6 possible causes of rib cage pain

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

Common reasons for rib cage pain include:

1. Injury

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

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

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

2. Costochondritis

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

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

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

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

3. Pleurisy

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

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

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

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

4. Cancer

Share on PinterestOther symptoms of lung cancer include a prolonged cough and shortness of breath.

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

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

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

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

5. Fibromyalgia

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

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

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

6. Pulmonary embolism

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

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

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

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

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

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

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

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

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

6 possible causes of rib cage pain

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

Common reasons for rib cage pain include:

1. Injury

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

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

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

2. Costochondritis

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

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

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

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

3. Pleurisy

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

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

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

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

4. Cancer

Share on PinterestOther symptoms of lung cancer include a prolonged cough and shortness of breath.

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

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

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

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

5. Fibromyalgia

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

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

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

6. Pulmonary embolism

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

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

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

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

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

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

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

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

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

6 possible causes of rib cage pain

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

Common reasons for rib cage pain include:

1. Injury

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

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

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

2. Costochondritis

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

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

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

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

3. Pleurisy

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

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

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

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

4. Cancer

Share on PinterestOther symptoms of lung cancer include a prolonged cough and shortness of breath.

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

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

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

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

5. Fibromyalgia

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

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

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

6. Pulmonary embolism

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

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

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

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

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

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

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

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

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

6 possible causes of rib cage pain

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

Common reasons for rib cage pain include:

1. Injury

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

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

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

2. Costochondritis

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

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

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

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

3. Pleurisy

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

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

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

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

4. Cancer

Share on PinterestOther symptoms of lung cancer include a prolonged cough and shortness of breath.

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

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

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

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

5. Fibromyalgia

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

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

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

6. Pulmonary embolism

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

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

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

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

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

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

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

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

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

Causes of Rib Cage Pain

There are many possible causes of rib cage pain or pain that seems to come from the area around your ribs. These can range from conditions that are primarily a nuisance to those that are life-threatening.

We will look at common and uncommon causes musculoskeletal causes of this pain, as well as causes that may be felt in the rib cage but instead originates in organs within or outside of the rib cage. When the cause of rib pain is uncertain, a careful history and physical exam can help guide you and your doctor to choose any labs or imaging studies that are needed.

DragonImages / Getty Images

Rib Cage Anatomy and Structure

When looking at potential causes and how rib cage pain is evaluated, it’s helpful to think about the structures in and around the rib cage.

Bony Structure

There are 12 ribs on each side of the chest. The upper seven ribs are attached directly to the breastbone (sternum) via cartilage. These are known as the “true ribs.” The remaining five ribs are referred to as the “false ribs.”

Of these, ribs eight through 10 are also attached to the sternum, but indirectly (they attach to the cartilage of the rib above which ultimately attaches to the sternum). Ribs 11 and 12 are not attached to the sternum either directly or indirectly and are called the floating ribs.

There can be variations to this pattern, with some people having an extra set of rubs and some have fewer ribs (primarily the floating ribs).

Surrounding Structures

In addition to the bones that make up the ribs, sternum, and spine, as well as the attaching cartilage, there are many other structures associated with the rib cage that could potentially cause pain. This includes the intercostal muscles (the muscles between the ribs) and the diaphragm (the large muscle at the base of the chest cavity), ligaments, nerves, blood vessels, and lymph nodes.

Organs Within the Rib Cage

The rib cage functions to protect several organs while allowing movement so that the lungs can expand with each breath.

Organs protected by the rib cage include the:

• Heart
• Great vessels (the thoracic aorta and part of the superior and inferior vena cava)
• Lungs and pleura (lining of the lungs)
• Upper digestive tract (esophagus and stomach)
• Liver (on the right side at the bottom of the rib cage)
• Spleen (on the left side at the bottom of the rib cage)

The area between the lungs, called the mediastinum, also contains many blood vessels, nerves, lymph nodes, and other structures.

Organs Outside of the Rib Cage

Organs not within the rib cage but that can sometimes cause pain that feels like it comes from the rib cage include the gallbladder, pancreas, and kidneys. The skin overlying the rib cage may also be affected by conditions (such as shingles) which cause rib cage pain.

Anatomical Variations

There are a number of variations that may be found in the rib cage that can, in turn, lead to or affect symptoms in this region.

• Extra ribs: An extra rib lies above the first rib in 0.5% to 1% of the population and is called a cervical rib or neck rib.
• Missing ribs, most often one of the floating ribs
• Bifurcated (bifid) ribs, a condition present from birth in which the rib splits into two parts by the sternum
• Pigeon chest (pectus carinatum), a deformity in which the ribs and sternum stick out from the body
• Sunken chest (pectus excavatum), in which abnormal growth of the ribs results in the chest having a sunken appearance

Causes

There are many potential causes of pain that feels like it arises from the rib cage, including injuries, inflammation, infection, cancer, and referred pain from organs such as the heart, lungs, spleen, and liver.

In an outpatient clinic setting (such as a family practice clinic), musculoskeletal conditions are the most common cause of rib cage pain. In the emergency room, however, serious conditions that mimic rib cage pain (such as a pulmonary embolism) are more common.

We will look at some of the common and uncommon musculoskeletal causes or rib cage pain, as well as causes that may arise from organs within or outside of the rib cage.

Common Musculoskeletal Causes

Some of the more common musculoskeletal causes of rib cage pain include:

Injuries

Muscle strains may occur with an injury or even coughing or bending. Rib fractures are relatively common and can sometimes cause intense pain. Ribs can also be bruised (bone bruise) without a fracture.

The sternum is infrequently fractured, but chest trauma can result in a number of abnormalities ranging from single fractures to flail chest. With osteoporosis, rib fractures can sometimes occur with very little trauma.

Inflammation

Costochondritis is an inflammatory condition that involves the cartilage that connects the ribs to the sternum. The condition is common, and can sometimes mimic a heart attack with the type of pain that occurs.

Fibromyalgia

Fibromyalgia is a relatively common cause of rib cage pain and can be challenging to both diagnose and treat (it’s primarily a diagnosis of exclusion). Along with pain and morning stiffness, people with the disorder often experience mental fog, fatigue, and other annoying symptoms.

Rheumatoid Conditions

Common rheumatoid conditions that can cause rib cage pain include rheumatoid arthritis and psoriatic arthritis.

Intercostal Neuralgia

Intercostal neuralgia is a condition in which nerve pain (neuropathic pain) arises from an injury, shingles, nerve impingement, and more. It can be challenging both to diagnose and treat.

Slipping Rib Syndrome

Slipping rib syndrome (also called lower rib pain syndrome, rib tip syndrome, or 12th rib syndrome) is thought to be under-diagnosed and can cause significant pain in the lower ribs (the floating ribs). In the condition, it’s thought that overly mobile floating ribs slip under the ribs above and pinch the intercostal nerves, nerves that supply the muscles that run between the ribs.

Other

Other relatively common causes can include pain related to conditions involving the thoracic spine (which not uncommonly causes chest pain in the front of the rib cage), Sternalis syndrome, and painful xiphoid syndrome (the xiphoid is the pointy bony growth at the bottom of the sternum).

Less Common Musculoskeletal Causes

Less common, but significant musculoskeletal causes of rib cage pain can include:

Rib Stress Fractures

Rib stress fractures are an overuse injury commonly seen with activities such as rowing or backpacking. They can be challenging to diagnose, so it is important to let your doctor know what type of exercises and sports you participate in.

Tietze Syndrome

Tietze syndrome is similar to costochondritis but less common. Unlike costochondritis, there is swelling that accompanies the inflammation of the cartilage connecting the ribs to the sternum.

Malignancies

A number of cancers can lead to rib cage pain. Both lung cancer and breast cancer commonly spread (metastasize) to bones, including those of the rib cage. This can occur with a number of different cancers as well.

Pain may be due to the presence of the tumor in bone (bone metastases) or due to fractures that result in weakened bones (pathologic fractures). In some cases, rib cage pain may be the first symptom of the cancer.

These tumors may also grow directly in to the rib cage and cause pain. Multiple myeloma is a blood-related cancer that may occur in the bone marrow of the rib cage and other bones and can also cause rib cage pain.

Other

A sickle cell crisis (bone infarct or essentially a death of bone) is an uncommon cause of rib cage pain. Rheumatoid causes such as lupus are less commonly associated with rib cage pain.

Some other potential but infrequent causes include infections in joints in the rib cage (septic arthritis), polychondritis, and sternoclavicular hyperostosis.

