a result of direct Injury or trauma to chest Stress fractures
Costochondritis Tietze’s syndrome
Slipped Rib Syndrome or lower rib pain syndromes Xiphoidalgia
Pain radiating from thoracic spine or costovertebral joints Spontaneous sternoclavicular subluxation
Intercostal muscle strain or pulled chest muscle
Sternalis syndrome

Costochondritis refer to Inflammation of the cartilage junctions of the sternum and ribs typically felt at the costosternal and costochondral joints. It is a relatively common condition seen in adult and patients who develop pain and tenderness at the front of the chest. It’s felt over the affected cartilage segments in multiple areas, usually on one, or occasionally both sides of the sternum. The most common sites of pain are the anterior cartilage segments of the 2th to 5th ribs at the front of the chest near where the ribs join the breastbone. This pain increases with activity, moving or twisting or when taking deep breaths. Conversely, it decreases as movement stops or with quiet breathing. The reproducible tenderness but without swelling you feel when you press on the sternal and rib joints (costosternal and costochondral junctions respectively) is a constant feature of costochondritis. Without this tenderness, a diagnosis of costochondritis is unlikely.

The cause is unknown but may be associated with unusual or excessive physical activity, minor trauma particularly repetitive and/or excessive over of use of arms. Occasionally, it can follow a viral infection or rarely a bacterial or fungal infection in patients prone to such infections.

There also appears to be a relationship between chest wall deformities and costochondritis and certainly younger patients with pectus excavatum and carinatum complain of cheat wall pain though it’s difficult ascertain whether this is costochondritis, idiopathic chest wall pain (chest pain in children without an obvious cause) or chest wall pain caused by the anatomical deformity associated with pectus.

Typical location of pain and tenderness noted in Costochondritis

Tietze syndrome is often confused with costochondritis but is rarer and importantly associated with sudden chest pain and localised swelling at junction of the ribs and breastbone. It usually affects the junctions at the 2nd and 3rd ribs. The swelling may last for several months and often radiates to the arms and shoulders. The cause is unknown.

For Lower rib pain syndromes. See Slipped rib syndrome. Pain originating from the thoracic spine and specifically from the ‘spinal-rib complex’ is common. The pain experienced in the front or side of the chest is described as referred pain and may arise from the posterior thoracic spinal structures including the intervertebral discs and facets. Costotransverse disorders or costovertebral joint dysfunction are disorders affecting or involving specifically the costotransverse and costovertebral joints and ligaments which are felt to be related to pain experienced in the thorax. See other associated problems.

Muscle strain or a ‘pulled muscle’ refers to muscle overstretching leading to a partial or complete tear and can occur in any muscle. Muscles affected tend to be in ones that cross two joints; exposed to sudden explosive action, such as sprinting and the hamstrings; or following periods of overtraining. In the chest, sudden twisting or movement ‘at the torso’ particularly against resistance can lead to an intercostal muscle strain. The diagnosis is a clinical one, that is relying on the clinical history and examination as the muscle and injury to it, is hard to ‘see’ using radiology (MRI and ultrasound) and so grades of muscle strain are hard to allocate to intercostal muscle strain. The pain is typically sharp and stabbing immediately but typically becomes a dull ache overtime and can be associated with swelling, muscle spasms, difficulty moving the affected area, pain while breathing and even bruising.

Muscle strains can be categorized into three grades, based on severity

Grade Features
Grade 1 Mild damage to individual muscle fibres (less than 5% of fibres) that causes minimal loss of strength and motion.
Grade 2 More extensive damage with more muscle fibres involved. However, the muscle is not completely ruptured. These injuries present with significant loss of strength and motion.
Grade 3 Complete rupture of a muscle or tendon. These can present with a palpable defect in the muscle or tendon. However, swelling in the area may make this difficult to appreciate.

Activities and Sports that may cause chest wall muscle strain:

Intercostal muscle Pectoralis muscle Latissimus dorsi Serratus muscle
Weight training (side to side against resistance) Weight training (bench press) Weight training (bench press) Weight training (heavy weights)
Heavy lifting with side bending, twisting or turning Heavy lifting from front to chest height Heavy lifting with upper body Repetitive motions against resistance
Bowling Rugby Climbing Swimming
Cricket, Baseball (bowling, throwing) Skiing Cricket, baseball & throwing activities Tennis
Rowing Wrestling Rowing
Tennis Hockey Tennis
Hockey Parachuting

Large chest wall and abdominal muscles

Larger chest wall muscle groups can also be strained. The Pectoralis major muscle is a large muscle at the front of the chest. It used to rotate the arm inwards, pull a horizontal arm across the body, pull the arm from above the head down and pull the arm from the side upwards. Pectoralis Major strain can happen during vigorous sports activity classically weight training. Its weak point is where the pectoralis or pec muscle tendon attaches to the upper humerus (arm bone) though rarely its tendinous insertion to the upper ribs and sternum can also tear. Symptoms of a pec major sprain include a sudden sharp pain at the front of the upper arm, near the shoulder and depending on the grade of muscle strain, swelling (haematoma) of the front of the shoulder and upper arm. Tests which reproduce pain help confirm the diagnosis and include getting the patient to pull their arm across the front of the chest or rotate it inwards against resistance. A visible gap or lump in the muscle may appear.

The Latissimus dorsi muscle or ‘lats’ is another large, flat “V” shaped muscle of the torso. It spans the width of your back and helps control the movement of your shoulders and is often referred as the “climbers” muscle. With a Latissimus dorsi strain, you might feel pain in your low back, mid-to-upper back, along the base of your scapula or shoulder blade, or in the back of the shoulder. You may even feel pain along the inside of the arm, all the way down to your fingers.

The Serratus anterior muscle spans the upper eight or nine ribs. This muscle helps you rotate or move your scapula or shoulder blade forward and up. Sometimes it’s referred to as the “boxer’s muscle,” since it’s responsible for the movement of the scapula when a person throws a punch. Serratus muscle strain typically from repetitive activities such as tennis results in pain in the chest, back, or arm and can make it difficult to lift your arm overhead or have a normal range of motion with the arm and shoulder. It can also be associated with arm or finger pain, difficulty with deep breathing and shoulder blade pain. Serratus anterior myofascial pain syndrome is part of a broader set of conditions known as myofascial pain syndromes. Myofascial pain is a process in which pain and dysfunction are related to the development and persistence of focal sensitive areas or trigger points, that when pressed can cause referred pain (pain felt elsewhere).

Though not strictly a chest wall muscle, the upper Rectus abdominis muscle and External oblique muscle can also be strained, torn or even ruptured leading to pain, which depending on the site of injury can lead to lower chest wall pain and pain when pain twisting from a seated position or when rising from a bed particularly if flexing (bending).

Sternalis syndrome presents with anterior chest pain associated with localised tenderness over the body of the sternum or overlying sternalis muscle; palpation often causes radiation of pain bilaterally. It is an unusual cause of anterior chest wall pain as it appears to be associated with an accessory muscle, the sternalis muscle which is present in only around 5-10% of people and sit in a variable position in front of the main pectoralis muscle. When symptomatic, it is another form of myofascial pain syndrome.

Though uncommon, Stress fractures of the ribs can be seen following repetitive activity or in increased loading. They can occur in the first rib, and less commonly other ribs particularly in those engaged in repetitive forceful sports such as rowers or weightlifters. The pain which is localised to the area with associated tenderness may start gradually but ends to worsen and is only eased with rest and or avoidance of the repetitive activity.

Xiphoid process pain (xiphoidalgia) occurs for varying reasons but is often related to minor trauma to the area or over exercise (such as abdominal crunches). Local inflammation can also occur. See Complex chest wall problems.

Spontaneous subluxation of the sternoclavicular joint is another very specific cause of isolated chest wall pain. See other associated problems.

Stress fracture of right first rib (red ring) in a body builder

90,000 Costal chondritis (Tietze’s syndrome) – treatment, symptoms, causes, diagnosis

Costal chondritis (often called Tietze’s syndrome) is an inflammation in the area of ​​the cartilaginous attachment of the ribs to the sternum. The disease is characterized by local soreness in the chest, aggravated by palpation and pressure on these areas. Costal chondritis is relatively harmless and usually goes away without treatment. The cause is not known.

  • Costal chondritis is a common cause of chest pain in childhood and adolescence and accounts for 10-30% of all chest pain at this age.Most often occurs between the ages of 12-14 years.
  • Costal chondritis is also considered a possible diagnosis in adults who have chest pain. Chest pain in adults is considered a potentially serious symptom of the disease and, first of all, it is necessary to exclude cardiac pathology (ECG, tests, examination, etc. ). Only after a thorough examination and exclusion of the cardiac genesis of pain can the presence of costal chondritis be assumed. Differential diagnosis is sometimes difficult.In adults, costal chondritis is more common in women.

