Slipping Rib Syndrome – Physiopedia

Original Editor – Jeroen Verwichte

Top Contributors – Tessa de Jongh, Laura Van Der Perren, Areeba Raja, Ine Wittevrongel, Kim Jackson, Gwen Wyns, Jeroen Verwichte, Lucinda hampton, Evan Thomas, Anouk Van den Bossche, Joao Costa, Claire Knott and Khloud Shreif

Contents

• 1 Introduction
• 2 Epidemiology
• 3 Clinically Relevant Anatomy
• 4 Pathophysiology
• 5 Etiology
• 6 Risk Factors
• 7 Clinical Presentation
  • 7.1 Signs and Symptoms
• 8 Physical Examination
• 9 Diagnostic Procedures
• 10 Outcome Measures
• 11 Differential Diagnosis
• 12 Management
  • 12.1 Non-conservative Management
  • 12.2 Conservative Management
    • 12.2.1 Activities to Avoid
    • 12. 2.2 Oral Medications
  • 12.3 Intercostal Nerve Blocks
• 13 Physical Therapy Management
• 14 Clinical Bottom Line
• 15 References

Slipping rib syndrome (SRS) is characterized by pain in the lower chest or upper abdominal region caused by intercostal nerve impingement as a result of abnormal movement of false ribs (8-12) related to unstable costal cartilaginous attachments^[1][2][3]

Slipping rib syndrome goes by many names, including:

• Clicking rib
• Displaced ribs
• Rib tip syndrome
• Costal margin syndrome
• Floating rib syndrome
• Nerve nipping
• Painful rib syndrome
• Slipping-rib-cartilage syndrome
• Gliding ribs
• Traumatic intercostal neuritis
• Twelfth rib syndrome
• Cyriax syndrome
• Interchondral subluxation, among others.^[1][4][5]

Slipping rib syndrome is a rare condition that affects both men and women of all ages. A review of slipping rib syndrome by Gress et al states that the available evidence relating to the epidemiology is often conflicting and anecdotal.^[6]

• It is considered to be a rare syndrome and accounts for approximately five percent of all musculoskeletal chest pain in primary care. ^[1][7]
• May occur at any age, more common in middle-aged women, and is a relatively uncommon, but recognized cause of recurrent lower chest and/or upper abdomen pain in adolescents. ^[8][9][10]
• It’s been reported in people as young as 7 years and as old as 86, but it mostly affects middle-aged people.^[1][4]

Clinically Relevant Anatomy[edit | edit source]

The slipping rib syndrome is a condition affecting the false ribs.

There are 3 types of ribs:

• Ribs which are attached to the sternum by costosternal joints and ligaments (true ribs – 1-7th)
• Ribs which are connected to each other through a weaker cartilaginous or fibrous band (false ribs – 8-10th)
• Ribs which aren’t attached to the sternum or to each other (floating ribs – 11-12th)

The condition arises from hypermobility of the anterior ends of the false rib costal cartilages, which often leads to slipping of the affected rib under the superior adjacent rib. This slippage or movement can lead to an irritation of the intercostal nerve, strain of the intercostal muscles, sprain of the lower costal cartilage, or general inflammation in the affected area. Because of their weak connection, there is increased mobility and greater susceptibility to trauma ^[11][12]. Anterior rib hypermobility is also likely to cause problems in the posterior thoracic area, because it’s a closed system ^[11].

Image: False ribs (highlighted in green) – posterior view ^[13]

Subluxation of the rib tips caused by disrupted articulation causes ends of ribs to curl up inside and impinge on the intercostal nerves.  The impingement causes the pain as the result of repeated irritation of the intercostal nerves.^{[7][14][15][16][17]}

It can be caused by:

• Congenital anomaly of the chest wall^[14]
• The destruction of the fibrous articulation of the rib or their cartilage portion^[14]
• Hypermobility of the costal cartilages of the false ribs^[4][7]

Following factors can contribute to the risk of developing SRS^[4]

• overuse
• direct trauma that causes the pain.
• Sudden extension or flexion, repeated one-sided weight bearing or exercise such as throwing a ball, vigorous swimming, or swinging a bat.

Slipping rib syndrome is presented through the following characteristics ^{[11][15][18][19]}

• Intense pain in the lower chest or upper abdomen above the costal margin, mostly at the height of the 8th, 9th and 10th ribs (false ribs).
• A tender spot on the costal margin
• Reproduction of the pain by pressing the tender spot or by external influences
• Signs and symptoms are usually unilateral, however there are also cases where patients reported bilateral pain.

