Sore ribs and sternum: Sternal pain – different causes
Costochondritis vs. MS Hug: What’s the Difference?
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Medically reviewed by
Joseph V. Campellone, M.D.
Article written by
Anika Brahmbhatt
What Is MS Hug? | MS Hug Causes | How MS Hug Feels | What Is Costochondritis? | Costochondritis Causes | How Costochondritis Feels | Difference | Management | Seeing a Doctor | Support
If you’re living with multiple sclerosis (MS), you may have experienced a common symptom of the condition called the “MS hug,” also known as girdling or banding. Those who’ve had it describe it as feeling like a tight band being squeezed around your chest or ribs. Sometimes, the MS hug can be confused with another common pain symptom, called costochondritis, which is inflammation of the cartilage between the ribs.
People’s experiences with MS can vary so much, and many types of pain can be described similarly. Therefore, trying to communicate to your doctor what you’re going through to determine the cause can be frustrating and confusing.
“Anybody else battle with costochondritis?” asked one MyMSTeam member. Another member responded, “I don’t know what that is, or maybe I know it by a different name. What does it do?”
If you’re living with MS and have experienced unexplained pain or tightness in your torso, this article may shed some light on potential causes and better equip you to talk to your doctor about your symptoms.
Each person experiences the MS hug differently. The symptom can cause tightness anywhere between the neck and waist. It may be felt on one or both sides of the body, and it can range from an annoying tickle to a vise-like grip that makes it difficult to breathe.
With MS hug, pain symptoms are related to nerves (neuropathic), muscles (nonneuropathic), or both.
Nerve damage produces the abnormal sensations of the MS hug and muscle spasms create the pressure, tightness, and aching.
Heat, stress, and exertion are common triggers of multiple sclerosis symptoms, including the MS hug. The hug can also be triggered by a flare or relapse. And in some cases, costochondritis can trigger an MS hug.
MyMSTeam members have described the MS hug in various ways, ranging from mild discomfort to severe pain:
- “It feels like a boa constrictor tightening around me.”
- “Mine are on the mellow side but very annoying!”
- “Feels like my bra is on too tight, then I realize I’m not wearing one!”
Costochondritis occurs due to an inflammation of the cartilage between the ribs. The term “costochondritis” comes from “costosternal” — which means “relating to the ribs and sternum” — and “chondrodynia,” which refers to pain felt in cartilage.
Other terms for costochondritis include:
- Chest wall pain
- Costosternal syndrome
- Costosternal chondrodynia
The names all provide ways of describing the painful effects the condition has on your intercostal muscles, or the muscles in between your ribs.
In most cases, doctors don’t believe there is any clear cause for costochondritis. There are, however, a few risk factors to consider:
- An acute injury, like a hard blow to your chest
- Physical strain, including heavy coughing or overly strenuous exercise
- Joint conditions including osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis
- Infections including tuberculosis, syphilis, and aspergillosis
- Both cancerous and benign tumors
Researchers haven’t determined exactly how common costochondritis is for people with MS.
MyMSTeam members have shared their own experiences with it.
“Guessing it is possible to have the hug and costochondritis,” wrote one member. “Horribly painful.” Another member said, “I was told by my neuro that [costochondritis] was part of my MS hug in that it involved part of the rib cage … such terrible pain, I thought I was having a heart attack. The attack lasted about two weeks and hasn’t ever returned.
”
Other members have discussed the randomness with which costochondritis symptoms can come on. “For two months now, I’ve had dull chest pain near my sternum that my GP diagnosed as costochondritis,” a member wrote. “During this time, the pain comes and goes, no rhyme or reason. However, in the past two weeks, the pain can be anywhere on my chest, and I’ll also feel it in the same location on my back. At times, my shoulders and neck have been tense.”
When you’re already dealing with symptoms of MS, the painful effects of costochondritis can feel overwhelming. Talk to your doctor if you start experiencing new symptoms that concern you.
It can be hard to tell the difference between MS hug and costochondritis, given that they can both cause an uncomfortable or painful squeezing sensation around the chest and can both make breathing difficult.
A few key things to remember about costochondritis are:
- It usually occurs on the left side of your breastbone.
- It affects more than one of your ribs.
- It gets worse when you cough or take deep breaths.