Costal chondritis is very often called Tietze’s syndrome. Tietze syndrome is a rare inflammatory disorder characterized by chest pain and swelling of the cartilage at the attachment of the second or third rib to the sternum. The pain arises sharply and there is irradiation to the arm, to the shoulder. Both men and women are sick more often at the age of 20 to 40 years. It occurs mainly in people whose work is related to physical activity or athletes.

Reasons

Costal chondritis is an inflammatory process in the cartilage tissue, usually without any specific cause. Repeated minor trauma to the chest and acute respiratory infections can provoke the appearance of soreness in the area of ​​attachment of the ribs (the effect of both the viruses themselves and frequent coughing on the areas of attachment of the ribs). Sometimes costal chondritis occurs in people taking parenteral drugs or after surgery on the chest.After operations, damaged cartilage tissue is more susceptible to infection due to disturbances in its blood supply.

Symptoms

Chest pain associated with costal chondritis is usually preceded by physical overload, minor trauma, or acute upper respiratory tract infections.

  • Pain, as a rule, appears acutely and is localized in the anterior region of the chest. The pain may radiate downward or more often to the left side of the chest.
  • The most common localization of pain is the region of the fourth, fifth and sixth ribs.The pain increases with movement of the trunk or with deep breathing. Conversely, there is a decrease in pain at rest and with shallow breathing.
  • Soreness, which is clearly visible on palpation (pressing in the area of ​​attachment of the ribs to the sternum). This is a characteristic feature of chondritis and the absence of this sign suggests that the diagnosis of costal chondritis is unlikely.

When rib chondritis is caused by postoperative infection, you may notice swelling, redness and / or pus in the area of ​​the postoperative wound.

Given that the symptoms of chondritis are often similar to emergency conditions, it is necessary to urgently seek medical help in the following cases:

  • Breathing problems
  • High temperature
  • Signs of an infectious disease (swelling, redness in the area of ​​rib attachment)
  • Chest pain of a persistent nature, accompanied by nausea, sweating
  • Any chest pain without clear localization
  • Increased pain during treatment

Diagnostics

The basis of diagnosis is the medical history and external examination.A characteristic feature of this syndrome is pain on palpation in the area of ​​attachment of 4-6 ribs.

Radiography (CT, MRI) is usually not very informative for the diagnosis of this syndrome and is used only for differential diagnosis with other possible causes of chest pain (cancer, lung disease, etc. ). ECG, laboratory tests are necessary to rule out heart disease or infections. The diagnosis of rib chondritis is made last after excluding all possible other causes (especially heart disease).

Treatment

If the diagnosis is verified, then the treatment consists in prescribing NSAIDs for a short time, physiotherapy, limiting physical activity for a certain period of time, sometimes injecting an anesthetic into the area of ​​pain localization together with a steroid.

90,000 Osteoarticular pain in the thoracic spine and chest

N.V. PIZOVA , MD, professor, Yaroslavl State Medical Academy, Ministry of Health of Russia

The article discusses in detail the causes and mechanisms of vertebral pain syndromes.A differentiated approach to therapy is presented, taking into account the pathogenesis and stage of the underlying disease. The advantages of using combined drugs (diclofenac and B vitamins) in the treatment of patients with back pain are described.

Back pain is one of the most frequent sufferings of modern man. It is associated with significant economic losses due to temporary and even permanent disability in young and middle-aged people. Back pain accounts for up to 6% of all direct costs of treatment of various diseases, 15% of all days of disability and 18% of causes of disability [1].Acute and chronic back pain can be a manifestation of any disease. And a doctor of any specialty has two main tasks – to identify the cause of pain and find a drug that adequately helps with it.

All back pain syndromes can be classified into the following categories:

1. by reason – vertebrogenic and non-vertebral;
2. by the mechanism – reflex, compression, against the background of instability of the spinal motion segment (VMS), vascular, inflammatory;
3.by localization – local, reflected and radiating;
4. in duration – acute and chronic.

During life, back pain occurs in 70–90% of the population, and in 20–25% it is recorded annually. In the vast majority of patients, as a result of the therapy, pain is relieved within 4 weeks. At the same time, 73% of patients develop at least one exacerbation during the first year [2, 3, 4]. Thus, according to a Russian study, the most frequent localization of pain (576 patients – 60.6%) was the back.According to medical records, back pain was regarded as dorsopathy in 417 (72.4%) patients and, as a result of herniated disc in 104 (18.1%) patients. In 34 (5.9%) patients, osteoporotic fractures of the vertebral bodies were established, and in 21 – other causes of back pain [5].

Chronization of back pain is observed in 20–25% of cases, and this category of patients accounts for up to 80% of the economic costs associated with the pain syndrome of this localization [6]. Chronic pain is the result of a complex interaction between biological, psychological, social and cultural factors that make it difficult to diagnose and treat [7, 8].Chronic back pain can be classified as nociceptive, neuropathic, inflammatory, dysfunctional, or may be mixed when there are characteristics of several types of pain [9]. Although the causes and clinical manifestations are different, the mechanisms by which these types of pain occur may overlap and the patient may develop chronic back pain with more than one type of pain.

A source of back pain can be painful impulses associated both with the spine itself – vertebral factors (ligaments, muscles, periosteum of processes, annulus fibrosus, joints, roots), and with other structures – extravertebral factors (muscles, visceral organs, joints ).Traditionally, thoracalgia, like other pain syndromes, depending on the cause, are divided into vertebrogenic (pathogenetically caused by changes in the spine) and non-vertebral pain syndromes. Vertebrogenic thoracalgic syndromes include lesions of the thoracic roots in a herniated disc, stenosis of the spinal canal, spondylolisthesis and instability, arthropathic syndrome in degenerative lesions of the facet and costal-transverse joints. Vertebrogenic causes of pain in the thoracic spine also include relatively rare malignant neoplasms of the spine (primary tumors and metastases), inflammatory (spondyloarthropathies, including ankylosing spondylitis) and infectious lesions (osteomyelitis, epidural abscess, tuberculosis), as well as compression fractures of the bodies due to osteoporosis. The cause of non-vertebral pain syndromes can be the pathology of internal organs and muscle pain syndromes, which can form under the influence of both vertebrogenic and non-vertebral changes. Therefore, the division into vertebrogenic and non-vertebral pain syndromes can be considered rather relative. In addition, psychogenic pain syndromes (panic attacks and hyperventilation disorders) are a possible cause of non-vertebral chest pain.

Clinical syndromes in spondylogenic thoracalgia include [10]:

1.local vertebral syndrome, often accompanied by local pain syndrome, tension and soreness of the adjacent muscles, soreness and deformity, limited mobility or instability of one or more adjacent segments of the spine;
2. remote vertebral syndrome;
3.reflex (irritative) syndromes: reflected pain, muscle-tonic, neurodystrophic syndromes, autonomic (vasomotor, etc.) disorders, etc.;
4.compression (compression-ischemic) radicular syndromes;
5. syndrome of compression (ischemia) of the spinal cord.

Vertebral pain syndromes are conventionally divided into reflex (found in 85–90% of cases) and compression (observed in 10–15% of cases). Reflex pain syndromes occur due to irritation of the receptor apparatus in muscles, tendons and fascia, ligaments, joints of the spine, intervertebral disc, etc. due to the formation of sites of nociception with a local nonspecific inflammatory reaction.Under conditions of activation of the synthesis and release of pro-inflammatory and algogenic substances (substance P, kinins, prostaglandins, leukotrienes, cytokines, nitric oxide, tumor necrosis factor, etc.), the excitability (sensitization) of nociceptors increases. As a result, a powerful stream of nociceptive afferentation is formed, which enters through the dorsal roots into the neurons of the dorsal horns of the spinal cord, from where, along the ascending nociceptive pathways, it reaches the central parts of the nervous system (reticular formation, thalamus, limbic system and cerebral cortex), causing NMDA-dependent increases in these structures intracellular calcium concentration and activation of phospholipase A2. The latter stimulates the formation of free arachidonic acid and the synthesis of prostaglandins in neurons, which, in turn, enhances their excitability [11, 12]. Simultaneously, in the posterior horns of the spinal cord, the flow of pain impulses through the intercalary neurons activates the neurons of the lateral horn with the activation of adrenergic (sympathetic) innervation and the motor neurons of the anterior horns of the spinal cord. The activation of the latter leads to a spasm of the muscles innervated by this segment of the spinal cord (sensorimotor reflex). Muscle spasm is an additional source of pain due to the activation of muscle nociceptors due to its shortening, the development of neurodystrophic changes and impaired microcirculation in muscle tissue.As a result, the vicious circle “pain, neurogenic inflammation – increased protective muscle tension, pathological changes in muscles – increased pain” is closed, which contributes to the development of persistent reflex muscular-tonic syndrome [11, 12, 13]. Normally, there is a strictly balanced relationship between the intensity of the stimulus and the response to it. The antinociceptive system carries out downward inhibitory cerebral control over the conduction of pain impulses, inhibits the transmission of pain stimuli from primary afferent fibers to intercalary neurons.The interaction of these structures leads to the final assessment of pain with an appropriate behavioral response. However, long-term preservation of nociceptive impulses leads to the formation of stable pathological connections, the appearance of pronounced dystrophic changes in the surrounding tissues, which, in turn, become a source of pain signals, thereby increasing peripheral pain afferentation, which contributes to the depletion of the antinociceptive system [11, 12, 13] … The chronic course can be facilitated by inadequate treatment of acute pain, excessive limitation of physical activity, “painful” personality type, low mood background, in some cases, the patient’s interest in long-term disability, aggravation of existing symptoms or “rent” attitude to the disease. With a long course of the disease, pathological changes occur in the roots with the development of axonal and / or demyelinating processes.