Signs and Symptoms[edit | edit source]

Following signs and symptoms can be observed:^{[4][14][8][11][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]}

• Upper abdominal and lower anterior chest wall pain.
• Flank pain
• Tenderness over the affected costal margins
• Clicking, popping or slipping sensation can also be present.
• Pain was preceded by certain activities such as sitting, leaning forward, and interestingly she found that using a swing machine was especially likely to produce discomfort.
• Pain associated with slipping rib syndrome has distinct characteristics which can be used in identifying the syndrome:
  • Intermittent sharp stabbing pain followed by a constant monotonous pain that may last from several hours to many weeks.
  • Range of severity of pain varies from being a minor nuisance, moderately severe to interfering with activities of daily living.
  • May also be reported to radiate from the costochondral area to the chest or to the same level in the back .
  • Exacerbated by certain postures and movements: lying or turning in bed, rising from a chair, driving, stretching, reaching, lifting, bending, twisting the trunk, coughing, walking, or bearing loads.
  • May affect sporting activities involving trunk movements and deep breathing, but in particular running, horseback riding, arm abduction, or swimming. Pain may be severe enough to make patients stop playing sports.
  • Visceral innervation converges at the same spinal cord levels as slipping ribs and intercostal nerves and this close association of the intercostal nerves and the sympathetic system may also cause a variety of somatic and visceral complaints, such as biliary or renal colic.

The physiotherapist looks for an association between certain movements or postures and pain intensity (signs and symptoms), determines if the patient has experienced recent trauma (not always present), constrained posture, or previous abdominal surgery and reproduces the symptoms (eg, pain, clicking) ^{[11][40][41][42]}

• ^{Palpation – At physical examination, the most common finding in a case of slipping rib syndrome is the tenderness above the costal margin. The physiotherapist can reproduce chest pain by palpation.}
• ^{A painful click is sometimes felt over the tip of the involved costal cartilage with certain movements.}
• The Hooking manoeuvre – positive test.^{[18][19][24][43]}

Diagnosing SRS is the main challenge, which is based on the careful patient history, physical examination, and knowledge of its existence. ^[16][44] However, following procedures can be use for diagnosis:^{[4][11][16][17][31][42][45][46]}

• Hooking maneuvre: Reproduce the symptoms. This is a relatively simple clinical test where the clinician places his or her fingers under the lower costal margin and pulls the hand in an anterior direction. Pain or clicking indicates a positive test
• Intercostal nerve blocks can be performed after positive hooking manoeuvre, to confirm the diagnosis.
• Dynamic ultrasound of the ribs can be performed with valsalva, coughing, twisting, crunch and push manoeuvres to diagnose SRS.

• The physiotherapist can reproduce chest pain by palpation of the ribs and chest wall ^[11].
• Hooking manoeuvre^{[11][19][28][41]}
• Patient-specific functional scale ( PSFS)^[47].
• The Global rating of change (GROC) – To measure the patient’s subjective rate of improvement, the GROC has been stated to be reliable ^[48].

The differential diagnosis of slipping rib syndrome includes a variety of conditions^{[1][16][17][35][37]}

• Cholecystitis
• Esophagitis
• Gastric ulcers
• Stress fractures
• Muscle tears
• Pleuritic chest pain
• Bronchitis
• Asthma
• Costochondritis, or Tietze syndrome
• Appendicitis
• Heart conditions
• Bone metastases
• Hepatosplenic issues
• Peptic ulcer
• Renal colic
• Pancreatitis

In some cases, slipping rib syndrome resolves on its own without treatment if not, the choice of treatment depends on the severity of patient’s symptoms. There are different approaches in Conservative and non-conservative management that can be taken into account when treating SRS.^{[1][49][50][51]}

Non-conservative Management[edit | edit source]

If the condition persists or causes severe pain, surgery may be recommended. Following surgical procedures can be done ^{[1][2][16][17][35][44][52]}

• Partial rib resection can be done to alleviate the symptoms. Following video demonstrates the surgical procedure:

^[53]

• Minimally Invasive Repair of Adult Slipped Rib Syndrome Without Costal Cartilage Excision .

• Vertical rib plating with bioabsorbable plates significantly decreased the rate of recurrence in our early experience.