Non-Musculoskeletal Causes

It can sometimes be very difficult to know whether pain that is felt in the rib cage is related to rib cage itself, or underlying structures. Some potential causes of rib cage pain include the following.

Shingles

Shingles is a condition in which the chickenpox virus (which remains in the body after the initial infection) reactivates. Symptoms include fever, chills, and rash distributed on one side of the body, but pain (which can be severe) often occurs before these other symptoms and can be challenging to diagnosis.

Heart Disease

Heart disease not uncommonly causes pain that is felt as rib cage pain, and women especially, tend to have atypical symptoms such as these. The possibility of a heart attack should always be considered in a person who has any form of chest-related pain. Pericarditis, an inflammation of the membrane that lines the heart is also a potential cause.

Aorta

Enlargement of the large artery (aorta) in the chest may cause rib cage pain. Risk factors include the condition Marfan’s syndrome as well as cardiovascular disease.

Lung Conditions

Lung conditions such as pneumonia or lung cancer may cause rib cage pain. Lung cancer, in particular, may irritate nerves that lead to pain that feels like it originates in the rib cage. Pulmonary emboli, or blood clots in the legs (deep venous thromboses) that break off and travel to the lungs are a serious cause of rib cage pain.

Pleural Conditions

Inflammation of the pleura (pleurisy) or the build-up of fluid between the two layers of pleura can cause rib cage pain. This may cause pain with a deep breath and in some positions more than others.

Enlargement of the Spleen

Spleen enlargement, such as with some blood-related conditions or cancers, may cause rib cage pain. The spleen may also become enlarged (and sometimes rupture with mild trauma) with the infectious mononucleosis.

Liver Conditions

Inflammation or scarring of the liver, such as with hepatitis or cirrhosis may cause rib cage pain.

Digestive System Conditions

Gastroesophageal reflux disease (GERD) often causes heartburn, but can also cause other types of pain. Peptic ulcer disease or gastritis are other potential causes.

Referred Pain From Outside of the Rib Cage

Organs outside of the rib cage may also cause pain that feels like it arises in the rib cage. Some of the organs and medical conditions to consider include:

• Gallbladder: Gallstones or cholecystitis (infection of the gallbladder)
• Pancreas: Pancreatitis or pancreatic tumors
• Kidneys and ureters: Kidney stones may sometimes cause referred pain that’s felt in the rib cage (and is often severe).

Rib Cage Pain in Pregnancy

Rib cage pain, especially upper rib cage pain, is also relatively common in pregnancy. Most of the time it’s thought that the pain is due to the positioning of the baby or related to the round ligament.

Much less commonly, and after the 20th week of gestation, pain on the right side felt under the lower ribs is sometimes a sign of preeclampsia or HELLP syndrome, a medical emergency.

When to See a Doctor

If you are experiencing rib cage pain that does not have an obvious explanation, it’s important to make an appointment to see your doctor.

Symptoms that should alert you to call 911 and not wait include:

• Chest pressure or tightening
• Pain in the rib cage that radiates into your arm, back, or jaw
• Heart palpitations
• Shortness of breath, especially of sudden onset
• Pain that is severe
• Sudden onset of sweating
• Lightheadedness
• New onset confusion or change in consciousness
• Coughing up blood, even if only a very small amount
• Difficulty swallowing
• Numbness or tingling in your arms or legs

Diagnosis

In order to determine the cause or causes of rib cage pain, your doctor will take a careful history and may do a number of different tests based on your answers.

History

A careful history is essential in making a diagnosis when the cause of rib cage pain in unknown. The questions noted above may help narrow down potential causes and further guide your work-up. These will include questions to not only understand the characteristics of your pain, but a review of past medical conditions, risk factors, and family history.

To narrow down potential causes, your doctor may ask a number of questions. Some of these include:

• What is the quality of your pain? Is the pain sharp or dull?
• How long have you had the pain? Did it start gradually or abruptly?
• Have you ever experienced pain like this in the past?
• Where is the location of your pain? Is it localized or diffuse? Does it affect both sides of your chest or is it isolated to the left side or right side?
• Is there anything that makes your pain better or worse? For example, pain with a deep breath (pleuritic chest pain) may suggest pleurisy or other lung conditions. Movement may worsen musculoskeletal pain.
• Is the pain present at rest or only with movement?
• Is the pain worse during the day or at night? Pain that is worse at night may suggest serious causes such as an infection, fracture, or cancer.
• Is the pain worse in one particular position (PE)?
• Can your pain be reproduced by pressing on any area of your chest?
• If you also have neck or shoulder pain, does it radiation to your arms? Do you have any weakness, tingling, or numbness of your fingers?
• What medical conditions do you have and have you had? For example, a history of early stage breast cancer in the past might raise concern over a bony recurrence in the rib cage.
• What illnesses have your family members experienced (family history)?
• Do you or have you ever smoked?
• What other symptoms have you experienced (associated symptoms)? Symptoms such as palpitations, shortness of breath, a cough, a rash, jaundice (a yellowish discoloration of the skin), nausea, vomiting, itchy skin, etc. should be shared with your doctor.

Physical Exam

On physical examination, your doctor will likely begin with an examination of your chest (unless you have symptoms suggesting an emergency condition is present). Palpation (touching) your chest will be done to look for any localized areas of tenderness, such as over a fracture or inflammation.

With costochondritis, pain is most commonly noted with palpation to the left of the sternum in a very localized region. Swelling may be related can occur if Tietze syndrome is present or with an injury such as a fracture.

With fractures, tenderness is usually very localized. With sternalis syndrome, pain is often felt over the front of the rib cage, and palpation can cause the pain to radiate to both sides of the chest. With intercostal neuralgia, pain may be felt over the whole chest or along one rib, but can not usually be reproduced with palpation.

Range of motion tests, such as having you lean forward (flexion), stand up straight (extension), and turn to the right and left are done to see if any of these movements can reproduce the pain.

An examination of your skin will be done to look for any evidence of shingles rash, and an examination of your extremities might show signs of a rheumatoid condition such as any swelling or deformity of joints. In addition to examining your chest, your doctor will likely listen to your heart and lungs and palpate your abdomen for any tenderness.

A pleural friction rub is a breath sound that may be heard with inflammation of the lining of the lungs (the pleura). Other breath sounds might suggest an underlying pneumonia or other lung conditions.

In women, a breast exam may be done to look for any masses (that could spread to the ribs).

Labs and Tests

A number of laboratory tests may be considered depending on your history and physical exam. This may include markers for rheumatoid conditions and more. Blood chemistry including a liver panel, as well as a complete blood count may give important clues.

Imaging

Imaging tests are often needed if trauma has occurred, or if there are any signs to suggest an underlying cancer or lung disease. A regular X-ray may be helpful if something is seen, but cannot rule out either a fracture or lung cancer.

Rib detail exercises are better for visualizing the ribs, but can still easily miss rib fractures. In order to diagnose many rib fractures or stress fractures, an MRI may be needed. A bone scan is another good option both for detecting fractures and looking for potential bone metastases.

A chest computed tomography scan (CT scan) is often done if there is concern over lung cancer or pleural effusion. With cancer, a positron emission tomography (PET) scan can be good both for looking at bony abnormalities and other soft tissue spread, such as tumors in the mediastinum.

Since abdominal conditions (such as gallbladder or pancreatic conditions) may cause rib cage pain, an ultrasound or CT scan of the abdomen may be done.

Procedures

Procedures may be needed to diagnosis some conditions that can cause referred pain to the rib cage.

An electrocardiogram (ECG) may be done to look for any evidence of heart damage (such as a heart attack) and to detect abnormal heart rhythms. An echocardiogram (ultrasound of the heart) can give further information about the heart and also detect a pericardial effusion (fluid between the membranes lining the heart) if present.

If a person has had a choking episode or has risk factors for lung cancer, a bronchoscopy may be done. In this procedure, a tube is inserted through the mouth (after sedation) and threaded down into the large airways. A camera at the end of the scope allows a physician to directly visualize the area inside the bronchi.

Endoscopy may be done to visualize the esophagus or stomach for conditions involving these organs.

Treatment

The treatment of rib cage pain will depend on the underlying cause. Sometimes this simply requires reassurance and advice to avoid activities and movements that aggravate the pain.

Rib fractures are difficult to treat, and many physicians are leaning against only conservative treatments such as wrapping the rib cage due to the potential for complications.

For musculoskeletal causes of rib cage pain, a number of options may be considered ranging from pain control, to stretching, to physical therapy, to local injections of numbing medication.