However, it is important to check in with your doctor to rule out other conditions if you’re still unsure.
Usually, costochondritis has to run its course until it goes away on its own. There are a few strategies doctors may recommend to help manage your symptoms:
- Medications such as gabapentin (Neurontin) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- Physical therapy, such as stretches or nerve stimulation
- Surgical procedures or the injection of numbing medication over the joint
There are also do-it-yourself strategies you can use if your symptoms aren’t severe. For example, using heat or ice or simply resting your body could help make you feel better. Mindfulness and cognitive behavioral therapy could also help you shift your focus and ride out the painful symptoms. Ultimately, it’s important to check with a medical professional before deciding on a management approach.
Learn more about ways to manage MS hug symptoms.
If you’re feeling any uncertainty about your symptoms or if they’re persisting for a long period of time, it may be a good idea to speak with your doctor.
Some things you can do ahead of your appointment to make the most of your time include:
- Try to pinpoint a time when your symptoms started or worsened.
- Think about major physical or emotional stressors that have occured recently in your life.
- Note what kinds of activities you’re most concerned about the pain affecting, such as a job function or hobby.
While this is by no means an exhaustive list, coming prepared to your appointment will help you give your doctor an idea of how exactly your costochondritis symptoms have been impacting your life. They can also provide a segue to the more specific medical follow-up questions your doctor may ask, or discussions about the best ways to move forward while managing symptoms.
Additionally, remember that you are not alone in this struggle.
On MyMSTeam — the social network for people with multiple sclerosis — more than 185,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Have you experienced costochondritis symptoms? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.
References
- Pain in Multiple Sclerosis — National Multiple Sclerosis Society
- Costochondritis — Mayo Clinic
- Multiple Sclerosis Information Page — National Institute of Neurological Disorders and Stroke
- Comorbidity in Multiple Sclerosis — Frontiers in Neurology
- MS Hug — Multiple Sclerosis Society
- Altered Sensations — Multiple Sclerosis Trust
Joseph V. Campellone, M.D. is board-certified in neurology, neuromuscular disease, and electrodiagnostic medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Anika Brahmbhatt is an undergraduate student at Boston University, where she is pursuing a dual degree in media science and psychology.
Learn more about her here.
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Bruised Rib: Care Instructions | Kaiser Permanente
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Overview
You can get a bruised rib if you fall or get hit, such as in an accident or while playing sports.
The medical term for a bruise is “contusion.” Small blood vessels get torn and leak blood under the skin.
Most people think of a bruise as a black-and-blue area. But bones and muscles can also get bruised. An injury may damage the rib but not cause a bruise that you can see.
Sometimes it can be hard to tell if a rib is bruised or broken. The symptoms may be the same. And a broken bone can’t always be seen on an X-ray. But the treatment for a bruised rib is often the same as treatment for a broken one.
An injury to the ribs can cause pain. The pain may be worse when you breathe deeply, cough, or sneeze.
In most cases, a bruised rib will heal on its own. You can take pain medicine while the rib mends. Pain relief allows you to take deep breaths.
Follow-up care is a key part of your treatment and safety.
Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.
How can you care for yourself at home?
- Rest and protect the injured or sore area. Stop, change, or take a break from any activity that causes pain.
- Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
- After 2 or 3 days, if your swelling is gone, put a heating pad set on low or a warm cloth on your chest. Some doctors suggest that you go back and forth between hot and cold. Put a thin cloth between the heating pad and your skin.
- Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
- As your pain gets better, slowly return to your normal activities. Be patient. Rib bruises can take weeks or months to heal. If the pain gets worse, it may be a sign that you need to rest a while longer.
Be safe with medicines. Read and follow all instructions on the label.When should you call for help?
Call 911 anytime you think you may need emergency care. For example, call if:
- You have severe trouble breathing.
Call your doctor now or seek immediate medical care if:
- You have trouble breathing.
- You have a fever.
- You have a new or worse cough.
- You have new or worse pain.
Watch closely for changes in your health, and be sure to contact your doctor if:
- You do not get better as expected.
Where can you learn more?
Go to https://www.healthwise.net/patientEd
Enter R125 in the search box to learn more about “Bruised Rib: Care Instructions”.
causes, treatment – how to get rid of pain under the ribs
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Pain in the right hypochondrium radiating to the back
This symptom is treated by an Orthopedic Traumatologist.