The term “osteochondrosis” was proposed in 1933 by the German orthopedist Hildebrandt to denote involutional changes in the musculoskeletal system [14]. Osteochondrosis (Greek osteon – bone, chondros – cartilage, osis – suffix denoting a pathological condition) is understood as a congenital or acquired degenerative-dystrophic cascade process, which is based on disc degeneration with subsequent secondary involvement of the bodies of adjacent vertebrae, intervertebral joints and ligamentous apparatus …In turn, the intervertebral disc is a component of the intervertebral symphysis – a complex connection of the vertebrae in the spinal column. In the symphysis of the spine, in contrast to the synovial joints between the surfaces of the vertebrae covered with hyaline cartilage, there is not synovial fluid, but a specific formation of a cartilaginous nature – an intervertebral disc, consisting of a nucleus pulposus and an annulus fibrosus. The first in morphological structure approaches hyaline cartilage due to the high content of proteoglycans, hyaluronic acid, type II collagen and water.Whereas the annulus fibrosus belongs to fibrous cartilage with a high collagen content (up to 68%), mainly due to type I collagen in the outer plates of the annulus, and rich in sulfitated glycosaminoglycans integrated into large proteoglycan molecules, with their characteristic ability to retain water [11, fifteen]. Nevertheless, despite the existing differences in the morphological structure of synovial joints and intervertebral symphysis, there is an opinion about the similarity of arthritic changes occurring in them, expressed in the imbalance of anabolic and catabolic processes in the cartilage matrix [16].An imbalance of the most important homeostatic processes leads to a decrease in the synthesis of complete collagens and proteoglycans by chondrocytes. Non-sulfated glycosaminoglycan, hyaluronic acid, is no exception, providing the formation of matrix proteoglycan aggregates and hydration of the nucleus pulposus, which plays the role of a protective cushion (due to hydration and changes in its volume). Changes in the quality and quantity of hyaluronic acid in osteochondrosis leads to a decrease in the content of bound water in the nucleus pulposus and to the destruction of the collagen network, especially in the pericellular zones of chondrocytes [17, 18, 19].The latter is primarily associated with an increase in the synthesis of metalloproteinases (collagenase, stromelysin), which ultimately leads to the complete disappearance of the pericellular collagen network, to the loss of the amortization properties of the intervertebral disc as a whole.

Osteochondrosis and spondyloarthrosis are provoked by identical pathogenetic factors, in response to which, in the involved structures of the PDS (including two adjacent vertebrae and an intervertebral disc, own articular, muscular-ligamentous apparatus, the vascular system, as well as the area of ​​the spinal cord corresponding to this level, roots and spinal vegetative ganglia with their connections within this segment), biochemically and immunologically active mediators interacting with sensitive receptors are released, which in turn triggers complex and not yet fully understood neurophysiological mechanisms of pain formation [11].It has been established that the source of pain can be an anatomical structure innervated by unmyelinated fibers or containing substance P (or peptides similar to it) [20, 21]. For a long time, the intervertebral disc was considered indifferent to the generation of pain impulses by the formation, since no nerve endings were found in it. More detailed anatomical and histochemical studies have shown the presence of thin nerve endings in the outer third of the annulus fibrosus – 1–2 segments above or below its outlet [11, 18, 19].

Another source of pain is considered to be the facet joints, the synovial capsule of which is richly innervated by the articular nerves, which are branches of the posterior branches of the spinal nerves, and small accessory nerves from the muscle branches. The facet joints, due to their vertical orientation, offer very little resistance to compression, especially flexion. This slight resistance is most likely due to the stretching of the capsular ligaments.In conditions of extension, the facet joints account for 15 to 25% of the compression forces, which can increase with disc degeneration and narrowing of the intervertebral space [11, 21]. With sudden unprepared movements associated with rotation of the torso, lifting weights, when working with arms raised above the head, facet syndrome often occurs. The pathogenesis of this syndrome is associated with the convergence of the articular surfaces of the facet (facet) joints and their blockage when the load on the joint and its ligamentous apparatus increases.Pain associated with facet syndrome in the thoracic spine can range from mild to severe discomfort and severe disability. It usually increases with extension and decreases with flexion of the spine and can be reflected on the anterior surface of the chest. Below and above the level of joint blocking, reflex spasm of the muscle that straightens the spine is often determined [22, 23, 24, 25, 26].

One of the causes of chest pain may be Tietze’s syndrome, first described by Tietze in 1921.This syndrome is a relatively rare condition characterized by the presence of nonspecific benign, reversible painful edema in region II (in 60% of cases) or III costal cartilage. In 80% of cases, there is a unilateral lesion limited to one costal cartilage. The pain is usually well localized, but it can radiate along the entire front surface of the chest wall, as well as in the shoulder girdle and neck. Redness, fever and other changes in the skin over the affected area are absent.The pain usually regresses spontaneously after 2-3 weeks, but it often bothers for several months, and the residual edema can persist for up to several years. Usually the disease develops in young or childhood years. Its reasons are unknown [22, 23, 24, 25, 26].

Costo-sternum syndrome is one of the most common causes of chest pain. This syndrome is much more common than Tietze’s syndrome. In rib-sternum syndrome, palpation in 90% of cases reveals multiple zones of pain: in the left parasternal region, below the left breast, in the projection of the pectoral muscles and sternum.There is no local edema with rib-sternum syndrome. The cartilages of the II and V ribs are most often affected. With the defeat of the upper costal cartilage, pain irradiation to the region of the heart is often noted. The pain usually increases with chest movements. The disease is more common in women over 40 years of age [22, 23, 24, 25, 26].

Sliding rib syndrome is another common cause of chest pain. The syndrome is characterized by intense pain in the projection of the lower edge of the costal arch and an increase in the mobility of the anterior end of the costal cartilage, usually X and less often VIII and IX ribs.It is believed that this condition has a traumatic origin and is associated with recurrent subluxation of the costal cartilage during torso rotation. Unlike the superior ribs, the cartilaginous parts of which form the sternocostal joints, the cartilaginous parts of the VIII – X ribs form articulations with the cartilaginous parts of the superior ribs using the external intercostal membrane. This zone is anatomically the weakest area of ​​the chest, prone to trauma. Following damage to the cartilaginous articulation, the free cartilaginous part of the rib deviates upward, shifting in the vertical or anteroposterior direction during breathing relative to the overlying cartilage, which is accompanied by pain and a characteristic clicking sensation.The pain, as a rule, is acute or shooting in nature, is localized in the upper quadrant of the abdominal wall and is provoked by hyperextension of the chest when lifting the arms up. In the acute stage of the disease, the patient often takes a forced position with the torso tilted forward and to the painful side to reduce the tension of the abdominal wall muscles attached to the costal corners. In some cases, displaced costal cartilage can injure the perichondrium of the superior rib and intercostal nerve. Pathognomonic for this condition is the test described by Holms, which consists in pulling the edge of the rib anteriorly with a bent finger.In this case, a typical pain pattern is reproduced, accompanied by a characteristic click. Carrying out such a manipulation on the healthy side is not accompanied by the described phenomenon. The diagnosis can also be confirmed by infiltration of the space between the separated cartilage and the rib with 5 ml of 0.5% lidocaine solution, leading to a complete regression of pain sensations 10 minutes after the procedure [22, 23, 24, 25, 26].