A Word From Verywell

Rib cage pain can signal a number of different musculoskeletal conditions as well as non-musculoskeletal conditions within or outside of the chest. Some of these conditions can be challenging to diagnose. Taking a careful history is often the best single “test” in finding an answer so the underlying cause can be treated.

It can be frustrating to be asked a thousand questions (that are sometimes repeated more than once), but in the case of rib cage pain, is worth the time it takes to make sure you doctor has all of the clues possible to diagnose, and subsequently treat, your pain.

10 Rib Pain Causes, Treatments & More

What causes pain in or around the ribs?

Rib pain, or pain in the chest wall that feels like it comes from a rib, has a variety of causes. Rib pain following any sort of trauma to the chest wall is the most concerning, and is possibly due to a rib fracture, clavicle or sternal fracture, or internal injury to the lungs or other organs in the chest. Seek emergency medical treatment for rib pain following traumatic injury. Rib pain without traumatic injury may be due to muscular strain, joint inflammation, or a pain syndrome of unknown cause. Some systemic illness such as autoimmune disorders or fibromyalgia also cause rib pain.

Causes of rib pain following trauma

The following injuries will result in rib pain.

• Rib fracture: Rib fractures are common following trauma to the chest wall and can be extremely painful. Rib fractures usually present with focal pain along a rib and may present with chest deformity or difficulty breathing. It is common for chest wall trauma such as a fall or car accident to cause multiple rib fractures at the same time.
• Clavicle or sternal fracture: The clavicle (collarbone) or the sternum (the bone in the center of the chest) can also be fractured due to trauma and causes pain in the chest similar to rib pain.
• Lung bruising: Trauma to the chest can lead to pulmonary contusion or bruising to the lung tissue. This can cause significant pain to the chest wall that might mimic rib pain. It is possible to have both rib fracture and pulmonary contusion following chest trauma.
• Internal injuries: Any significant trauma to the chest wall can result in internal injuries. Chest wall trauma always requires emergent evaluation by a physician to identify and treat injuries.

Musculoskeletal chest pain causes

Rib pain may be the result of musculoskeletal issues, such as the following.

• Rib joint inflammation: There is a junction between the rib bones and the rib cartilage that can become inflamed and cause rib pain or chest pain. The cause of this inflammation and pain is unknown. Costochondritis occurs when the inflammation is at the rib attachments to the sternum.
• Pulled muscle: There are small muscles in between each rib that can become strained or pulled. Heavy lifting or intense coughing are two common causes of chest wall muscle strain. Strained muscles in the chest can cause pain that feels like rib pain.
• Pain syndromes: There are several pain syndromes that cause rib pain. A pain syndrome is defined as chronic pain with an unclear cause. Lower rib pain syndrome, Sternalis syndrome, and Tietze syndrome are some examples of pain syndromes that present with rib pain.

Other causes

Other causes of rib pain may include the following.

• Fibromyalgia: Fibromyalgia is a chronic pain syndrome that presents with multiple tender points as well as sleep disturbance and depression. Chest pain is common in fibromyalgia and can feel like rib pain.
• Autoimmune disorders: Some autoimmune disorders such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis present with pain the in the chest. This is often pain at the junction between the rib bone and the rib cartilage and can feel like rib pain.
• Other systemic illness: Some less common illness such as lung cancer, breast cancer, or sickle cell disease and present with pain in the chest that feels like rib pain.

9 rib pain conditions

Acute costochondritis (chest wall syndrome)

Acute costochondritis is the inflammation of the flexible cartilage that connects each rib to the breastbone. Costochondritis is caused by excessive coughing or by straining the upper body, as with weightlifti..

Normal occurence of chest pain

Sometimes chest pain is not a sign of a heart attack. The following symptoms are usually typical of more benign conditions:

If the pain is brief, like a short shock, and subsides right away, it is most likely from an injury such as a broken rib or pulled muscle in the chest.

Sharp pain in the chest that improves with exercise is probably from acid reflux or a similar condition, and will be eased with antacids.

A small, sharp pain anywhere in the chest that actually feels worse on breathing is probably from a lung inflammation such as pneumonia or asthma.

An actual heart attack involves intense, radiating chest pain that lasts for several minutes; worsens with activity; and is accompanied by nausea, shortness of breath, dizziness, and pain in the arms, back, or jaw. Take the patient to the emergency room or call 9-1-1.

If there is any question as to whether the symptoms are serious or not, a medical provider should be seen as soon as possible.

Rarity: Common

Top Symptoms: chest pain, rib pain

Symptoms that always occur with normal occurrence of chest pain: chest pain

Symptoms that never occur with normal occurrence of chest pain: being severely ill, shortness of breath, fainting, severe chest pain, crushing chest pain, excessive sweating, nausea or vomiting

Urgency: Phone call or in-person visit

Atypical chest pain

Atypical chest pain describes the situation when someone’s chest pain is unlikely to be related to heart or lung disease. There are many other possible causes that could explain chest pain, like sore chest wall muscles or psychological factors like stress and anxiety.

Rarity: Common

Top Symptoms: chest pain, shortness of breath

Symptoms that always occur with atypical chest pain: chest pain

Symptoms that never occur with atypical chest pain: fever

Urgency: Primary care doctor

Chronic costochondritis (chest wall syndrome)

Costochondritis is an inflammation of the cartilage that connects a rib to the breastbone. Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.

Rarity: Uncommon

Top Symptoms: rib pain, chest pain, chest pain that is worse when breathing, rib pain when moving, pain when pressing on the chest

Urgency: Phone call or in-person visit

Bronchitis

Acute bronchitis is an inflammatory reaction to an infection in the airways. Most cases of acute bronchitis are caused by a viral infection, although some cases may be due to a bacterial infection.

Symptoms include an acute-onset cough with or without sputum production, low-grade fever, shortness of breat..

Rib bruise or fracture

Broken or bruised ribs are usually caused by a fall or a blow to the chest, although occasionally this can happen due to severe coughing. With a broken rib, the pain is worse when bending and twisting the body.

Rarity: Uncommon

Top Symptoms: rib pain that gets worse when breathing, coughing, sneezing, or laughing, rib pain from an injury, sports injury, rib pain on one side, injury from a common fall

Symptoms that always occur with rib bruise or fracture: rib pain from an injury

Urgency: Primary care doctor

Bacterial pneumonia

Bacterial pneumonia is an infection of the lungs caused by one of several different bacteria, often Streptococcus pneumoniae. Pneumonia is often contracted in hospitals or nursing homes.

Symptoms include fatigue, fever, chills, painful and difficult breathing, and cough that brings up mucus. Elderly patients may have low body temperature and confusion.

Pneumonia can be a medical emergency for very young children or those over age 65, as well as anyone with a weakened immune system or a chronic heart or lung condition. Emergency room is only needed for severe cases or for those with immune deficiency.

Diagnosis is made through blood tests and chest x-ray.

With bacterial pneumonia, the treatment is antibiotics. Be sure to finish all the medication, even if you start to feel better. Hospitalization may be necessary for higher-risk cases.

Some types of bacterial pneumonia can be prevented through vaccination. Flu shots help, too, by preventing another illness from taking hold. Keep the immune system healthy through good diet and sleep habits, not smoking, and frequent handwashing.

Rarity: Common

Top Symptoms: fatigue, cough, headache, loss of appetite, shortness of breath

Symptoms that always occur with bacterial pneumonia: cough

Urgency: In-person visit

Viral pneumonia

Viral pneumonia, also called “viral walking pneumonia,” is an infection of the lung tissue with influenza (“flu”) or other viruses.

These viruses spread through the air when an infected person coughs or sneezes.

Those with weakened immune systems are most susceptible, such as young children, the elderly, and anyone receiving chemotherapy or organ transplant medications.

Symptoms may be mild at first. Most common are cough showing mucus or blood; high fever with shaking chills; shortness of breath; headache; fatigue; and sharp chest pain on deep breathing or coughing.

Medical care is needed right away. If not treated, viral pneumonia can lead to respiratory and organ failure.

Diagnosis is made through chest x-ray. A blood draw or nasal swab may be done for further testing.

Antibiotics do not work against viruses and will not help viral pneumonia. Treatment involves antiviral drugs, corticosteroids, oxygen, pain/fever reducers such as ibuprofen, and fluids. IV (intravenous) fluids may be needed to prevent dehydration.

Prevention consists of flu shots as well as frequent and thorough handwashing.

Rarity: Uncommon

Top Symptoms: fatigue, headache, cough, shortness of breath, loss of appetite

Urgency: Primary care doctor

Chest bruise

A bruise is the damage of the blood vessels that return blood to the heart (the capillaries and veins), which causes pooling of the blood. This explains the blue/purple color of most bruises. Bruises of the chest are common, given how exposed this area of the body is.