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When it hurts on the right under the ribs from behind from the back, you should consult a doctor. This is a common symptom associated with pathologies of the musculoskeletal system, cardiopulmonary diseases, inflammatory processes and other ailments.
It is necessary to exclude a life-threatening condition and, if necessary, immediately treat. Diagnosis is carried out using laboratory and instrumental studies.
CMRT specialist tells
Kuchenkov A.V.
Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience
Publication date: September 23, 2021
Verification date: January 30, 2023
All facts have been verified by a doctor.
Contents of the article
Causes of pain in the right hypochondrium from behind from the back
Varieties
Which doctor to contact
Diagnostic methods
Treatment of right subcostal back pain
Rehabilitation
In case of diseases of the spine, heart, lungs and other important anatomical structures, the patient needs recovery after the main course of treatment.
Based on the diagnosis, the doctor prescribes physiotherapy, therapeutic massage, exercise therapy or diet.
Specialists successfully carry out the rehabilitation of patients in the rehabilitation center “Laboratory of Movement”.
Consequences
Prevention of subcostal pain in the right back
Other related articles:
Sclerosis of the spine
Subchondral sclerosis of the cervical spine is a thickening of the bone under the cartilage at the facet joints. Pathological changes are associated with the destruction of cartilage tissue and the formation of bone growths – spurs. Subchondral sclerosis of the endplates of the vertebral bodies is one of the signs of spondylarthrosis in a systemic degenerative-dystrophic process. Diagnosis is based on x-ray methods of research, magnetic resonance imaging. Treatment correlates with the stage; to stabilize the condition and preserve the biomechanics of the central axis of the musculoskeletal system, it is important to undergo regular rehabilitation.
Edema of the bone marrow of the spine
Ribs, sternum, pelvic bones, skull, vertebrae, epiphyses of long bones are a receptacle for red bone marrow.
Excessive deposition of fluid (edema) in the tissues of the latter in the segments of the spine at the level of L1-5 may be the result of trauma or a number of diseases. Clinical manifestations are represented by symptoms of the underlying pathology. Bone marrow edema in the lumbar spine is detected using magnetic resonance imaging. Treatment is predominantly conservative.
Radicular syndrome of the lumbar spine
Radicular syndrome of the lumbar spine is characterized by compression of the spinal nerves with the development of neurological symptoms. The severity of clinical manifestations is variable, the main symptoms are unbearable pain, loss of sensation in the area of innervation, and movement disorders. To confirm the diagnosis, magnetic resonance imaging, computer scanning, and electroneuromyography are used. Treatment of radicular syndrome of the spine can be conservative; if ineffective, surgery is performed, the purpose of which is decompression and restoration of blood circulation.
Intervertebral hernia
As a result of violation of the integrity of the fibrous ring, the nucleus of the intervertebral disc protrudes into the spinal canal – this is how an intervertebral hernia is formed. The main symptoms of the pathological condition are pain, muscle tension, and over time, restriction of mobility develops. In uncomplicated cases, doctors prescribe conservative treatment, the development of pathology and the refusal of medical care leads to serious complications requiring surgical intervention.
Scoliosis
Spinal deformity that occurs in three areas at once with posture disorders – scoliosis – often develops in childhood, then progresses, turning into a severe form. The disease can develop after serious spinal injuries or for other reasons.
Bruise of the spine
Bruise of the spine – an injury to the soft tissues of the back of the paravertebral region. The main causes of occurrence are blows, falling on the back during sports, industrial and household injuries.
Symptoms are manifested by pain of varying intensity, hematoma and swelling, and limited mobility. With mild injuries, only tissues suffer, with moderate damage, loss of sensation in the limbs is possible. The most dangerous is a bruise of the cervical region, leading to respiratory arrest. Treatment of bruises is conservative, appointments determine the severity of injuries and timely first aid.
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Bone metastases in cancer: symptoms and treatment, how it hurts, prognosis
Bone metastases can develop with absolutely any malignant process, for some cancers this is almost mandatory localization, for others diseases are rare. In the metastatic ranking, the first place in terms of frequency of occurrence will go to lung metastases, the second – to hepatic foci, and the third – to skeletal metastases.