Conservative Management[edit | edit source]

Conservative management includes the following:^[4][50]

• Rest.
• Avoiding strenuous activities.
• Applying heat or ice to the affected area.
• Oral medications like NSAIDS.
• Topical analgesics.
• Physical Therapy.
• Nerve blocks.

Activities to Avoid[edit | edit source]

Reassurance of the benign nature of the disease combined with explanation and advice concerning postural avoidance^[42][54]Following activities should be avoided:^[55]

• Heavy lifting.
• Twisting.
• Pushing.
• Pulling.

Oral Medications[edit | edit source]

• Acetaminophen (Tylenol)^[1]
• Nonsteroidal anti-inflammatory drug (NSAID)^[35][50], such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve)^[1]

Intercostal Nerve Blocks[edit | edit source]

If the pain continues despite taking a painkiller following can be done to elicit the symptoms:^{[1][4][30][35][56]}

• A corticosteroid injection to help reduce the swelling
• An intercostal nerve block (an injection of an anesthetic in the intercostal nerve) to relieve pain

Physical Therapy Management[edit | edit source]

• Manual therapy: manipulation of the costovertebral joint and electric stimulation can help manage the pain, but probably no long term relief ^[11].

• Taping of ribs can possibly provide some temporary relief. To decide on the location and direction of taping, apply a manual superior compression force through the postero-lateral aspect of the rib cage. Now ask the patient to take in a deep breath or rotate. If the patient notes a significant improvement in symptoms, then apply the tape at that level ^[57].

• Rib mobilization with movement (MWM) as proposed by Brian Mulligan. The range of motion and pain level are evaluated. A cranial glide is applied over the lateral as3pect of the rib above the painful region. While sustaining this rib elevation (unloading), the patient is asked to rotate again while ROM and pain are once again evaluated. If there is no change, the technique is repeated on a rib above or below. If MWM on a rib at a specific level is found to reduce or eliminate the pain, it is repeated 10 times ^[57].

• A home program of self MWM may be provided. Instruction: “lift the rib up with the web space of one hand and actively rotate towards the painful direction, repeat as often as necessary”. The goal is to move the irritated costovertebral joint without pain as often as possible to reduce both the protective muscle spasm and the local inflammation ^[57]

^[58]

• The Slipping rib syndrome is an often under diagnosed disease for which sometimes comprehensive diagnostic evaluation is performed.
• Knowledge of the slipping rib syndrome can lead to quick and simple diagnosis and prevent months or years of chronic complaints.
• The impingement can cause severe constant pain and a slipping sensation provoked by several movements.
• It can also lead to an irritation of the intercostal nerve or problems to structures in that area.
• Knowledge of the syndrome is important; it can lead to quick and simple diagnosis.