Rarity: Common

Top Symptoms: rib pain, constant rib pain, rib pain from an injury, recent chest injury, bruised chest area

Symptoms that always occur with chest bruise: rib pain from an injury, recent chest injury, constant rib pain

Urgency: Self-treatment

Costochondritis – NHS

Costochondritis is the medical term for inflammation of the cartilage that joins your ribs to your breastbone (sternum). This area is known as the costochondral joint.

Cartilage is tough but flexible connective tissue found throughout the body, including in the joints between bones.

It acts as a shock absorber, cushioning the joints.

Costochondritis may improve on its own after a few weeks, although it can last for several months or more.

The condition does not lead to any permanent problems, but may sometimes relapse.

Tietze’s syndrome

Costochondritis may be confused with a separate condition called Tietze’s syndrome.

Both conditions involve inflammation of the costochondral joint and can cause very similar symptoms.

But Tietze’s syndrome is much less common and often causes chest swelling, which may last after any pain and tenderness has gone.

Costochondritis also tends to affect adults aged 40 or over, whereas Tietze’s syndrome usually affects young adults under 40.

As the conditions are very similar, most of the information below also applies to Tietze’s syndrome.

Signs and symptoms of costochondritis

When the costochondral joint becomes inflamed, it can result in sharp chest pain and tenderness, which may develop gradually or start suddenly.

The pain may be made worse by:

• a particular posture, such as lying down
• pressure on your chest, such as wearing a seatbelt or hugging someone
• deep breathing, coughing and sneezing
• physical activity

When to seek medical help

It can be difficult to tell the difference between the chest pain associated with costochondritis and pain caused by more serious conditions, such as a heart attack.

But a heart attack usually causes more widespread pain and additional symptoms, such as breathlessness, feeling sick and sweating.

If you or someone you’re with experiences sudden chest pain and you think there’s a possibility it could be a heart attack, dial 999 immediately and ask for an ambulance.

If you have had chest pain for a while, do not ignore it. Make an appointment to see a GP so they can investigate the cause.

Causes of costochondritis

Inflammation is the body’s natural response to infection, irritation or injury.

It’s not known exactly why the costochondral joint becomes inflamed, but in some cases it’s been linked to:

• severe coughing, which strains your chest area
• an injury to your chest
• physical strain from repeated exercise or sudden exertion you’re not used to, such as moving furniture
• an infection, including respiratory tract infections and wound infections
• wear and tear – your chest moves in and out 20 to 30 times a minute, and over time this motion can lead to discomfort in these joints

Diagnosing costochondritis

If you have symptoms of costochondritis, a GP will probably examine and touch the upper chest area around your costochondral joint.

They may ask you when and where your pain occurs and look at your recent medical history.

Before a diagnosis can be confirmed, some tests may need to be carried out to rule out other possible causes of your chest pain.

These may include:

If no other condition is suspected or found, a diagnosis of costrochondritis may be made.

Self-help for costochondritis

Costochondritis can be aggravated by any activity that places stress on your chest area, such as strenuous exercise or even simple movements like reaching up to a high cupboard.

Any activity that makes the pain in your chest area worse should be avoided until the inflammation in your ribs and cartilage has improved.

You may also find it soothing to regularly apply heat to the painful area, such as using a cloth or flannel that’s been warmed with hot water.

Treatments for costochondritis

Painkillers

Painkillers, such as paracetamol, can be used to ease mild to moderate pain.

Taking a type of medication called a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen and naproxen, 2 or 3 times a day can also help control the pain and swelling. 

Aspirin is also a suitable alternative, but should not be given to children under 16 years old.

These medicines are available from pharmacies without a prescription, but you should make sure you carefully read the instructions that come with them before use.

NSAIDs are not suitable for people with certain health conditions, including:

Contact a GP if your symptoms get worse despite resting and taking painkillers, as you may benefit from treatment with corticosteroids.

Corticosteroid injections

Corticosteroids are powerful medicines that can help reduce pain and swelling.

They can be injected into and around your costochondral joint to help relieve the symptoms of costochondritis.

Corticosteroid injections may be recommended if your pain is severe, or if NSAIDs are unsuitable or ineffective.

They may be given by a GP, or you may need to be referred to a specialist called a rheumatologist.

Having too many corticosteroid injections can damage your costochondral joint, so you may only be able to have this type of treatment once every few months if you continue to experience pain.

Transcutaneous electrical nerve stimulation (TENS)

TENS is a method of pain relief where a mild electric current is delivered to the affected area using a small battery-operated device. 

The electrical impulses can reduce the pain signals going to the spinal cord and brain, which may help relieve pain and relax muscles.

They may also stimulate the production of endorphins, which are the body’s natural painkillers.

Although TENS may be used to help relieve pain in a wide range of conditions, it does not work for everyone.

There’s not enough good-quality scientific evidence to say for sure whether TENS is a reliable method of pain relief.

Speak to a GP if you’re considering TENS.

Find out more about transcutaneous electrical nerve stimulation (TENS)

Community content from HealthUnlocked

Page last reviewed: 24 April 2019
Next review due: 24 April 2022

90,000 Chest pain ➣ symptoms and causes of pain

Chest pain often manifests itself in different forms. Sometimes it is a sharp pain in the chest, sometimes a feeling of squeezing or burning.

Chest pain can cause a wide variety of health problems. The most life-threatening causes are related to the heart or lungs. Since chest pain can indicate a serious problem, it is important to seek medical attention as soon as possible.

Chest pain associated with problems of the cardiovascular system

Symptoms:

• pressing pain in the chest, burning or tightness in the chest
• Severe pain that lasts more than a few minutes and gets worse with physical activity
• dizziness or weakness
• shortness of breath
• cold sweat
• feeling nauseous or vomiting

Causes of heart pain in chest

Acute cardiovascular disease .A heart attack occurs as a result of blocked blood flow, often from a blood clot, in the heart muscle.

Angina . The chest pain in this case is caused by poor blood supply to the heart. This is due to the accumulation of thick plaque on the inner walls of the arteries. These plaques narrow the arteries and limit the blood supply to the heart, especially during exercise.

Aortic dissection . This is a life-threatening condition. The inner layers of this blood vessel are divided, blood flows between the layers of the walls of the aorta.This can lead to rupture of the aorta – rapid and severe blood loss.

Pericarditis . This is an inflammation of the lining of the heart. Usually causes severe pain that gets worse when you breathe in or when you lie down.

Chest pain caused by problems with the digestive system

Symptoms

• sour or bitter taste in the mouth
• Burning pain after a heavy meal
• increasing and decreasing pain for a long time
• aching pain for many hours

Chest pain can be caused by disorders of the digestive system, including:

Heartburn . This painful burning sensation behind the breastbone occurs when stomach acid is flushed from the stomach into the tube that connects the throat to the stomach (esophagus).

Esophageal obstruction can make swallowing difficult and even painful.

Pain-free video endoscopy at the International Innovation Clinic. Read more… ..

Problems with the gallbladder or pancreas . Gallstones or inflammation of the gallbladder or pancreas can cause abdominal pain that radiates to the chest.

The classic symptoms of heartburn – a painful burning sensation behind the breastbone – can be caused by heart or stomach problems.

Chest pain associated with problems in the musculoskeletal system

Certain types of chest pain are associated with trauma and other problems affecting the structures that make up the chest, including:

Osteochondrosis . Degenerative changes in the spine can cause pressing pain in the chest, pain between the shoulder blades and in the hypochondrium.

Intercostal neuralgia. Sharp pain that worsens with any change in body position, when you breathe deeply or cough. It occurs due to compression, irritation or inflammation of the nerve with problems with the spine.

Muscle pain . Chronic pain syndromes such as fibromyalgia can cause persistent muscle pain in the chest.

Do you know the sensation of pain all over your body? Read more…….

Injured ribs . A bruised or broken rib can cause chest pain.

Chest pain associated with lung problems

Many lung diseases can cause chest pain, including:

Pulmonary embolism . This occurs when a blood clot enters the pulmonary artery, blocking blood flow to the lung tissue.

Pleurisy. If the membrane covering your lungs becomes inflamed, it can cause chest pain that gets worse when you inhale or cough.

Pneumothorax. Chest pain associated with a collapsed lung usually begins suddenly and can last for hours and is usually associated with shortness of breath. A compressed lung occurs when air seeps into the space between the lung and the ribs.