Diffuse idiopathic skeletal hyperostosis (Forestier disease) is a disease that is relatively common in middle-aged and elderly people, mainly in men.The main symptoms are usually mild to moderate pain and a feeling of stiffness in the thoracic and lumbar spine. On examination, an increase in thoracic kyphosis, limitation of the range of motion in the thoracic spine and chest excursions are determined. Local tenderness is often detected on palpation of the thoracic and lumbar spine. To confirm the diagnosis of diffuse idiopathic skeletal hyperostosis, it is necessary to conduct an X-ray of the spine, which reveals hyperostosis, which is most pronounced in the thoracic region and manifests itself by linear ossification along the anterior surface of four adjacent vertebrae and more with preservation of X-ray clarification between the bone deposits and the vertebral bodies, as well as the relative preservation of the height of the intervertebral interval.Also characteristic is the formation of osteophytes between the bodies of adjacent vertebrae, which are interconnected in the form of “bridges” [22, 23, 24, 25, 26].

Diagnosis of vertebrogenic pain syndromes includes establishing the nature of pain and their relationship with static and dynamic loads, identifying trigger points, symptoms of tension of the nerve trunks. Computed tomography and magnetic resonance imaging and radiography are important for determining the nature of the process, assessing the degree of existing changes.Electroneuromyography is used to determine the functional state of the roots, to determine the place and stage of their lesion [2, 6, 12, 13]. Already at the first examination of the patient, danger symptoms (“red flags”), which are generally recognized in dorsalgia, should be excluded, namely, to pay attention to the presence of fever, local pain and local temperature rise in the paravertebral region, which are characteristic of an infectious lesion of the spine. A tumor (primary or metastatic) may be evidenced by an unreasonable decrease in body weight, a history of malignant neoplasm of any localization, persistence of pain at rest and at night, as well as the patient’s age over 50 years.Compression fracture of the spine is more often observed with trauma, the use of corticosteroids, and in persons over 50 years of age. With a tumor lesion of the spinal cord, pain can be constant or recurrent, appear at rest and decrease with movement, often leads to sleep disturbance, forcing to move or sleep in a forced position, for example, sitting. Against the background of constant pain, lumbago is often noted, provoked by coughing or sneezing. Motor and sensory disorders are identified, corresponding to the level of damage.With syringomyelia and multiple sclerosis, pain can also occur, the localization of which depends on the area of ​​the spinal cord injury.

Other causes of lesions of the thoracic roots can be herpes zoster with the development of postherpetic neuralgia, diabetes mellitus, and fractures of the thoracic vertebrae. The pain in these cases, as a rule, is prolonged, intense, localized in the area of ​​the corresponding segment, has a constricting or burning character, is often accompanied by short lumbago, may be lancinating.The pain increases at night and with movements in the thoracic spine. Hyperesthesia, hyperalgesia, and hyperpathy are common in the affected segments. To clarify the diagnosis, it is necessary to carry out radiography, CT, MRI of the thoracic spine. With injuries of the ribs, the interosseous nerves can be affected, which is accompanied by sharp superficial, burning pains in the area of ​​their innervation. The pain increases with inspiration or with movement of the chest, resembling pain with pleurisy. As a rule, a small area of ​​segmental hyperalgesia or hyperesthesia is detected, which occurs even when one nerve is damaged.

After identifying the cause, mechanism, nature and duration of the pain syndrome, the question of the selection of adequate therapy is decided. Treatment should always be individualized. It depends on the nature of the underlying disease and is subdivided into undifferentiated and differentiated therapy. The main objectives of undifferentiated therapy are to reduce pain or the patient’s reactions to pain and eliminate autonomic reactions. The main direction of differentiated therapy for back pain syndromes is to influence their pathogenetic mechanisms, treatment also depends on the phase of the underlying disease.The basic principles of conservative treatment include: 1) drug treatment with the use of analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), dehydration, vascular and phlebotonic agents, angioprotectors, antihypoxants, antioxidants, muscle relaxants, B vitamins, biostimulants, immunostimulants, neurotransmitters, desiccants , metabolites, anticholinesterase, absorbable and vegetotropic drugs; 2) reflex treatment using acupuncture, laser therapy, physiotherapy, massage (segmental), thermal procedures, physiotherapy exercises (exercise therapy), manual therapy, local irritants; 3) orthopedic treatment involving immobilization, traction therapy, massage, exercise therapy, manual therapy; 4) local anesthetic treatment with the appointment of chloroethyl irrigation, blockades, applications of Dimexidum, analgesic and anti-inflammatory ointments, gels, patches.

The first and fundamentally important task facing the doctor is the fastest and most effective relief of pain. NSAIDs are the most widely used drugs for symptomatic pain relief [27]. They are quite effective, easy to use, inexpensive and generally well tolerated. It should be noted that the effectiveness of NSAIDs as analgesics is determined not only by the peripheral action associated with a decrease in the synthesis of prostaglandins, as well as other mediators of pain and inflammation in damaged or inflamed tissues.

The most widely used NSAIDs are from the group of non-selective cyclooxygenase inhibitors (COX). The main recommendations for the use of NSAIDs (in monotherapy or in combination with other analgesic drugs): 1) their appointment is advisable for acute or chronic diseases and pathological conditions, manifested by pain associated with both inflammatory and degenerative lesions of the organs of the musculoskeletal system, acute trauma and surgery; 2) the duration of the use of NSAIDs depends on the duration and intensity of pain in a particular situation; 3) for the relief of acute pain syndrome, it is advisable to prescribe parenteral forms of NSAIDs or giving the most pronounced analgesic effect with a minimal risk of side effects; 4) with a long course of treatment, NSAIDs with a medium or long half-life are recommended orally or in the form of rectal suppositories.These drugs are characterized by a good analgesic and anti-inflammatory effect, provide a relatively rapid elimination of pain.

In modern medicine, the recognized standard for the treatment of diseases with severe pain syndrome is diclofenac, which is one of the most commonly prescribed pain medications. Like other NSAIDs, dilofenac inhibits the activity of the enzyme COX, which is involved in the formation of prostaglandins from arachidonic acid. Diclofenac also inhibits the activity of the lipoxygenase enzyme.According to Russian studies, with the simultaneous administration of diclofenac and B vitamins, a higher Cmax value was noted compared with the use of only diclofenac [28]. To increase the therapeutic effect of diclofenac, while minimizing its dose, with the help of B vitamins, a highly effective combined preparation Neurodiclovit was created, one capsule of which contains 50.0 mg of diclofenac, 50.0 mg of vitamin B1, 50.0 mg of vitamin B6 and 250.0 mcg of vitamin B12.B vitamins have a wide range of pharmacodynamic properties and are involved as coenzyme forms in most metabolic processes. It is known that thiamine (vitamin B1) has a significant effect on the regeneration of damaged nerve fibers, provides energy for axoplasmic transport, regulates protein and carbohydrate metabolism in the cell, affects the conduction of nerve impulses, and promotes the development of an analgesic effect. Pyridoxine (vitamin B6) is a cofactor for many enzymes acting in the cells of the nervous tissue, participates in the synthesis of neurotransmitters of the antinociceptive system (serotonin, norepinephrine), supports the synthesis of transport proteins and sphingosine, a structural element of the nerve fiber membrane.provides delivery of fatty acids for cell membranes and myelin sheath. Cyanocobalamin (vitamin B12) provides the delivery of fatty acids to cell membranes and myelin sheath. The use of vitamin B12 promotes not only remyelination (due to the activation of the transmethylation reaction, which ensures the synthesis of phosphatidylcholine of nerve cell membranes), but also a decrease in the intensity of the pain syndrome, which is associated with the intrinsic antinociceptive effect of high doses of cyanocobalamin [29]. Experimental studies have shown that vitamin B1 alone or in combination with vitamins B6 and B12 is capable of inhibiting the passage of pain impulses at the level of the posterior horns of the spinal cord and thalamus [30].B vitamins perform the function of coenzymes in metabolism, in particular in the nervous tissue, which enhances the analgesic effect of diclofenac. Using B vitamins in the treatment of pain syndrome, it should be remembered that their analgesic properties decrease accordingly: B12˃B6˃B1 and that the multivitamin complex (B1 + B6 + B12) has a more pronounced analgesic effect than monotherapy with vitamin B1, B6 or AT 12. In the treatment of acute back pain, the combination of B vitamins with NSAIDs is more effective than NSAID monotherapy [31].The drug is used for inflammatory and degenerative diseases of the joints and spine (chronic polyarthritis, rheumatic and rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, spondyloarthrosis). Neurodiclovitis has a low incidence of unwanted complications and good individual tolerance, which allows it to be recommended for widespread use in the treatment of patients with osteoarticular pain in the thoracic spine and chest.

The main therapeutic measures of individual forms are presented in table 1.