1. ↑ ^{1.01.11.21.31.41.51.61.71.81.9} Healthline Slipping Rib Syndrome Available from:https://www.healthline.com/health/slipping-rib-syndrome#symptoms (last accessed 6.5.2020)
2. ↑ ^2.02.1 Panka CT, Tchebegna PY. Cyriax syndrome in a young male professional soccer player: A case report. South African Journal of Sports Medicine. 2020;32(1):1-2.
3. ↑ Holmes JF. Slipping rib cartilage: with report of cases. The American Journal of Surgery. 1941 Oct 1;54(1):326-38.
4. ↑ ^{4.04.14.24.34.44.54.64.7} McMahon LE. Slipping rib syndrome: a review of evaluation, diagnosis and treatment. InSeminars in Pediatric Surgery 2018 Jun 1 (Vol. 27, No. 3, pp. 183-188). WB Saunders.
5. ↑ Patel N, John JK, Pakeerappa P, Aiyer R, Zador LN. Slipping rib syndrome: case report of an iatrogenic result following video-assisted thoracic surgery and chest tube placement. Pain Management. 2021 May;11(5):555-9.
6. ↑ Gress K, Charipova K, Kassem H, Berger AA, Cornett EM, Hasoon J, Schwartz R, Kaye AD, Viswanath O, Urits I. A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management. Psychopharmacology Bulletin. 2020 Oct 15;50(4 Suppl 1):189.
7. ↑ ^7.07.17.2 Gress K, Charipova K, Kassem H, Berger AA, Cornett EM, Hasoon J, Schwartz R, Kaye AD, Viswanath O, Urits I. A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management. Psychopharmacology bulletin. 2020 Oct 15;50(4 Suppl 1):189.
8. ↑ ^8.08.1 Porter GE. Slipping rib syndrome: an infrequently recognized entity in children: a report of three cases and review of the literature. Pediatrics. 1985 Nov;76(5):810-3.
9. ↑ Lum-Hee N, Abdulla AJ. Slipping rib syndrome: an overlooked cause of chest and abdominal pain. International journal of clinical practice. 1997 Jun 1;51(4):252-3.
10. ↑ Turcios NL. Slipping rib syndrome in an adolescent: an elusive diagnosis. Clinical Pediatrics. 2013 Sep;52(9):879-81.
11. ↑ ^{11.011.111.211.311.411.511.611.711.8} Udermann B.E. et al.; Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report; J Athl Train, 2005 (LoE 3B)
12. ↑ McBeath A.A. et al.; The rib-tip syndrome; J. Bone Joint Surg. Am., 57 (1975), pp. 795–797 (LoE 3A)
13. ↑ False ribs (highlighted in green) – posterior view image – © Kenhub https://www.kenhub.com/en/library/anatomy/the-ribs
14. ↑ ^{14.014.114.214.3} Romano R, Gavezzoli D, Gallazzi MS, Benvenuti MR. A new sign of the slipping rib syndrome?. Interactive CardioVascular and Thoracic Surgery. 2022 Feb;34(2):331-2.
15. ↑ ^15.015.1 SANGHANI RR, ZESTOS MM, THOMAS ST. A CAse RepoRt of slipping Rib syndRome: An UnCommon And UndeRdiAgnosed CAUse of AbdominAl pAin.
16. ↑ ^{16.016.116.216.316.4} Hussain A. Diagnosing and treating Slipping Rib Syndrome: An unusual case of undiagnosed pain for 5 years. COPD. 2020.
17. ↑ ^{17.017.117.217.317.4} Fu R, Iqbal CW, Jaroszewski DE, Peter SD. Costal cartilage excision for the treatment of pediatric slipping rib syndrome. Journal of pediatric surgery. 2012 Oct 1;47(10):1825-7.
18. ↑ ^18.018.118.2 Scott EM, Scott BB. Painful rib syndrome–a review of 76 cases. Gut. 1993 Jul 1;34(7):1006-8.
19. ↑ ^19.019.119.2 Keoghane SR, Douglas J, Pounder D. Twelfth rib syndrome: a forgotten cause of flank pain. BJU international. 2009 Mar;103(5):569-70.
20. ↑ Cranfield KA, Buist RJ, Nandi PR, Baranowski AP. The twelfth rib syndrome. Journal of pain and symptom management. 1997 Mar 1;13(3):172-5.
21. ↑ Mooney DP, Shorter NA. Slipping rib syndrome in childhood. Journal of pediatric surgery. 1997 Jul 1;32(7):1081-2.
22. ↑ Arroyo JF, Vine R. Slipping rib syndrome: don’t be fooled. Geriatrics. 1995;50(3):46-9.
23. ↑ Copeland GP, Machin DG, Shennan JM. Surgical treatment of the ‘slipping rib syndrome’. British journal of surgery. 1984 Jul;71(7):522-3.
24. ↑ ^24.024.1 Saltzman DA, Schmitz ML, Smith SD, Wagner CW, Jackson RJ, Harp S. The slipping rib syndrome in children. Pediatric Anesthesia. 2001 Nov 9;11(6):740-3.
25. ↑ Machin DG, Shennan JM. Twelfth rib syndrome: a differential diagnosis of loin pain. British Medical Journal (Clinical research ed.). 1983 Aug 27;287(6392):586.
26. ↑ Van Delft EA, Van Pul KM, Bloemers FW. The slipping rib syndrome: a case report. International Journal of Surgery Case Reports. 2016 Jan 1;23:23-4.
27. ↑ Mynors J.M. et al.; Clicking rib; Lancet, 1 (1973), p. 674 (LoE 1B)
28. ↑ ^28.028.1 Bass J. et al. ; Slipping Rib Syndrome; Journal of the National Medical Association, 1979;71(9):863-865. (LoE 4)