Pulmonary hypertension . This condition occurs when you have high blood pressure in the arteries that carry blood to your lungs, which can cause chest pain.

Other causes of chest pain

Chest pain caused by panic attacks. Periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness, and fear of death.

Shingles. This skin condition can cause one-sided pain and a band of blisters from the back to the chest wall.

If you have unexplained chest pain or suspect you are having a heart attack, seek emergency medical attention immediately.

Chest pain does not always signal a heart attack. But this is what emergency room doctors will check first, because it is potentially the most immediate threat to your life. They can also check for life-threatening lung diseases such as a collapsed lung or a pulmonary artery clot (PE).

Diagnostics for chest pain

Electrocardiogram (ECG) . This test records the electrical activity of your heart through electrodes attached to your skin.Since the damaged heart muscle does not conduct electrical impulses normally, the EKG may indicate that you have had a heart attack.

Blood tests . Your doctor may order blood tests to check for elevated levels of certain proteins or enzymes normally found in the heart muscle. Damage to heart cells from a heart attack can cause these proteins or enzymes to enter your bloodstream within hours.

Radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound examination (US) of the chest. These studies will assess the condition of the chest organs, identify injuries, neoplasms, signs of internal bleeding and other pathological changes.

Based on the results of the tests done, your doctor can determine if you have a heart attack, as well as determine the cause of your chest pain and prescribe treatment.

Timoshenko Anna Sergeevna, neurologist of the International Innovation Clinic.

Back and joint problems? Don’t restrict your movement because of the pain! Read more… ..

Video endoscopy without pain Read more… ..

Do you want to know if your thyroid is okay? Take test

Do you know the sensation of pain all over your body? Read more… ..

90,000 Exercises to improve lactation

The proposed set of exercises helps to strengthen the muscles of the chest and lymph, activate the lactic functions of the breast.

1. Stand straight, feet shoulder-width apart, raise your arms to the sides, bend your elbows parallel to your shoulders, exhale and bring them together in front of your chest (elbows at shoulder level), spread your elbows. Repeat 24 times, all subsequent exercises too.

2. Starting position too. Raise your arms forward and spread them to the side at shoulder level.

3. As you exhale, clench your fists and raise your bent arms to your shoulders.

four.Raise your arms forward, palms down, clench your fists vigorously, lower your arms.

5. Take your straight arms back, palms inward. Don’t lean forward.

6. Raise your arms forward, rotate your forearms, opening your palms up.

7. Raise your arms to the sides, make circular movements with your forearms inward (12 times) and out (12 times).

8. Inhale and spread your arms to the sides; while exhaling, cross them in front of you, as if hugging yourself.

9. Standing facing the wall, about a step away from it, rest with straight arms, bend your arms and push off the wall without moving your legs.

FOOD DURING PREGNANCY AND BREASTFEEDING.

During pregnancy and breastfeeding, your body requires more nutrients to meet your and your baby’s needs.

The main requirement for food is that it must be natural and whole.

You need products from all major groups every day:

1) foods rich in proteins;

2) milk and dairy products;

3) vegetables, fruits, juices;

4) cereals;

You need food rich in protein four times a day.Protein products are meat, poultry, fish, legumes, nuts. Proteins are the main building blocks. Protein foods also provide the body with iron and B vitamins.

· Eat nuts instead of chips.

· Add more cheese to your food.

· Use vegetable oil for cooking.

· Add more legumes to salads.

You need milk and dairy products every day – kefir, Katyk, fermented baked milk, cottage cheese, cheese.Dairy products provide the body with calcium, which is essential for healthy teeth and bones. Calcium also provides normal muscle contraction, is involved in the process of blood clotting. Dairy products provide the body with a large amount of protein.

You need fruits and vegetables every day. Vitamin C is rich in grapefruit, bell peppers, black currants, strawberries, melon and oranges. Vitamin A contains orange plant foods: carrots, turnips, zucchini, peaches, apricots.Zucchini contains a large amount of trace elements. Fruits and vegetables prevent constipation, provide the body with vitamins and mineral salts.

· Eat more fresh fruits and vegetables.

· Eat fruit with homemade cheese.

· Try to season vegetables with katyk, fermented baked milk.

The daily diet during pregnancy and lactation should include:

one.Up to 1 liter of milk (you can replace it with cheese or cottage cheese).

2. Two servings of fish, poultry, or lean beef.

3. Two servings of fresh vegetables: beets, turnips, spinach, cabbage, parsley.

4. Two dishes from the set: potatoes, bell peppers, tomatoes.

5. Five servings of whole grain bread, porridge.

6. 50-60 g of butter or an equivalent amount of vegetable oil.

7. Yellow and orange vegetables – 5 times a week.

8. Salt food to taste!

9. Drink water to quench your thirst.

When pregnant and lactating mothers follow this plan, they will receive approximately 2,600 calories, 80 to 100 grams of high quality protein and all other nutrients in sufficient quantities for a woman in this position.

CORRECT BREAST FIT:

STEP BY STEP (WHO / UNICEF, 1997).

1. Sit comfortably, relax, get into a comfortable lying or sitting position to keep the baby close to the chest for a relatively long time.

2. Hold the baby in such a position that he does not have to pull out the head. This means that the baby’s breast should be turned towards its own breast.

3. Place your baby close to your breast so that he does not have to make an effort to reach for the breast while feeding.If the baby tries hard to hold the nipple in his mouth, your nipple will be damaged.

4. Support the baby’s back, do not hold the head. If the baby’s head is firmly gripped in your hand, he will instinctively try to wriggle out, “fight” at the breast.

5. The baby’s nose during feeding should be flush with the nipple.

6. Do not use your fingers to adjust the distance between the baby’s nose and chest.When positioned correctly, the baby breathes through the edges of the nasal passages.

7. The baby should fully grasp the areola to reach the place where the milk has accumulated. If there is a need for breast support, hold it from below, preferably with the entire palm of your hand, with the edge pressed against the chest. Keep your fingers at a distance of 9-10 cm from the nipple.

8. If the baby is sleepy or restless, draw his attention to feeding by gently touching the cheek, mouth, or nipple.Squeeze a drop of milk onto the surface of the nipple to stimulate the baby’s appetite.

9. When you see that the child’s mouth is wide open, the tongue is deep at the bottom of the mouth, your task is to show dexterity, quickly bring the child closer to you and give him a chance to “grab”. It will take the experience of several feedings to learn, not everything is done right away on the first try.

10. In the event that the baby is angry, very hungry and crying at the moment of latching on to the breast, he raises his tongue, making feeding impossible.Try to calm the baby down before feeding. Some babies have periods of protest before each feed. Take every opportunity to feed your baby when it comes up.

Remember that you need to pull the baby to the breast, and not you reach for him with the breast!

BREAST CARE BEFORE AND AFTER BIRTH

PRE-BIRTH:

During pregnancy, the breast enlarges and begins to prepare for lactation.In the second half of pregnancy, you can find droplets of colostrum from the breast – the precursor of milk.

During pregnancy, the breasts require some preparation to prevent the difficulties of the first week of feeding the baby. Air and sun baths, massage with vitamin E, gentle twitching of the nipples for 3-5 minutes are useful for the breast.

Another way to prepare the nipples for breastfeeding is to gently massage the entire breast area from the chest wall to the nipple, lightly expressing colostrum.

Remember that proper and nutritious nutrition is critical to a successful breastfeeding start.

AFTER BIRTH:

On the first day after childbirth, colostrum is excreted from the breast – it is very valuable for the newborn. Colostrum differs from mature breast milk: it is richer in amino acids, contains antibodies that protect the baby from infectious diseases. It also contains living cells – macrophages, lymphocytes, which help to cleanse the baby’s intestinal tract and facilitate the digestive process.Colostrum contains antibodies against infectious diseases that a woman has accumulated during her life (measles, rubella, mumps, polio).

Even a drop of colostrum that has entered the body of a newly born child will protect him from many diseases. Children who are allowed unrestricted access to colostrum rarely lose little or no initial weight.

Sucking your baby activates milk production. Frequent breastfeeding prevents excess milk flow.Breastfeeding is the mainstay of mastitis prevention.

Even if the nipples are prepared in good faith during pregnancy, “harsh” handling by the baby during feeding can cause soreness and cracking. The most common causes of these painful conditions are:

– rare attachment to the breast, causes excessive engorgement of the glands, induration of the nipples (in the first few weeks of life, 10-12 feeding times are common).

– Improper use of breast pumps.

– Use of airtight pads and compresses on the nipple area.