Bone metastases, the symptoms of which often include severe pain, are difficult to treat, however, skeletal foci of less than other tumor locations shorten life, but can reduce its quality by fracture or compression of the spinal cord.
What are bone metastases?
According to clinical and radiological features, all bone foci are divided into three groups:
- osteoblastic metastases – with a predominance of compaction beyond the physiological measure, but additionally grown tumor tissue does not give strength to the bone and can compress the nerves passing nearby;
- osteolytic – destruction of the structure prevails and the likelihood of fracture increases as the cancer grows;
- mixed – a combination of two types and this situation occurs most often.
It almost never happens that a patient has exclusively osteolytic or only osteoblastic foci, as a rule, a combination with a prevalence of either a rarefied lytic or excessive blastic structure is diagnosed.
What kind of cancers develop?
The leader among all malignant processes occurring with metastatic lesions of the skeleton, multiple myeloma – bone destruction begins at the very beginning of the disease and in 100% of clinical cases there is multiple destruction of bone tissue.
In breast and prostate cancer, skeletal metastases are diagnosed in two-thirds of patients, and pathological observations reveal the involvement of bones in the malignant process in almost 90% of patients. In breast cancer (BC), mixed and osteolytic variants prevail, in prostate cancer – osteoblastic bone metastases.
A high frequency of bone metastasis is observed in lung cancer, but in the small cell variant – twice as often and multiple bone defects, while in the non-small cell variant – in 40% of patients with a tendency to single or solitary foci, that is, the only one.
Every fourth person suffering from kidney cancer has skeletal metastases; in case of bladder carcinoma, bone neoplasms are much less common.
In colon cancer, bone metastasis is detected in every eighth patient, in stomach cancer – not often, because cancer affects the liver and abdominal cavity earlier and more abundantly. Intestinal cancer gravitates towards small-focal and multiple secondary formations.
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When do skeletal metastases appear?
In malignant processes, the time of occurrence of metastases in the bone varies, while the growth rate of the focus depends solely on the individual biological characteristics of the tumor tissue, which change under the influence of treatment and as cancer dissemination.
During the initial treatment, bone foci in the absence of other manifestations of the cancer process are found in hardly 20% of patients, in the vast majority of cases, tumor lesions of the bones are a sign of cancer dissemination – spread through systems or generalization.
This is exactly what happens with breast cancer, non-small cell lung carcinoma, and colon cancer.
In prostate cancer, skeletal pathology is often detected simultaneously with a prostate tumor or as soon as possible after the diagnosis of problems in the gonad.
In case of renal carcinoma, metastases are often found first in the bones and lung tissue, and then the primary tumor is found.
What parts of the skeleton are affected most often?
The localization of bone metastasis is determined not by the nosological affiliation of the primary malignant tumor, but by the functional load and the development of the blood supply associated with it. Multiple foci in the skeleton are more characteristic of highly aggressive cancer, single and even more so one metastasis testifies in favor of a favorable prognosis of the disease.
- Most often, secondary cancer screenings occur in the spongy bones that are abundantly fed with blood – the vertebrae, and mainly in the lumbar and thoracic spine experiencing a high load.
- Next in frequency are metastases in the pelvic bones – almost half of all cases. Typical localizations are metastases in the ilium and pubic bones.
- Metastasis occurs half as often in the bones of the skull and lower extremity, where the femur is predominant.
- The chest, mainly the ribs and sternum, are involved in the malignant process in almost 30% of cases.
Clinical manifestations of bone metastasis
Contrary to popular myths, skeletal metastasis often occurs without significant pain and even no symptoms at all. Osteoblastic foci are less often accompanied by pain than osteolytic ones.
Dangerous manifestations of metastatic bone disease:
- hypercalcemia – a significant increase in calcium concentration due to the destruction of the bone matrix leads to a severe condition that requires correction of metabolism by actually resuscitation measures;
- fracture – destruction of half the diameter of a bone or vertebra is sufficient for the occurrence, every eleventh patient with a pathological fracture needs urgent surgical care;
- syndrome of compression or compression of the spinal cord by fragments of a broken thoracic or lumbar vertebra is complicated by severe neurological disorders below the injury zone;
- violation of motor activity up to paralysis is possible with compression of the spinal cord in the cervical region by an osteoblastic focus or damage by fragments during lytic destruction.