Table 1. Main treatment measures

Nosological form

Treatment activities

Tietze syndrome

Local warming procedures and the use of NSAIDs. With a high intensity of pain syndrome – infiltration of the affected joints with local anesthetics (0.25–0.5% novocaine solution), sometimes in combination with corticosteroids.

costo-sternum syndrome

Intercostal nerve blocks with local anesthetic in the posterior axillary line

sliding rib syndrome

Explaining to the patient the benign nature of the condition, NSAIDs, blockade with local anesthetics and corticosteroids.If the listed measures are ineffective, they sometimes resort to resection of the edge of the rib.

sternoclavicular hyperostosis

NSAIDs, warming physiotherapy and exercises aimed at strengthening the muscles of the back.

facet syndrome

Infiltration of the affected joints with a local anesthetic solution, warming the painful area and active physiotherapy aimed at strengthening the muscles of the abdominal wall and the muscle that straightens the spine.


Literature:

1. Statistisches Bundesamt. Health report for Germany: Federal Health Bulletin. Wiesbaden: Metzler-Poeschel; 1998.
2. Putilina M.V. Features of diagnosis and treatment of dorsopathies in neurological practice. Consilium medicum: An evidence-based journal for medical practitioners. 2006; 8 (8): 4448.
3. Fedin A.I. Dorsopathies (classification and diagnosis). Atmosphere.Nervous diseases. 2002; 2: 28.
4. Manek N., MacGregor A.J. Epidemiology of low back disorders. Curr. Opin. Rheumatol. 2005; 17 (2): 134140
5. Naumov A.V., Semenov P.A. Pain in Russia: facts and conclusions. Consilium Medicum 2010; 12 (2): 38–41.
6. Buchner M., Neubauer E., ZahltenHinguranage A., Schiltenwolf M. Age as a predicting factor in the therapy outcome of multidisciplinary treatment of patients with chronic low back pain a prospective longitudinal clinical study in 406 patients.Clin. Rheumatol. 2007; 26: 385392.
7. Hainline B. Chronic pain: Physiological, diagnostic, and management considerations. Psychiatr Clin North Am. 2005; 28: 713-5.
8. Morley S. Psychology of pain. Br J Anaesth. 2008; 101: 25-31.
9. Costigan M., Scholz J., Woolf C. J. Neuropathic pain: A maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009; 32: 1-32.
10. Handbook on the formulation of the clinical diagnosis of diseases of the nervous system / Ed.V.P. Stock, O.S. Levin. – M .: MIA, 2006 .– 520 p.
11. Ivanova M.F., Evtushenko S.K. Dorsalgia due to degenerative dystrophic pathology of the spine. News of medicine and pharmacy. 2010; 15 (335): 1617.
12. Pain (a practical guide for doctors) / Ed. N.N. Yakhno, M.L. Kukushkina. – M .: Publishing house of the Russian Academy of Medical Sciences, 2011 .– 512 p.
13. Damulin I.V. Back pain: diagnostic and therapeutic aspects. – M .: RKI Severo press, 2008 .– 40 p.
14. Mendel O.I., Nikiforov A.S. Degenerative diseases of the spine, their complications and treatment. Russian medical journal. 2006; 14 (4): 34-39.
15. Shostak N.A. Modern approaches to the treatment of pain in the lower back. Consilium medicum. 2003; 5 (8): 457-461.
16. Khodyrev V.N., Golikova L.G. Clinical efficacy of alflutop in spinal osteochondrosis (12-month study). Scientific and practical rheumatology. 2005; 2: 33-36.
17.Zborovskiy A.B., Brain E.E. Alflutop: experience of many years of clinical use. Pharmateca. 2006; 19: 35-40.
18. Mense S. Pathophysiology of low back pain and transition to the chronic state – experimental data and new concepts. Schmerz. Der. 2001; 15: 413-420.
19. Kamchatov P.R. Acute spondylogenic dorsalgia is a conservative therapy. Russian medical journal. 2007; 15 (10): 64-74.
20. Golubev V.L. Neurological Syndromes: A Guide for Physicians / Ed.V.L. Golubeva, A.M. Wayne. – 2nd ed., Add. and revised – M: MEDpress-inform, 2007 .– 736 p.
21. Podchufarova E.V. Chronic back pain: pathogenesis, diagnosis, treatment. Russian medical journal. 2003; 11 (25): 1395-1401.
22. Danilov A.B. Cardialgia and abdominalgia. Pain syndromes in neurological practice / Ed. Veyna A.M. – M .: Medpress-inform, 2001.
23. Khabirov FA Clinical neurology of the spine. – Kazan, 2003 .– 472 p.
24.Podchufarova E.V., Yakhno N.N. Pain in the back and extremities // Diseases of the nervous system: A guide for doctors / Ed. N.N. Yakhno. – M., 2005 .– T. 2.
25. Bonomo L., Fabio F., Larici A.R. Non-traumatic thoracic emergencies: acute chest pain: diagnostic strategies. Eur. Radiol. 2002; 12: 1872-85.
26. Ho K.Y., Kang J.Y., Yeo B. Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors. Gut. 1998; 43: 105-10.
27. The use of non-steroidal anti-inflammatory drugs: Clinical guidelines.Nasonov E.L., Lazebnik L.B., Belenkov Yu.N. et al. M .: Almaz, 2006.
28. Zhuravleva M.V., Makhova A.A., Shikh E.V. Place of milgamma in the complex therapy of back pain. Pharmateca. 2013; 19: 1-4.
29. Zaichenko A.V., Barinov A.N., Makhinov K.A., Bryukhanova T.A. Treatment of NSAID refractory back pain Medical advice. 2013; 12: 2-8.
30. Pizova N.V. Milgamma and Milgamma compositum in the treatment of neurological diseases. Neurology, neuropsychiatry and psychosomatics.2009; 3-4: 75-81.
31. EF. Neurology and Psychiatry. 2012; 4: 1-7.

Treatment of rib contusion

A bruised rib is damage to the soft tissues of the chest as a result of a strong blow. At the same time, the integrity of the skin and bones is preserved.

With regard to the severity of such an injury, the purpose of the ribs is precisely to protect internal organs from damage. However, such a bruise is always particularly painful, and sometimes it can be accompanied by the development of a serious illness.

Symptoms of a bruised rib

  • intense pain syndrome;
  • shortness of breath;
  • discomfort during movement;
  • edema;
  • hematoma formation;
  • bruise;

Features of the treatment of rib contusion

After receiving an injury, the victim must be kept at rest and during the first few days to remain in bed, so as not to provoke an increase in pain.Applying cold immediately is recommended to stop internal bleeding and reduce swelling.

If there is complete confidence in the absence of a fracture or fracture of the rib, then a bandage can be applied. A person without relevant experience is unlikely to be able to do it correctly, so many go to the doctor.

After about two days, you should change the cold to warm compresses, which will help resorb the hematoma. Regenerating, pain relieving and antipyretic drugs can be used if necessary.

Only after the pain sensations have subsided, should the stretching exercises begin gradually.

All these measures are appropriate if the contusion was mild. Otherwise, for example, after a strong blow, when the pain does not stop for a long time, a high temperature persists, the victim has difficulty breathing or unnatural dents and protrusions are noticeable at the site of the injury, it is better to go to a medical institution.

The specialist will conduct an examination, direct the patient to an X-ray, and then prescribe a treatment complex.Perhaps the fears will turn out to be in vain, but on the other hand, it will be possible for certain to exclude serious consequences.

Elimination of the consequences of a severe injury

Sometimes the diagnosis after a bruised rib can reveal a fracture, fissure or the development of hemopneumothorax.

  1. A fracture can damage the pleura and lung. In the case of prolonged swelling, a puncture is used to remove fluid (with hemothorax) or air (with pneumothorax) from the pleural cavity. If clotting blood in the area of ​​the hematoma interferes with this, then surgical intervention is performed to eliminate such accumulations.
  2. If a crack is detected, then a pressure bandage is not applied, but other standard methods of treatment are used, For example, physiotherapy procedures (UHF, electrophoresis, sollux, dry heat). It is important to make sure that there is no bleeding in the chest.
  3. Pneumonia can occur after an infection enters the lung if the injury has resulted in prolonged inflammation. In this case, antibiotics are used.