– Wearing a tight bra.

If cracks appear on the nipples, vitamin E (treatment of the nipples with an oil solution of this vitamin), air and sun baths can be useful. The sore breast should be offered to the baby in the second place, making sure that he does not grab it very greedily.

BREASTFEEDING RECOMMENDATIONS.

– Feeding a full-term baby should be at his request (free feeding). Allow your nipples to air dry after each feed.

– A newborn sucks better when he is hungry. If the baby is asleep, do not wake him up to feed. In the first few days, he may sleep more. Better wait for the baby to get hungry.

– Offer both breasts to your baby at each feed.If breastfeeding lasts 15-20 minutes, change breasts in the middle of the feed, that is, after 7-10 minutes. The “final” milk has a high fat content. Fats are essential for the growth and healthy functioning of your child’s nervous system.

– The best feeding regime for the baby is the one that suits him. Your baby may require feeding every hour for both physiological (empty stomach) and emotional (your society wants) reasons. Both reasons are valid.Breast milk is absorbed easily and completely. Making a child wait because of a previously drawn up template schedule means not with his own needs.

– Your breasts are unable to produce enough milk without significant stimulation from the sucking baby. Feeding is a “requirement for milk supply”, the more the baby requires, the more milk your breasts can supply, provided they are well nourished.

– The skin of your nipples is very delicate, cracks may appear on it, so you should feed your baby for no more than 20-25 minutes every hour.To prevent sore nipples, treat them with sea buckthorn oil, an oil solution of vitamin E, and open your breasts to the sun.

– Don’t give your baby bottle water. The baby satisfies the need for fluid with frequent breastfeeding.

– If the baby spits up, then it is possible that he swallowed a lot of air during feeding. Hold it upright after feeding, massage the back.

– Avoid strong-smelling or spicy foods in your diet until you are sure your baby likes these smells.

– If you are happy and relaxed, then there will be enough milk in your breast.

METHODS FOR FITTING A CHILD TO THE BREAST.

Lying on its side

In the first days after childbirth, this

The most common position. Place 1-2 pillows under your head to make it easier for you to lie down. Lying on your right side and breastfeeding with your right breast, support the baby with your right hand.Switch sides for the next feeding.

Football regulation

Place your baby’s legs under your arm – this is the so-called soccer position. Place a pillow on your knee with your baby’s head and body on it, supporting him with your hand. Use your palm to support the baby’s head as you apply it to your chest.

Lying on your back.

It is not very easy and convenient, but it can be a solution, especially after a caesarean section.Make sure the baby grasps the nipple along with the areola.

Sitting in a chair.

Sit up straight with your feet touching the floor. The child should be at the same level with the breast – you can put a pillow on your knees.

RECOMMENDATIONS FOR THE FIRST FEEDING OF A NEWBORN.

– After giving birth, breastfeed your baby as soon as possible and willing.

– Breastfeeding a few minutes after giving birth and stimulating your nipples will trigger in your body the mechanism of release of oxytocin – a hormone responsible for stimulating milk production, uterine contraction, rapid expulsion of the placenta, and reducing blood loss during childbirth.

– If your childbirth was complicated or there is some other reason why you cannot attach the baby to the breast immediately after birth, do not worry! Wait patiently for the baby to be brought to you for feeding.

– You took the child in your arms … you have a favorable opportunity for privacy with your baby. Talk to him in the same way as you talked to an unborn child. He recognizes your voice. He will be glad to meet you. When the baby seems calm to you, insert the nipple into his mouth.

– Do not worry that he will not cope with feeding – a set of innate reflexes (searching, sucking, swallowing) of a full-term, healthy baby will help him cope with this task.

– Keep the baby close to your breast. The sounds of your heartbeat will calm him down. Keep the head on the curve of your arm.

– If your baby is retrieved by caesarean section, place a pillow on your lap while feeding while sitting to bring the baby closer to the nipple.The pillow will protect your postoperative scar from the baby’s jolts.

– If the newborn does not immediately find your nipple, touch his cheek closest to your breast. The baby will twist its head until it finds the nipple.

– Sometimes your help is needed to get the baby to “cling” to the nipple and start sucking. Place your fingers on your chest in front of his nose. This will slightly flatten the nipple and help

adapt it to the shape of the child’s open mouth.Use your other fingers to hold your chest down.

– If your nipple continually slips out of your baby’s mouth, keep inserting it over and over. After a few tries, your child will be successful.

– The baby should capture not only the nipple, but also most of the areola, which should be between the tongue and the palate. In this case, the nipple will be held in the mouth, and the baby’s jaws will move along the outer edge of the areola.

– The baby finishes sucking on its own.Once full, it will “fall off” from the chest in a relaxed state, with even breathing.

FIRST FEEDING

The most perfect nutrition for a newborn is human milk!

Immediately after birth, a healthy baby begins an instinctive search for food. In the first hours of life, the baby is awake, active and ready to suck. If the baby is placed on the mother’s belly immediately after birth, it will crawl to the mother’s breast, mainly to the left (mother’s heart).If the baby is not disturbed, he will find the breast on his own, usually within the first hour of life. Some newborns will stay awake at the breast for up to two hours, while others, after sucking on the breast, fall asleep. According to WHO experts, labor is considered complete only after the baby has successfully passed from placental feeding to breastfeeding.

Breast milk is the most perfect food for a baby. Human milk contains up to 90 different substances and their composition and ratio are the most favorable for the newborn.The composition of human milk differs significantly from the milk of various animals in the quantitative ratios of proteins, fats, carbohydrates, mineral salts and water. The energy value of 100 ml of human milk is 69-70 kilocalories. The qualitative difference between human milk and cow’s milk, which is most often used in the absence of milk from the mother, lies in its easier digestion and assimilation. An important feature of human milk is that of the many proteins included in it, 18 are identical to those of the blood serum of a newborn baby.These proteins (lactoalbumin, lactoglobulin, immunoglobulin), when curdled in the stomach, form easily digestible flakes. Due to the identity of the proteins of human milk and the proteins of the baby’s blood serum, part of the proteins of breast milk from the gastrointestinal tract of the newborn is absorbed and passes into the blood of the baby unchanged.

In addition, human milk contains a large amount of immunoglobulins necessary to protect the child’s body from infectious agents – viruses, bacteria.The body of a newborn does not yet have its own immunoglobulins, so their intake with mother’s milk is very valuable for the child in preventing pyoinflammatory diseases. It should be noted that during pasteurization and boiling of breast milk, immunoglobulins are destroyed and lose their biological value.

The most favorable for the baby is also the qualitative and quantitative composition of breast milk fats. Although the amount of fat in human and cow’s milk is almost the same (3.4-3.7%), however, the composition of fats in human milk is significantly different from that of cow’s.In it, fats are represented by unsaturated fatty acids – essential ones that are not synthesized in the body. Unsaturated fatty acids of human milk increase the processes of protein assimilation, promotes the manifestation of the physiological activity of vitamins C and group B, and increase the body’s resistance to infections.

In addition, unsaturated fatty acids are essential for the normal functioning of the nervous system, blood vessels and, to some extent, play the role of hormones.

The amount of milk sugar (lactose) in human milk is higher than in cow’s milk. Lactose has twice the energy value than other types of sugar and is more preferable than glucose, it is used in the body to synthesize the substance necessary for the child’s brain – galactoserebrosides. The mineral composition of human milk differs from cow’s milk in a smaller amount of mineral salts: calcium, magnesium, potassium, sodium, phosphorus, sulfur. This is essential for the neonatal kidney function.At the same time, human milk is much richer than cow’s milk, iron, copper, zinc.

It has long been known that the health, development, morbidity, and sometimes the viability of children depend on the type of feeding. Breastfed babies receive passive immunity with mother’s milk, which contains antibodies and other antibacterial substances that protect the newborn from pathogens of many infections. Cow’s milk and milk formula are devoid of human immunobiological factors.The problem of food allergy is associated with the method of feeding a newborn. Cow’s milk proteins, being alien to the newborn’s body, cause allergy. Human milk, unlike cow’s and other varieties of whole milk, is devoid of antigenic properties and does not cause allergies. When breastfeeding, the intestines of the newborn are populated with beneficial microbial flora, which plays an essential role in protecting the body from allergies.

Thus, a brief listing of the advantages of human milk clearly shows that breastfeeding contributes to the health and harmonious development of newborns.

Severe cough and “whistling” in the chest in a child: answers to questions

Severe cough and “whistling” in the chest in a child: answers to questions

Materials for parents

You brought a child with a severe cough for examination and the pediatrician surprises you: he has a “whistle” in his chest. Of course, anxiety cannot be avoided, let alone questions.