Complications of bone metastasis fatally affect the patient’s condition and actively interfere with adequate treatment, which can reduce life expectancy in the absolute absence of quality.
Why does pain occur?
Pain is due to three causes:
- destruction of a richly innervated periosteum by a cancer conglomerate;
- irritation in the periosteum of pain receptors by biologically active waste products of cancer cells;
- involvement in the metastatic node of the nerve endings of the muscles.
Unbearable pain is by no means always associated with skeletal metastasis, as a rule, this is a consequence of the high aggressiveness of tumor cells in the terminal stage of the process, when the blood contains a huge concentration of biologically active substances – cytokines, which literally “burn” the nerve endings of even tissues not affected by the tumor.
With a high degree of malignancy of the primary tumor, the pain syndrome is more frequent and more intense.
The most obvious example, widespread and constant pain in absolutely intact bones in lung adenocarcinoma, surgery to remove the affected lung completely cures the pain.
How are bone metastases detected?
Diagnosis of skeletal injuries is not complicated, but high-tech, starting with an isotope examination – osteoscintigraphy, which reveals minimal cancerous neoplasms. Then, the “hot spots” illuminated by the isotope are subjected to radiography or, better, computed tomography (CT). PET is the “queen” of evidence; unfortunately, it is an expensive study, so it is not very suitable for monitoring the effectiveness of therapy.
Bone resorption markers are not suitable for detecting foci in the skeleton; they have not been actively used in practical oncology.
Blood tests suggest a bone marrow tumor, which often accompanies metastasis to the sternum.
Treatment of skeletal lesions
Can bone metastases be cured? Definitely, treatment can prolong life with good health.
On the one hand, skeletal lesions are a manifestation of the spread of cancer throughout the body, on the other hand, they are a sign of a relatively favorable prognosis of the disease in the absence of a tumor in other tissues and visceral (internal) organs, which gives years of life when the process stabilizes.
At the stage of bone metastasis, the question of radical treatment is no longer necessary, but the operation is not excluded with a favorable histological structure and solitary – the only bone lesion. So, in case of lung or kidney cancer with metastasis to the humerus or thigh, one-stage intervention can be performed with the removal of the diseased organ and bone resection with prosthetics, but after several months of chemotherapy.
Chemotherapy is the main treatment for bone lesions, the dosage regimen is determined by the primary tumor. In breast and prostate cancer, hormonal therapy shows good results.
Complementing chemotherapy with local radiation improves overall outcome, relieves pain, reduces bone loss from cancer, and reduces the chance of fracture.
So, with damage to the cervical vertebrae, radiation therapy is mandatory already at the first stage.
Surgery is necessary if there is a threat of compression (compression) of the spinal cord by a broken vertebra, as a rule, the affected part of the vertebra is removed – laminectomy. With a long-term stabilization of more than six months as a result of chemotherapy, it is possible to raise the question of removing the affected limb bone and replacing it with a prosthesis, if there are no other manifestations of cancer.
Why do we need bisphosphonates?
The use of bisphosphonates in skeletal metastatic disease has become the standard of care for adequate therapy.
Human bones are constantly renewed: osteoclasts destroy, and osteoblasts increase tissues, normally the processes are balanced, in the presence of a malignant tumor, osteoclasts acquire excessive activity. Bisphosphonates are similar in structure to the bone matrix, therefore, after being introduced into the body, they are sent to the bones, where they have a detrimental effect on osteoclasts activated by cancer products, simultaneously relieving pain and protecting against fractures.
Bisphosphonates can be treated for about two years, with loss of sensitivity to them, a similar role is played by the monoclonal body denosumab. Denosumab and bisphosphonates are classified as osteomodifying agents (OMAs).
For the appointment of OMA, it is not enough to identify “hot” foci during osteoscintigraphy, they are used in case of a tumor lesion proven by X-ray methods.
Chemotherapy and OMA are the main treatments for skeletal lesions, but not the only ones. The treatment of bone metastases should be complex, only a combination of radiation and drugs, with the correction of metabolism and the addition of palliative surgery, can relieve pain and return the patient to an active life.
Specialists of our clinic know when and what is necessary and possible in each specific clinical case of oncological disease. Learn more, call:
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References:
- Aliev M.