29. ↑ Cyriax E, et al., On various conditions that may simulate the referred pains of visceral disease and a consideration of these from the point of view of cause and effect, Practitioner, 1919
30. ↑ ^30.030.1 Germanovich A;Ferrante FM. “Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature.” Pain Physician, vol. 19, no. 3, 2016,
31. ↑ ^31.031.1 Kumar R, Ganghi R, Rana V, Bose M. The painful rib syndrome. Indian Journal of Anaesthesia. 2013 May;57(3):311.
32. ↑ Davies-Colley R. Slipping rib. British Medical Journal. 1922 Mar 18;1(3194):432.
33. ↑ Arya S, Verma AK, Gupta BK, Hifzur M, Gupta S, Singh N. Twelfth rib syndrome-an often missed differential diagnosis of hypogastric and lumbar pain: case series. Int J Reprod Contracept Obstet Gynecol. 2014 Mar 1;3:263-5.
34. ↑ Mazzella A, Fournel L, Bobbio A, Janet-Vendroux A, Lococo F, Hamelin EC, Icard P, Alifano M. Costal cartilage resection for the treatment of slipping rib syndrome (Cyriax syndrome) in adults. Journal of Thoracic Disease. 2020 Jan;12(1):10.
35. ↑ ^{35.035.135.235.335.4} Kamal YA. Slipping rib syndrome: A neglected cause of hypochondrial pain. Formosan Journal of Surgery. 2019 Nov 1;52(6):229.
36. ↑ Migliore M, Signorelli M, Caltabiano R, Aguglia E. Flank pain caused by slipping rib syndrome. The Lancet. 2014 Mar 1;383(9919):844.
37. ↑ ^37.037.1 Turcios NL. Slipping rib syndrome: an elusive diagnosis. Paediatric Respiratory Reviews. 2017 Mar 1;22:44-6.
38. ↑ Hughes KH. Painful rib syndrome: a variant of myofascial pain syndrome. AAOHN Journal. 1998 Mar;46(3):115-20.
39. ↑ Bong J, Healey D. Slipping rib syndrome. Journal of Medical Imaging and Radiation Oncology. 2021 May 30.
40. ↑ Meuwly JY, Wicky S, Schnyder P, Lepori D. Slipping rib syndrome: a place for sonography in the diagnosis of a frequently overlooked cause of abdominal or low thoracic pain. Journal of ultrasound in medicine. 2002 Mar;21(3):339-43.
41. ↑ ^41.041.1 Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ: Canadian Medical Association Journal. 1985 Sep 1;133(5):379.
42. ↑ ^42.042.142.2 Khan NA, Waseem S, Ullah S, Mehmood H. Slipping rib syndrome in a female adult with longstanding intractable upper abdominal pain. Case Reports in Medicine. 2018 Jul 2;2018.
43. ↑ Ronga A, Vaucher P, Haasenritter J, Donner-Banzhoff N, Bösner S, Verdon F, Bischoff T, Burnand B, Favrat B, Herzig L. Development and validation of a clinical prediction rule for chest wall syndrome in primary care. BMC family practice. 2012 Dec;13(1):1-9.
44. ↑ ^44.044.1 Hansen AJ, Toker A, Hayanga J, Buenaventura P, Spear C, Abbas G. Minimally Invasive Repair of Adult Slipped Rib Syndrome Without Costal Cartilage Excision. The Annals of thoracic surgery. 2020 Sep 1;110(3):1030-5.
45. ↑ Foley CM, Sugimoto D, Mooney DP, Meehan III WP, Stracciolini A. Diagnosis and treatment of slipping rib syndrome. Clinical Journal of Sport Medicine. 2019 Jan 1;29(1):18-23.
46. ↑ Van Tassel D, McMahon LE, Riemann M, Wong K, Barnes CE. Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal Radiology. 2019 May;48(5):741-51.
47. ↑ Westrick RB, Zylstra E, Issa T, Miller JM, Gerber JP. Evaluation and treatment of musculoskeletal chest wall pain in a military athlete. International Journal of Sports Physical Therapy. 2012 Jun;7(3):323.
48. ↑ Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American family physician. 2009 Sep 15;80(6):617-20.
49. ↑ Telford KM. Slipping rib syndrome. Canadian Medical Association Journal. 1950 May;62(5):463.
50. ↑ ^50.050.150.2 Davelaar CM. A Clinical Review of Slipping Rib Syndrome. Current Sports Medicine Reports. 2021 Mar 1;20(3):164-8.
51. ↑ Fares MY, Dimassi Z, Baydoun H, Musharrafieh U. Slipping rib syndrome: solving the mystery of the shooting pain. The American journal of the medical sciences. 2019 Feb 1;357(2):168-73.
52. ↑ McMahon LE, Salevitz NA, Notrica DM. Vertical rib plating for the treatment of slipping rib syndrome. Journal of Pediatric Surgery. 2021 Oct 1;56(10):1852-6.
53. ↑ reference
54. ↑ Gregory PL, Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Medicine. 2002 Apr;32(4):235-50.
55. ↑ “Slipping Rib Syndrome.” Ucsfhealth.org, 25 Mar. 2020,
56. ↑ Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Primary Care: Clinics in Office Practice. 2013 Dec 1;40(4):863-87.
57. ↑ ^57.057.157.2 Bahram J. et al.; Ribs don’t sublux, ribs don’t “go out” … so what’s going on?; Advanced Physical Therapy Education Institute, 2015 (LoE: 4)
58. ↑ Rib MWM. [Accessed 16 May 2020]