Is the “whistle” in the chest dangerous?

This problem can occur in young children. The thinnest branches of the bronchi – bronchioles – are very delicate and narrow in children. The mucous membrane becomes easily inflamed, forming a secret that is difficult to leave due to additional spasm. This condition is called bronchiolitis. The child does not cough up a secret well, the respiratory muscles come to the rescue, and the parent notices difficult and rapid breathing, in the upper abdomen and above the sternum.

The most common causes are viruses. Treatment – inhalation with a medicine that dilates the bronchi and promotes the elimination of secretions. Mild to moderate seizures are successfully treated at home under the guidance of a pediatrician. In severe cases, hospitalization is indicated, where the child’s condition is monitored around the clock and the necessary therapy is carried out.

Does “whistle” indicate the development of asthma?

No, many children develop this problem without developing asthma.Diagnosis: “Bronchial asthma” is established after the observation of a pediatric pulmonologist and special respiratory examinations – spirometry, pulse oscillometry. The number of bronchitis and bronchiolitis suffered by the child, their severity, in what period they appear, at what age they began, are there any other allergic diseases, heredity, as well as a reaction to treatment, the need for hospitalization, etc.

Is dirty air to blame?

Small dust particles irritate the mucous membrane of the respiratory system, but are not the main culprit for “whistling” in the chest.In Russia, about 10-15% of children suffer from bronchial asthma, and in Scandinavian countries with cleaner air – 30%. Heredity, atopic relief (atopic dermatitis, allergic rhinitis, food allergy, etc.) are important. Children living in rural areas are more likely to be infected with bacteria, parasites and other microorganisms, and they are less likely to develop asthma. Their immune systems are “trained” and working in the right direction, not against their own body. The “hygienic” hypothesis is increasingly being promoted as one of the causes of asthma.When a child grows up in an environment that is too clean, sterile, the immune system does not encounter “stimuli” and does not learn to respond to them.

Is asthma a lifelong diagnosis?

In 75% of cases, the attacks are not severe, and with prolonged treatment they disappear by 7-8 years. In other cases, asthma is lifelong with an exacerbation during puberty. To prevent this from happening, treatment should be prescribed by a pediatric pulmonologist. And strictly observed by the parents.

Share:

90,000 “Covid” pneumonia does not look like ordinary pneumonia

07/15/2020

“Covid” pneumonia does not look like ordinary pneumonia

More than four and a half thousand people in the Arkhangelsk region since the beginning of the pandemic have had a new COVID-19 infection and recovered. More than two thousand are now undergoing treatment.And if with a mild form of coronavirus, there may not be any symptoms at all , then against the background of moderate and severe, pneumonia often develops .

What determines the health of the lungs and how to recover from an illness – Anna Karabet, a pulmonologist at the First City Clinical Hospital named after V.I. E. E. Volosevich.

The disease does not respond to antibiotics

– Anna Aleksandrovna, is there any regularity: who is most vulnerable to pneumonia ? What contributes to its occurrence?

– Risk factors include the presence of chronic diseases, the state of the immune system and lifestyle.Much depends on whether a person has respiratory problems – for example, asthma or chronic obstructive pulmonary disease, other chronic lung diseases. Patients with such diagnoses are always more at risk of developing pneumonia. As well as people with weakened immunity, diseases of the cardiovascular system, diabetes mellitus. If colds occur frequently, several times a year, then it is imperative to look for the cause. Perhaps there is some kind of disease that has a negative effect on the immune system as a defense against external factors.And of course, it is important how a person eats, whether he leads an active lifestyle, smokes or not.

– How does the one that occurs against the background of coronavirus differ from ordinary pneumonia ? And how does this affect the patient’s recovery after treatment?

– Pneumonia, which is the most common and with which we work most often, is caused by bacteria. They proceed differently than viral ones.First, they respond well to antibiotics. Second, resolution of bacterial pneumonia usually occurs fairly quickly. Of course, there are situations when a patient is admitted in a serious condition and is even in the intensive care unit – then the treatment is more complicated and the recovery process is longer. As for viral pneumonia, this phenomenon is also not new. We have encountered them before. For example, when they were caused by a flu infection. But covid pneumonia is a different story.In general, the coronavirus as such has existed for a long time, people have been sick with it in the last century, but it was not the same as it is now, and did not cause such serious manifestations. This pneumonia does not respond to antibiotics. Complicating the situation is the fact that so far there is no drug in the world directly to combat COVID-19. The course of the disease is different, it develops according to a special mechanism and affects other structural units of the lungs. On computed tomography, we see in patients, as a rule, bilateral serious changes and rather slow positive dynamics.- The most severe patients with coronavirus are connected to a ventilator. How does being on mechanical ventilation affect the further state of the respiratory system? – The use of a ventilator has no long-term consequences. Complications can occur with mechanical ventilation, but in the presence of certain chronic lung diseases. Such situations are a rare phenomenon, resuscitators control the process and immediately take the necessary measures. So artificial ventilation is not a procedure to be feared.On the contrary, it is of great help when the lung cannot breathe on its own: the apparatus takes over this work.

Inflating the balloon – big mistake

– How does a patient recover from pneumonia? Is rehabilitation required?

– Since the treatment of viral pneumonia is a long and difficult process, the recovery does not always go smoothly. Changes in the lungs in patients can “freeze” for some time, remain in one state for a long time.After being discharged from the hospital, a person may have a slight dry cough and asthenia – weakness, increased fatigue. Of course, many patients are intimidated by this. Imagine the situation: a person used to not be ill with anything serious, was strong, strong and athletic, and now he constantly experiences weakness, discomfort in the chest, cannot breathe as usual. People with chronic respiratory diseases over time adapt to such manifestations and learn to cope with them. For those who encounter for the first time, this causes panic.Therefore, if treatment is no longer required, and the above manifestations remain, then attention should be paid to the patient’s rehabilitation. In particular, to carry out breathing exercises. There is a special technique according to the Buteyko method, it is very effective. But training must be selected strictly individually. Physiotherapists, physiotherapy instructors perform this breathing exercises and educate patients. It is important to do breathing exercises strictly in accordance with the doctor’s prescription. Sometimes a person is discharged from the hospital and upon returning home, instead of the prescribed set of exercises, he begins to inflate balls, blow into a tube.This is a big mistake. Such methods are also used, but for other pathologies. With this type of pneumonia, this is contraindicated – you cannot inhale and exhale sharply when we do gymnastics. Breathing should be very slow and calm, even gentle. There are also special breathing simulators that help restore health. The body has muscles that help us breathe, activate breathing. And these machines help your muscles work so they function better. There are a lot of breathing simulators, they are different, and you can use them only on the recommendation of a doctor.Many patients after severe pneumonia, when they were in intensive care, lose weight. Therefore, we recommend protein food – meat, fish, dairy products. The third important stage of rehabilitation is psychological support. People are really scared, they went through a difficult and completely new stage of life for them. As I already gave an example: a person was an active athlete, but now he cannot breathe properly during physical exertion – for him it is scary. Therefore, it is important that the doctor can not only prescribe treatment and rehabilitation, but also psychologically adjust correctly, explain that this is a temporary phenomenon, you just need to work on yourself, follow the doctor’s recommendations and over time everything will recover – just not as quickly as we would like.

– Anna Alexandrovna, what does lung health depend on?

– Here we need to talk about the factors affecting the health of the entire respiratory system, since the lungs are part of it and they do not exist separately. First of all, it is heredity – something that is transmitted genetically from parents. Health largely depends on how the pregnancy proceeded – what lifestyle the mother led, what she was ill with and how this affected the development of the fetus.There are situations when a child is already born with a defect in the respiratory system, and sometimes such disorders on the part of genetics may not appear immediately, but in the first years of his life. The second is the negative factors that we face in the process of life. For example, emissions of toxic substances into the air: sulfur, nitrogen oxides, aldehydes, nitrates … First of all, this applies to those regions where hazardous production is located. Some people have to constantly work with chemicals – with ammonia or chlorine, with professional biological substances such as wood dust, cement, quartz, coal.This also affects health, and how much depends on how long they interact with these substances, what is the concentration of these substances per unit of time and what safety measures are taken. And the third factor is smoking, which is very bad for the lungs. Now many have switched to electronic cigarettes, hookahs. They are positioned as a less harmful option for health, since there is no nicotine. In fact, studies have been carried out on e-cigarettes, and it has been revealed that nicotine is contained there to one degree or another.As a result, some make money from this bad habit of millions of people, while others are trying to fight it. The person himself is between these two sides, and a lot depends on his choice.