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90,000 Intercostal neuralgia.Causes, symptoms and treatment of intercostal neuralgia. A.P.K.T.M. “MEDKINETICA” Intercostal neuralgia
Intercostal neuralgia is a condition that causes pain along the course of the intercostal nerves. Intercostal nerves are located between the ribs. Ribs
high temperature (fever)
itching
numbness
pain in the arm, shoulder, or back
limited mobility in the shoulders or back
tingling
sweating, skin redness
Serious symptoms of intercostal neuralgia Intercostal neuralgia can lead to severe, debilitating pain that makes breathing difficult.In addition, chest pain is caused not only by intercostal neuralgia, but also by other conditions that should be immediately evaluated by emergency care professionals. As mentioned above, a heart attack can cause symptoms similar to those of intercostal neuralgia. Get immediate medical attention (call 112 or 03) if you or someone else has unexplained, severe chest pain or any of the following symptoms: chest or rib pain that can spread to the left arm, jaw, shoulder, or back
chest pressure, cramps, tightness, or a “tearing” feeling in the chest
cough with yellow-green phlegm (mucus)
heart palpitations breathing problems such as severe shortness of breath, difficulty breathing, shortness of breath, or inability to breathe “deeply”
severe abdominal pain
severe chest pain when breathing or coughing
sudden confusion of consciousness, dizziness, or a change in the level of consciousness, for example, imperviousness to reality.Causes of intercostal neuralgia Shingles as a cause of intercostal neuralgia Intercostal neuralgia can be caused by various
intercostal nerve provocation nerve degeneration
neuritis (inflammation of a nerve or group of nerves)
pregnancy that can lead to expansion of the chest; deformity of muscles in the wall of the chest, shoulders, back, or arm
rib infection
shingles (reactivation of the varicella-zoster virus)
surgery of organs, bones and tissues in the chest cavity, such as the kidneys, ribs and spine
swelling in the chest and abdomen that can press on the intercostal nerves
Risk factors for intercostal neuralgia A number of factors increase the risk of developing intercostal neuralgia: infection with the varicella-zoster virus, the virus that causes chickenpox, and shingles
participating in sports that require high speeds or contact with other athletes, such as skiing, snowboarding, football, hockey, basketball, wrestling and rugby
unsafe driving and road accidents that can injure the ribs and intercostal nerves
How to reduce your risk of intercostal neuralgia These healthy lifestyle habits can help prevent intercostal neuralgia and the injuries that can lead to it: Safe driving using seat belts in your car
childhood chickenpox vaccination
shingles vaccine if you are 60 years of age or older
use of protective sports equipment.Intercostal neuralgia treatment Treatment of intercostal neuralgia complications Intercostal neuralgia may resolve on its own or may require treatment. Treatments include: blockage of intercostal nerves
Manual Therapy
acupuncture
massage therapy
KINESITERAPY
Potential Complications of Intercostal Neuralgia Complications of untreated or poorly controlled intercostal neuralgia vary with the underlying disease, disorder, or condition. Any kind of chest pain
chronic breathing problems
persistent stiffness and reduced range of motion in the back or shoulders
pneumonia
postherpetic neuralgia Disclaimer: The information provided in this article about intercostal neuralgia is for informational purposes only and should not be a substitute for consultation with a healthcare professional.MEDKINETICA TEAM
Kishinev,
st. Rose Valley 18,
Info -… – Medkinetica Asociația Kinetoterapeuților şi Terapeuţilor Manuali

Intercostal neuralgia. Causes, symptoms and treatment of intercostal neuralgia. A.P.K.T.M. “MEDKINETICA”

Intercostal neuralgia
Intercostal neuralgia is a disease that causes pain along the intercostal nerves. Intercostal nerves are located between the ribs. Ribs are long, thin bones around the chest that create the rib cage. The top 10 ribs on both sides of the body are attached to the thoracic spine and sternum.The bottom two ribs attach to the spine but not the sternum. These ribs are sometimes called “floating”. The intercostal area between the ribs contains muscles and nerves. These intercostal nerves can be compressed, damaged, or inflamed due to various diseases, disorders and conditions, which leads to intercostal neuralgia.

What is intercostal neuralgia. General facts

Intercostal neuralgia can cause sporadic attacks of acute pain or pain that is mild and persistent.Patients describe their pain in intercostal neuralgia in different ways: stabbing, sharp, burning, aching, spasmodic … But, as a rule, this pain “flows around” the upper part of the chest, which can be considered a common sign of intercostal neuralgia. The pain may worsen with exertion or sudden movements involving the upper chest, such as coughing or laughing.

Intercostal neuralgia is often associated with damage or inflammation of nerves, muscles, cartilage, and ligaments in the chest and mid-spine.Common causes of intercostal neuralgia include chest or rib injuries, chest or chest surgery, shingles, pregnancy, and tumors. The herpes virus can attack nerves in the chest and upper back.

Intercostal neuralgia can be preventable and can often be successfully treated. See your doctor for surgery for intercostal neuralgia to minimize your risk of developing herpes zoster, one of the common causes of intercostal neuralgia, and to diagnose and treat other causes.

In some cases, intercostal neuralgia can lead to severe, debilitating pain that makes it difficult to move and breathe effectively. In addition, chest pain can be caused by conditions unrelated to intercostal neuralgia, which should be assessed immediately by emergency care professionals. Heart attack is one example. Get medical help right away if you or someone near you develops unexplained, severe chest pain, chest pain, chest pressure, severe shortness of breath, difficulty breathing, or a change in consciousness.

What are the symptoms of intercostal neuralgia?

Pain in the heart can be a symptom of intercostal neuralgia

The main symptom of intercostal neuralgia is chest pain, it is often described as stitching, sharp, spasmodic, pulling, burning, aching. The pain can be localized around the chest or go from the back to the front of the chest. Sometimes the symptoms of intercostal neuralgia are expressed as pain that is evenly distributed along the entire length of the ribs.Pain with intercostal neuralgia can radiate to the scapula, neck, arm, lower back, and even the heart.

Symptoms of intercostal neuralgia often occur as sporadic episodes of acute pain, or the pain may be dull and persistent. Intercostal neuralgia pain may worsen with exertion. It includes routine activities such as lifting heavy objects, twisting or twisting the torso, coughing, sneezing, or laughing.

Intercostal neuralgia may present with other symptoms, including:

abdominal pain
high fever (fever)
itching
numbness
arm, shoulder, or back pain
limited mobility in the shoulders or back
tingling
sweating, redness of the skin
Serious symptoms of intercostal neuralgia

Intercostal neuralgia can cause severe, debilitating pain that makes breathing difficult.In addition, chest pain is caused not only by intercostal neuralgia, but also by other conditions that should be immediately evaluated by emergency care professionals. As mentioned above, a heart attack can cause symptoms similar to those of intercostal neuralgia. Get immediate medical attention (call 112 or 03) if you or someone else has unexplained, severe chest pain or any of the following symptoms:

chest or rib pain that may spread to the left arm, jaw, shoulder or back
chest pressure, cramps, tightness, or a “tearing” feeling in the chest
cough with yellow-green phlegm (mucus)
heart palpitations
breathing problems such as severe shortness of breath, difficulty breathing, shortness of breath, or inability Breathe deeply
Severe abdominal pain
Severe chest pain when breathing or coughing
Sudden confusion, dizziness, or a change in the level of consciousness, for example, insensibility to reality.
Causes of intercostal neuralgia

Shingles as a cause of intercostal neuralgia

Intercostal neuralgia can be caused by various causes – from mild to serious diseases, disorders and conditions. The causes of intercostal neuralgia include infections, inflammation, trauma, malignant tumors, and other pathological processes. A common cause of intercostal neuralgia is surgery that involves the chest, which often damages the intercostal nerves.

Causes of intercostal neuralgia include:

Injuries to the chest or ribs, such as a broken rib or bruised chest
Provocation of intercostal nerves
Degeneration of nerves
Neuritis (inflammation of a nerve or group of nerves)
Pregnancy that can lead to enlargement of the chest cells
deformation of muscles in the wall of the chest, shoulders, back or arm
infection of the ribs
shingles (reactivation of the varicella-zoster virus)
surgery of organs, bones and tissues in the chest cavity such as kidneys, ribs and spine
tumors in the chest and the abdomen, which can press on the intercostal nerves – both malignant (cancerous) and benign (noncancerous).
Risk factors for intercostal neuralgia

A number of factors increase the risk of developing intercostal neuralgia:

infection with varicella-zoster virus, a virus that causes chickenpox and shingles
participating in sports that require high speeds or contact with other athletes, such as skating skiing, snowboarding, football, hockey, basketball, wrestling and rugby
unsafe driving and road accidents that can injure ribs and intercostal nerves
How to reduce the risk of intercostal neuralgia

These healthy lifestyle habits can help prevent intercostal neuralgia and injuries that can lead to it:

Safe driving
Using seat belts in a car
Chickenpox vaccination in childhood
Shingles vaccination if you are 60 years of age or older
Use protective sports equipment.
Treatment of intercostal neuralgia

Treatment of complications of intercostal neuralgia

Intercostal neuralgia may resolve on its own or may require treatment. Treatments include:

Intercostal nerve blockade – injections of anesthetic or corticosteroids around the affected nerve
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, indomethacin. NSAIDs help reduce inflammation and pain in intercostal neuralgia.