What Causes Pain Around Ribs And Back Symptoms?

Our upper body is supported by the thoracic region that comprises the spinal cord. Issues in any muscle or ligament in this region can cause intense pain around the ribs and back. This pain can adversely affect your daily life activities. For instance, you may feel mild discomfort between your shoulders, stiffness in your back muscles, and sore arms.

Some common causes of pain around ribs and back symptoms include inflammation, strained back muscles, back rib injury, disc herniation, and irritation. However, on-time treatment can help eliminate pain around your ribs and back symptoms.  

Your doctor may recommend you apply hot or cold compresses to increase blood circulation in the affected part of your body. Posture-enhancing exercises, stretching, and orthobiologic treatments also relieve rib and back pain. 

5 Causes of Pain Around Rib and Back Symptoms

Many underlying health conditions can cause significant upper and middle back pain. The 5 most common ones include:

Intercostal Muscle Strain

The intercostal muscles are present in your rib cage. These muscles can become strained or torn when you twist your upper body roughly or suffer intense trauma on your back. Strained intercostal muscles put pressure on your rib cage, resulting in sharp, intense pain in your upper and middle back areas. In severe cases, the pain can also radiate to other body parts.

Intercostal muscle strain is usually common in athletes, employees who keep sitting for longer periods, and people who perform physically demanding tasks. You can look for these symptoms to know if the pain around your ribs and back is due to intercostal muscle strain:

• Swelling in your back
• Pain when moving the upper body
• Muscle spasms in your back

Intercostal Neuralgia 

Intercostal neuralgia is when the nerves in your rib cage become damaged due to inflammation in the thoracic region. Nerve damage in the thoracic area (rib and back) is common and is mainly caused due to natural wear and tear, trauma, back surgery, or aging.  

Intercostal nerves are responsible for sensations in the muscles, ribs, and back skin. Any damage in these nerves can lead to sharp pain in the shoulder blades, upper thigh, and back. Complicated cases of intercostal neuralgia can cause frozen shoulders, disturbed sleeping patterns, severe pain in the middle back and chest, and low appetite. 

Some other symptoms of intercostal neuralgia include the following:

• Muscle spasms and twitching in your arm, back, or shoulder
• Muscle tightness in the back, especially upper and middle parts
• Loss of sensitivity in several body parts

Costochondritis

Costochondritis refers to joint inflammation between your rib cage and breastbone, particularly the chest. It cause a burning back and left chest pain, often starting from your left shoulder blade. If not treated on time, this pain can become chronic. 

You may feel more intense chest pain when coughing or sneezing. The pain radiates from the chest’s front to your rib cage and the middle back.  

Poor Posture

Poor posture presses nerves in your spinal cord and strains your ribs and the entire back. As a result, you feel intense back pain and discomfort. Pressed nerves also cause irritation and pain in your upper, middle, and lower back, including the neck.

The common cause of poor posture is sitting in front of the computer for a long time.  According to a study, individuals who use computers are at a greater risk of back pain than those who do not.

Spinal Disc Issues

Disc herniation refers to ruptured or degenerated discs in the spinal region. This condition causes pain in the middle back region, especially when you move your upper body or twist your waist. You may also feel severe neck pain. 

The spinal injuries can also affect nerves causing severe headaches and neurological issues. They can also cause chronic abdominal pain. The herniated thoracic disc leads to debilitating, sharp pain that occurs out of nowhere.  