Alternative treatments for intercostal neuralgia

Several additional treatments may help some people better manage their symptoms of intercostal neuralgia.These treatments are sometimes referred to as alternative therapies and are used in conjunction with traditional medical procedures. Alternative treatments do not mean abandoning traditional treatments for intercostal neuralgia.

Additional treatments may include:
Manual Therapy
Acupuncture
Massage Therapy
KINESITHERAPY
Potential Complications of Intercostal Neuralgia

Complications of untreated or poorly controlled intercostal neuralgia vary depending on the underlying disease, disorder or condition.Any kind of chest pain, whether it occurs alone or is accompanied by other symptoms, should be evaluated by a physician. After the main cause of intercostal neuralgia has been identified, the treatment plan must be strictly followed, which will minimize the risk of complications of intercostal neuralgia and its root cause. These complications of intercostal neuralgia include:

Chronic rib pain, chest pain, weakness, or muscle stiffness
Chronic breathing problems
Constant stiffness and reduced range of motion in the back or shoulders
Pneumonia
Postherpetic neuralgia

Disclaimer: The information provided in this article on intercostal neuralgia is for informational purposes only and should not be used as a substitute for consultation with a healthcare professional.

MEDKINETICA TEAM
Chisinau,
st. Valley of Roses 18,
Info – 060508858.

Where the cunning intercostal neuralgia hides / Health / Nezavisimaya gazeta

In medical practice, there are often cases when a true ailment is disguised as other diseases

Often a spasm becomes a harbinger of an ailment. Photo Depositphotos / PhotoXPress.ru

The term “neuralgia” translated from Greek means intense pain spreading along the trunk of the nerve or its branches.Let’s say a person thinks that he is worried about pain in the heart, and as a result of the examination it turns out that he has intercostal neuralgia. In this case, it is caused by irritation or compression of the nerves located between the ribs.

The cause of intercostal neuralgia can also be trauma in the chest and back, sudden physical exertion, prolonged stay in an uncomfortable position or in a draft. The provoking factors include hypothermia, stress, metabolic disorders, deficiency of B vitamins, colds and flu.In all these cases, a focus of inflammation is created in the chest.

The main symptom of the disease is pain. But often a harbinger of an ailment is a spasm in the chest area, which many people do not attach serious importance to. And the pain – burning or aching – comes later. It spreads along the intercostal spaces and can be paroxysmal or constant. An important diagnostic feature is its spasmodic nature. In addition, it can be targeted, for example, it makes itself felt in the region of the heart, under the scapula or in the lower back.Of the accompanying symptoms, tension and twitching of the back muscles, numbness along the intercostal nerves, redness or, conversely, pallor of the skin should be noted.

Intercostal neuralgia is also called a “cunning” disease. The fact is that, depending on the location of the pain, it can, for example, mimic lung disease, shingles, or even renal colic. But it is especially often confused with angina pectoris, a form of coronary heart disease. What is important to know in this regard?

With neuralgia, chest pain often does not let go of a person, day or night.It is localized to the right or left between the ribs, has a point or small area manifestation (a person can indicate with his finger where it hurts), intensifies when probing the intercostal spaces, changing body position, walking, breathing deeply or exhaling, coughing, sneezing.

Another thing is an attack of angina pectoris, which is often caused by physical exertion, lasts about 10-15 minutes and disappears after taking the medication prescribed by the doctor. Heart pain, as a rule, is localized in the center of the sternum, sometimes radiates to the left hand, but unlike neuralgic pain it does not have a point character.For example, if you ask a person where his pain is, he will point to the entire chest area. In addition, pain in angina pectoris does not change with deep inhalation and exhalation, does not depend on changes in body position or movement.

To what has been said, we add that only a doctor can recognize this or that ailment, who should be consulted in any case.

Diagnosis of intercostal neuralgia includes a blood test, ECG, X-ray, and, if necessary, computed tomography.Based on the results of these studies, the doctor will make an accurate diagnosis and prescribe the appropriate treatment. As a rule, it is complex and is aimed primarily at the treatment of the underlying disease, for example, osteochondrosis or herniated disc.

If the cause of intercostal neuralgia is a cold or shingles, it is these diseases that are treated. As for the regimen that the patient must observe, in the acute period of intercostal neuralgia, he is recommended to bed rest for 1-3 days.It is advisable to lie on a firm and level surface, for which you can put a wooden shield under the mattress.

Drug therapy includes, in particular, pain relievers and anti-inflammatory drugs, which are prescribed by a doctor. The use of dry heat gives a good effect. For this purpose, you can bandage the chest with a woolen scarf. The complex of treatment methods also includes massage, manual and acupuncture, various physiotherapy procedures.

The recommendations of traditional medicine are also used, for example, indoor geranium, which relieves pain well.To do this, a leaf of this plant must be rubbed into a sore spot, and then tied with a woolen scarf on top. Rubbing fresh horseradish juice or black radish into the skin along the inflamed nerve roots also helps to reduce pain.

Prevention of intercostal neuralgia – physical exercises that develop muscles and strengthen the spine, as well as swimming. Hypothermia, prolonged stay in an uncomfortable position, excessive physical exertion should be avoided, especially for the elderly.And, of course, eat rationally, not forgetting to include in the diet foods rich in B vitamins.

Thoracic OSTEOCHONDROSIS

Pain in the thoracic spine

What should I do now to make the pain in the thoracic spine go away?

What not to do in case of pain in the thoracic spine

Treatment of thoracic osteochondrosis

Pain in the thoracic spine

There are various variants of how the problems in the thoracic spine are called.Most often one has to deal with such “free terms”: thoracic degenerative disc disease, chest degenerative disc disease of the spine, degenerative disc disease of the thoracic region.

Still, the only scientific term that most deeply reflects the essence of the disease sounds like this:

Osteochondrosis of the thoracic spine

You have probably already looked through a lot of material on the Internet at the request “ chest osteochondrosis ” and encountered with the most general information on this issue.As you read this web page, you will understand the most important thing – how to start SOLVING the problem right NOW from the first independent steps in the question of “how to help yourself” to going to the doctor.

The material of the article itself is selected in such a way that it covers the most diverse symptoms of chest osteochondrosis . Further, the causes of these symptoms and the ways to solve them are described in detail and clearly. symptoms of thoracic osteochondrosis include: pain in the thoracic spine, aching and sharp pains in the ribs, constant pain under the ribs, situations when the ribs hurt and nothing helps, localized pain (it hurts under the left rib, pain under the left shoulder blade, it hurts under right rib, pain under the right shoulder blade), constant pain between the shoulder blades, situations when it hurts between the shoulder blades when moving or periodically hurts under the shoulder blade, intercostal neuralgia.

In the vast majority of cases, they occur in people who lead a sedentary lifestyle. In this case, it is useful to undergo a course of lymphatic drainage massage to accelerate lymph flow.

As you yourself understand, such people are in the majority, and their professions are very different: programmers, accountants, doctors, teachers, drivers, you can list for a very long time …

What is the nature of the pain in the thoracic region?

Pain, usually pulling or aching, there is a feeling of a “protruding wedge” in the thoracic back.Often only the feeling of discomfort and tension worries, it is very annoying and very soon there is an intolerable desire to get rid of it in any way!

What should I do NOW so that the PAIN in the chest region goes away?

1. Exercise roller. Put your hands around your shins, bend your back so that your forehead approaches your knees. We make rhythmic rolls back and forth on the back. On exhalation – backward, on inhalation – forward. Number of repetitions: 7 – 10 times.

2. Swallow . The position of the body is lying on the stomach. We make a small movement with the pelvis forward and tuck the tailbone under us. The navel is pressed to the floor. Maintain the stretch with the crown. Bring your legs together and extend your arms along your torso. Raise your arms, head, neck, shoulders, and torso as high off the floor as possible. We lift without jerking. Breathing in this asana is measured: long inhalation and long exhalation. Fixation time is 2 minutes.

More difficult variation of the asana with arms behind the back and raised straight legs:

The most difficult variation of the asana with arms forward:

Optimal fixation time for the asana with arms forward: 1 minute.

3. Plow position. From a supine position, slowly, helping with your hands, throw your legs over your head. The legs are bent at the knee joints. MOST IMPORTANT: the main focus is on the thoracic spine and shoulders! Any additional pressure on the neck must be eliminated. The neck is relaxed. Free breathing. Exit from the asana: holding the pelvis with your hands, slowly, vertebra by vertebra, lower your back to the floor. Fixation time is 30 seconds.