However, sometimes, you may not even feel back pain but have a herniated disc. Here are some common symptoms of spinal disc issues:

• Muscle weakness
• Muscle stiffness
• Numbness in legs
• Pain radiating throughout the body

Other Causes of Pain Around Rib and Back

The issues in the internal organs can also cause pain around the rib and back symptoms. These include:

• Rib injuries
• Myofascial pain syndrome (muscle pain)
• Gallstones
• Pleurisy (inflammation in the lungs lining)
• Collapsed lung
• Arthritis
• Kidney stones

How To Treat Pain Around Rib and Back

You can treat pain around the rib and back with many natural remedies, depending on what is causing it. Natural remedies work wonders in treating mild pain around ribs and back symptoms. But if these methods don’t work, your doctor may suggest you go for a surgical procedure or orthobiologic treatments that are not invasive.  

Warm or Cold Compress

If your pain around the ribs and back symptoms are due to inflammation or swelling, you can treat the affected area with a cold pack to reduce the swelling. Then, you should use a warm compress to enhance your blood circulation and reduce muscle stiffness. 

You can use a bag of frozen peas or crushed ice as a cold compress and place it on your middle or upper back for about 20 minutes. For a hot compress, you can use a hot water bottle and place it on the area for 20 minutes to reduce muscle stiffness. Repeating this for 2 to 3 days will give you effective relief in pain around the ribs and back symptoms.

Posture Improvement 

Improving your posture will relieve tension and pressure from your rib cage. According to a study, posture improvement is an effective treatment for upper, middle, and lower back and shoulder pain. You must learn to sit in front of the computer and walk properly. 

Exercises

Doing physical exercises can also help you improve your posture and lessen rib and back pain. For instance, stretching helps reduce muscle tension, manage back pain, and enhance muscle strength. It also supports your upper body and improves the range of motion. 

The best stretching exercise to relieve back pain is prayer stretch. It relieves irritation of the ligaments in your thoracic region and discs. Apart from stretching, you can also do strengthening exercises to manage pain around the ribs and back symptoms. 

Orthobiologic Treatments

These methods are based on regenerative medicine, which focuses on treating different kinds of pain through the patient’s cells. At CELLAXYS, we perform two types of orthobiologic treatments:

Cell-Based Therapies

Also known as stem cell therapy, this treatment extracts healthy cells from the patient’s adipose (fat) tissues or bone marrow, processes them, and reinjects them into the injury site. When the cells are extracted from adipose tissue, the procedure is called Minimally Manipulated Adipose Tissue Transplant (MMAT). The process is called Bone Marrow Concentrate (BMAC) when it’s the bone marrow. 

Both MMAT and BMAC are performed within 1.5 to 2 hours. They are outpatient procedures, meaning you can go home right after the procedure. 

Platelet-Rich Plasma Therapy (PRP)

PRP involves taking the patient’s blood sample and isolating the healing components, platelets, from it. The platelets are then processed and reinjected into the patient’s injury site to promote healing.

Platelets release 10 Growth Factors, attract healthy cells from the blood, and produce a web-like scaffolding called fibrin to support the development of new tissues. A high number of platelets in the injury site promotes early relief from pain around the ribs and back symptoms.

PRP is performed within 45 minutes and is also an outpatient procedure. It has been a leading treatment for many orthopedic, spine, and sports-related injuries for decades.

How dangerous is bruised ribs and what to do about it

Likbez

Health

October 11, 2021

It is better not to refuse the help of a doctor.

How to tell if it’s a bruised rib

Injury can occur from a blow, a fall, a car accident, or even a violent cough. The following signs speak of bruising of the ribs:

• Severe pain that occurs or intensifies when inhaling, coughing, laughing or sneezing.
• Swelling or tenderness around injured ribs.
• Bruise on the skin in the chest area.

How dangerous is bruised ribs

Due to severe pain, a person tries to breathe not so deeply. Therefore, the lungs are poorly ventilated, and there is a possibility of developing pneumonia.

Simultaneously with a bruise, a person can also get a fracture of the ribs. It is not always possible to distinguish them from each other on their own: the symptoms are almost the same. But in the event of a fracture, there is a risk of damage to internal organs, such as the heart, liver or spleen. If you do not see a traumatologist in time, bleeding that threatens life may occur.

When a doctor is urgently needed

If a bruised rib is accompanied by trauma to internal organs or a fracture, a person can develop dangerous complications. Call an ambulance if:

• the injury occurred after a car accident;
• there is shortness of breath that only gets worse;
• chest pain worse;
• stomach or shoulder pain;
• cough up blood.

If, immediately after the bruise, the condition was normal, but there is no improvement after a few weeks, the help of a doctor is also needed, in this case, a therapist. Another reason to go to a specialist is a high fever or a cough with yellow-green mucus. This is usually a sign of pneumonia.

How a bruised rib is treated

First, the traumatologist will take an X-ray of the chest to determine exactly whether it is a fracture or a bruise. In some cases, even CT, MRI or angiography is performed. These methods help to see damage to internal organs and blood vessels.

If all goes well, bruised or even broken ribs usually heal on their own within 3-6 weeks. But in order to alleviate the condition during this period, the doctor may suggest symptomatic therapy:

• Take over-the-counter painkillers without exceeding the recommended dosage.
• For the first 1-2 days, apply an ice pack to the site of injury for 20 minutes 2-3 times a day to reduce swelling.
• Rest. Take a vacation if necessary.
• Breathe normally and cough if necessary. This will help clear the lungs of mucus and prevent infection. If the cough is accompanied by pain, press a pillow to your chest.
• Periodically move your shoulders to make breathing easier.
• Do gymnastics once an hour, 10 slow deep breaths.
• Sleep on your back in a semi-upright position for the first few nights, then on your healthy side.
• Drink plenty of fluids and eat foods rich in fiber to avoid constipation. Otherwise, you will have to strain your stomach in the toilet, and the ribs will hurt more.

If pneumonia occurs, antibiotics will be prescribed to treat it. And with internal bleeding, an emergency operation is required.

What not to do if the ribs are bruised

After such an injury, doctors do not recommend the following:

• Wrap the chest with a tight bandage. This prevents the lungs from working.
• Lying or sitting in one place for a long time.
• Strain and lift heavy objects.
• Play sports or exercises that increase pain.
• Smoking and drinking alcohol.

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How to diagnose bruised ribs – advice from a traumatologist

How to diagnose bruised ribs – advice from a traumatologist

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• Diagnosis of bruised ribs

How to diagnose bruised ribs : Bruised ribs is a closed injury to the tissues of the ribs without significant damage to their structure. More often, superficially located tissues (skin, subcutaneous tissue, muscles and periosteum) are damaged. Primary diagnosis of bruised ribs will require an x-ray and subsequent consultation with a surgeon or traumatologist. As an additional examination, the doctor may prescribe a CT scan of the ribs.

Which doctor treats bruised ribs : If you have symptoms of bruised ribs, you should first consult a surgeon or traumatologist.

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Rib bruises can be very painful but usually heal on their own. They usually result from a fall, a blow to the chest, or a violent cough.

Symptoms of bruised ribs

Symptoms of bruised ribs include:

• severe chest pain, especially when inhaling, swelling or tenderness around affected ribs;
• bruises on the skin;
• crack sound.

Diagnosis of bruised ribs

A patient with bruised ribs should see a traumatologist if:

• pain has not improved within a few weeks;
• he coughs up yellow or green mucus or blood;
• have high temperature;
• was injured in a serious accident such as a car accident;
• there is shortness of breath that gets worse;
• chest pain worse;
• have pain in the abdomen or shoulder.

These symptoms may indicate that there may be a broken rib that has damaged the lung, liver, or spleen.

Initial diagnosis of rib bruising requires a chest X-ray. Chest CT is done only in extreme cases, when bruised ribs are combined with a complex fracture or symptoms of damage to internal organs.

Treatment

The rib area is not as easily splinted or supported as other bones, so they are usually left to heal naturally. Broken or bruised ribs heal on their own within 3 to 6 weeks. Here are a few things a patient can do at home to help relieve pain and speed up healing:

• Take pain relievers such as paracetamol or ibuprofen, but avoid taking ibuprofen within 48 hours of the injury as it may slow healing;
• Regularly apply an ice pack to the ribs for the first few days to reduce swelling;
• breathe normally and cough if necessary as this helps to clear mucus from the lungs and prevent chest infections;
• if you need to cough, hold a pillow to your chest;
• walk and occasionally move your shoulders to ease breathing and clear mucus from your lungs;
• take 10 slow deep breaths every hour to clear your lungs;
• do not wrap the bandage tightly around the chest so that the lungs do not expand properly;
• do not lie down or sit still for a long time;
• do not strain or lift heavy objects;
• Do not play sports or do any exercise that aggravates the pain.

Author: Telegina Natalya Dmitrievna

Specialization: Therapist

Where does the appointment: MRI Center and Clinic RIORIT

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Literature

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