4. Pulling up on the horizontal bar

To work out the back muscles, pull yourself up with a straight grip (palms look “from the face”), hands are shoulder-width apart (the so-called “medium grip”).

The effectiveness of the exercise largely depends on the correct pull-up technique. Just imagine, in one high-quality approach you can relieve yourself of chest pain! Quality comes first! It is important to thoroughly follow the principles listed below:

– The pull-up should be done without jerking or swinging.

– the ascent, as well as the descent, are quite smooth and the same in time.

– On the rise – exhale. During the ascent, it is necessary to bring the shoulder blades together.

– At the peak of the lift, the chin is above the bar, the upper chest touches the bar.

– On the descent, inhale. At the end of the descent, arms should be fully extended.

– Throughout the entire exercise, you should maintain a strictly vertical position without hesitation.

Only the quality of the exercise is important! It is better to do it 1 time, following all the instructions, than 10 times somehow.

Another great way to relax and stretch your thoracic spine on your own is to simply hang on the bar.From 30 seconds, and further – the longer the better.

What DON’T DO for pain in the thoracic spine

You can’t twist and “crunch” your vertebrae on your own! When discomfort or fatigue appeared in the thoracic spine, you most likely also did this: hands in front of you into the lock, and then with a sharp jerk, turn the body first to the right and then to the left. Yes, so that everything that can be crunched!

By doing this, you are not solving the problem, you are exacerbating it.And even if instantly you feel some relief, then after a while your back will hurt even more.

One of the fundamental laws of the biomechanics of the spine sounds like this:

“The mobility of the thoracic spine is extremely low, especially in comparison with the mobility of the cervical and lumbar spine” …

This means that any sharp turns of the body will lead to blocking of the joints between adjacent vertebrae, as well as between vertebrae and ribs.Blocking a joint is limiting the range of motion. Blocking alone will not be enough. To it will be added more sprains of small ligaments and spasm of the paravertebral muscles.

Why is the range of motion in the thoracic spine so small and why is it normal?

First, the thoracic spine has the thinnest intervertebral discs. It is the thickness of the intervertebral discs that is one of the determining factors of the mobility of the vertebrae relative to each other.

Secondly, the spinous processes of the thoracic vertebrae are found on top of each other like shingles:

Thirdly, the thoracic vertebrae form joints with the ribs, which further reduces the amplitude of their movements:

As you can see in the picture, the upper half of the rib joins one vertebra, and the lower half of the rib joins the other.Now imagine what would happen to the rib if the vertebrae were “shaking”?

The low mobility of the thoracic region contains the Wisdom of Nature: after all, then the frame of the chest turns out to be stably fixed, which is vitally important to protect the heart and lungs from injury.

Who else wants to “crunch the thoracic vertebrae” on a grand scale?

Treatment of chest osteochondrosis

Pay attention to the nature of pain in chest osteochondrosis!

Unlike pain in the neck or in the lower back, pain in the thoracic spine is almost never of the “lumbago” type, that is, dagger-sharp pains when it wedges in one position, and it is impossible to turn, bend, or straighten …

This is due to the natural inactivity of the thoracic spine. And since the range of motion in the thoracic region is so small, the likelihood of herniation of intervertebral discs tends to zero. And if there are no hernias, then there will be no pinching of the nerves, and as a result, there will be no lumbago, dagger pains and fading in one position.

Pain in the thoracic spine is a consequence of muscle clamps!

While lower back and neck pains are often caused by problematic intervertebral discs.If so, then

The best treatment for thoracic osteochondrosis is therapeutic massage and manual muscle relaxation techniques!

The picture below shows the most common trigger points (muscle clamping points) not only of the thoracic spine, but also of the entire back!

When treating thoracic osteochondrosis, it is important to clearly understand all the anatomical features of this section, the specifics of the biomechanics of the vertebrae and ribs, the relationship of the spinal nerves and internal organs.

There are a lot of nuances and details, so you should only contact a certified chiropractor.

Treatment of thoracic osteochondrosis is performed without chemicals, using the most gentle, gentle, gentle techniques. Many years of experience have shown that after the first session the pain in the thoracic region is relieved by 80 – 1000% .

Elimination of muscle spasm is the central link in the treatment of chest osteochondrosis. The best work with muscle clamps is myofascial manual techniques, post-isometric relaxation, as well as kneading and rubbing techniques from the classic therapeutic massage using warming ointments.By the end of the first session, many literally feel how a heavy load falls from their shoulders, a pleasant feeling of warmth and lightness spreads over the entire back.

Learn more about the nuances of back and spine treatment.

The author of the article is Dr. Atroshchenko I.N.

To register for a massage and manual therapy session
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(846) 272 – 28 – 82

Caution: thoracic osteochondrosis – Management health care of the Tambov region

Thoracic osteochondrosis is less common than other types of disease – cervical and lumbar osteochondrosis due to the least mobility and the greatest protection due to muscles and ribs.However, if you do not pay attention to this disease in time, it can lead to serious consequences. Specialists of the Tambov Region Medical and Physical Training Dispensary spoke in detail about how to recognize thoracic osteochondrosis, as well as measures to prevent this ailment.

Signs of chest osteochondrosis:

1. chest pain, worse at night, with a long stay in one position of the body, with hypothermia, bending to the side and turning, with great physical exertion;
2.interscapular pain when the right or left arm rises;
3. pain worsens with deep breathing;
4. Pain between the ribs while walking;
5. A feeling of squeezing in the chest and back.
Pain during an exacerbation of the disease may last for several weeks.

There are additional symptoms of thoracic osteochondrosis:

– individual areas of the skin become numb;
– cold feet, sometimes burning and itching;
– skin flakes, nails break;
– pain in the pharynx and esophagus;
– the digestive organs do not work well.

Thoracic osteochondrosis has two symptoms – dorsago and dorsalgia.
Dorsago is a sharp, sharp pain in the chest. Occurs after monotonous work in the same position. When an attack occurs, it becomes difficult to breathe, and if the upper body rotates, the pain increases.
Dorsalgia – not severe pain in the area of ​​the affected intervertebral discs, begins gradually and lasts up to 2-3 weeks. The sensations of pain intensify when breathing deeply, at night and there may be a lack of air.It passes after a short walk.

Causes of thoracic osteochondrosis:

– computer work;
– frequent driving;
– received injuries of the spine;
– weak back muscles;
– scoliosis and other posture disorders.

What is the danger of chest osteochondrosis:

If the treatment is not timely and incorrect, then osteochondrosis of the thoracic spine can cause the following diseases:
– protrusion and hernia of the thoracic spine;
– spinal cord compression;
– problems with the heart, intestines, liver, kidneys and pancreas;
– disorders in the duodenum, intestinal motility, gallbladder dyskinesia;
– Intercostal neuralgia – compression or irritation of the intercostal nerves.
What can be confused with osteochondrosis of the chest
Due to the variety of symptoms, it is easy to confuse it with the following diseases:
– angina pectoris, heart attack. Difference: after taking heart medications, chest pains do not go away, the patient’s cardiogram is normal;
– appendicitis, cholecystitis, renal colic;
– gastritis, ulcer, colitis;
– pathology of the mammary glands;
– pneumonia. Inflammation of the lungs is distinguished from osteochondrosis by cough, shortness of breath and fever.
Prevention of chest osteochondrosis
We recommend for the prevention of the disease:
– lie down for 40-50 minutes during the day – relieves the load from the spine;
– change your position every 2 hours, get up from a chair, do 2-4 tilts in different directions, stretch, straighten your shoulders if the work is sedentary;
– it is advisable to do water sports: swimming, diving, water aerobics;
– try not to overcool, keep your back warm;
– regularly do physiotherapy exercises (exercise therapy).

Exercise therapy is an effective way to form a strong muscle corset, thanks to which you can avoid recurrence of the disease in the future. It is possible to increase the mobility of the thoracic spine, to increase the range of motion in the joints: both in the intervertebral and in the costal-vertebrates;
ensure correct deep breathing; develop and strengthen the muscles of the shoulder girdle; strengthen the muscles of the back, restore physiological curves and form the correct posture, thereby reducing the load on the spine and intervertebral discs; eliminate the stiffness of the deep muscles of the back; strengthen the respiratory muscles; improve ventilation of the lungs; prevent possible complications.
Exercise therapy affects the improvement of pulmonary ventilation – this is very important for patients who are afraid to take a deep breath, since a deep breath provokes severe back pain. The presence of such a connection forces patients to gradually reduce the depth of the entrance, hypoventilation (insufficient ventilation) of the lower parts of the lungs is obtained, which can provoke the development of pneumonia and a number of other pulmonary pathologies.