– Is it possible to increase the endurance of the lungs, reduce the risk of worsening their condition?

– First of all, if there are no contraindications, you must definitely go in for sports. Such breathing loads are important and beneficial for the body.Especially in childhood, when the lungs and the entire respiratory system are being formed. How it will develop – with that person and will have to live the rest of his life. It is necessary to strive to reduce the risk of respiratory infections, which can become a catalyst for pneumonia, and bronchopulmonary diseases. In particular, timely vaccination plays an important role here. Due to the high humidity in our region, the climate is not very favorable for the respiratory organs, so you must definitely go to the place where the sea, mountains, pine forests are.And of course, to lead a healthy lifestyle – this recommendation is relevant for the prevention of any disease.

Source: city newspaper “Arkhangelsk – the city of military glory” No. 53. July 15, 2020.

Esophageal-gastrointestinal-diaphragmatic murmur – a new objective sign of diaphragmatic hernias | Garanin

At present, there is an increase in the incidence of hiatal hernia (HH). According to epidemiological data, the prevalence of hiatal hernias increases by 10% for every 10 years of a person’s life.In people over the age of 65, diaphragmatic hernia (DH) is diagnosed in 75% of cases, while the disease has a pronounced gynecotropism [1].

HHH is the most common cause of chest pain (up to 60%), not associated with heart disease (“non-cardiac chest pain”), for which antianginal therapy was unsuccessfully prescribed [2]. A quarter of patients who underwent coronary angiography to diagnose coronary heart disease had intact coronary arteries [3].

Currently, the diagnosis of HH is carried out by interviewing the patient. DH is detected in the presence of complaints of chest pain (45–84% of cases), heartburn (47–64%), belching, rumination and regurgitation (30–52%), swallowing disorders (14–31%), vomiting and nausea (4-18%), shortness of breath and hiccups (3-5%), burning of the tongue (3-4%) [3].

Fibroesophagogastroscopy (FEGS) provides the researcher with indirect signs of DH [2]. However, the signs obtained during this study are more characteristic of gastroesophageal reflux (GER).FEGS is a procedure that is psychologically poorly tolerated by patients, many of whom refuse to carry it out. The performance of this study is associated with the risk of a potential life-threatening complication – perforation of a hollow organ, the development of Mallory-Weiss syndrome.

A widely used method for detecting DH is an X-ray of the esophagus and stomach with contrasting with a suspension of barium sulfate. This research method is considered the “gold standard” for the diagnosis of HH, however, the study is associated with one of the most aggressive ionizing radiation, which is unsafe for the patient and the doctor; it cannot be used as routine screening studies [2].

The only objective sign for the diagnosis of DG described in the literature is percussion with a tympanic sound in the paravertebral region on the left [3]. A significant drawback of the symptom is low specificity: it can occur in many diseases of the chest and abdominal cavities.

Thus, the physical diagnosis of HHH is currently difficult – between the complaints of a patient with DH and instrumental methods, which have a very limited range of applications, there is a “diagnostic gap”.This is often accompanied by late diagnosis of hiatal hernias, which causes complications when the only way out is surgery [2, 4, 5].

Purpose of the study: to describe and substantiate a new objective sign of DH – esophageal-gastrointestinal diaphragmatic murmur.

The study was carried out in accordance with the standards of good clinical practice and was approved by the Ethics Committee of the Samara State Medical University of the Ministry of Health of Russia (protocol No. 18 of 27.05.2017). Three groups of patients were studied

The first group included 127 patients with DH (the group of the examined): 62 men and 65 women. The average age of the surveyed was 56.2 ± 11.4 years.

At the first stage of our work, which was a cohort study, 60 patients were randomly included in the group when they detected complaints characteristic of HH, and in the case of detection by auscultation of the desired objective sign – esophageal-gastrointestinal diaphragmatic noise …

These patients underwent fluoroscopy of the esophagus and stomach with barium suspension, which confirmed the presence of DH. Trochoscopy was performed on an Italray Clinodigit 90/18 apparatus (Italy) according to the classical technique with a contrast in the form of a suspension of barium sulfate and an average X-ray dose of 8.7 mSv. Also, these patients underwent FEGS according to the traditional method using an Olympus GIFQ 150 video gastroscope equipped with a CV 150 video processor (Japan).

The second group was also the study group (the second stage of our work).A retrospective cohort study of patients was carried out. 67 people were selected based on archival records in the medical records of an inpatient, summoned to the clinic and physically examined in order to identify the desired symptom in them during auscultation of the chest. Patients with DH were included in the study before they underwent surgical treatment, since surgery to eliminate HHH would affect the effectiveness of determining the desired physical symptom.

This group of patients did not undergo gastric fluoroscopy with barium suspension and FEGS, since the diagnosis of HHH was already established on the basis of data from instrumental studies carried out earlier.

The criteria for inclusion in the study at this stage were the presence of DH in the patient, identified by trochoscopy, signed informed consent to participate in the clinical study.

The exclusion criteria from the study were pathological processes that disrupt the topographic location of the organs of the upper floor of the abdominal cavity and chest, chronic diseases of the digestive system during an exacerbation, errors in nutrition during the last 48 hours, and lack of consent to conduct the study.

The third group (control group), used to calculate the diagnostic effectiveness of a symptom, consisted of 100 practically healthy people: 55 women and 45 men, mean age 52.6 ± 2.3 years. Considering the fact that the incidence of HHH increases with every decade of life by 10%, taking into account the epidemiological studies carried out in relation to this disease, the control group, if possible, included people of relatively young age to avoid distortion of the result in case of accidental inclusion in the control group of patients with asymptomatic DH.

When healthy volunteers were found to have pathological peristalsis during auscultation of the chest and listen to the desired sound phenomenon, the presence of subjective signs of hiatal hernia, they underwent an X-ray examination of the esophagus and stomach with contrasting with a suspension of barium sulfate (the draft national clinical guidelines for the treatment of hiatal hermetic standard “diagnostics). Thus, we calculated the sensitivity and specificity of the proposed sign of DH.As true positive and false negative results, we used data from a study of patients with non-fixed axial hiatal hernia due to its highest prevalence in the population.

Of 127 patients with non-fixed axial cardiac DH participating in the study, in 106 it was detected using this objective sign. Thus, the proportion of truly positive results is 84%. The proportion of false positive results among all examined healthy volunteers was 5%.

The study was carried out in a room with a constant air temperature of 24 ° C in a horizontal position on the back. A phonendoscope was used to listen to the chest at four points of auscultation: points of the mitral and tricuspid valves, Botkin-Erb and the zone of absolute dullness of the heart according to generally accepted anatomical landmarks. In the case of auscultation of the desired noise at least at one point of auscultation indicated above, HHR was diagnosed.

Validation of the physical method was determined by the number of positive results obtained in the study of 127 people with HH, in the study of pathological peristalsis in the chest.

Calculation of the percentage ratio of the frequency of different types of DH and the frequency of the studied symptom was performed using Microsoft Office Excel 2007 (Microsoft, USA). The assessment of the diagnostic significance of the new physical trait was carried out using the method of constructing four-field tables.

As a result of the study, a sound phenomenon (esophageal-gastro-diaphragmatic noise) was obtained – listening to pathological peristalsis at the following points: projections of the tricuspid and mitral valves, Botkin-Erb point, zone of absolute dullness of the heart.This peristalsis is a soft gentle sound that differs from intestinal peristalsis in timbre and caliber. If we draw an analogy with pathological sounds in the chest in diseases of the respiratory system, then peristalsis in HH is correlated with intestinal noises, like small bubbling rales in the lungs with large bubbling ones.

Despite the fact that the detected sound differs from the main respiratory noises in sound strength, timbre and pitch, to eliminate the influence of various artifacts, listening to the chest was performed against the background of holding the breath after a calm inhalation and subsequent shallow exhalation.

Two factors enhance this sound phenomenon:

1) placing the patient in a horizontal position (often no noise in the upright position), causing the hernial sac to exit through the hernial orifice from the abdominal cavity into the chest;

2) food intake by the patient (the sound phenomenon may be absent or its intensity is lower on an empty stomach), leading to increased gastric motility.

Two factors determine the choice of the above localization of points for listening to pathological peristalsis.

– Firstly, these points are generally accepted for auscultation of sounds and heart murmurs and are used in the practice of therapeutic specialists, which means that there is a possibility of “accidental” detection of esophageal-gastrointestinal phrenic noise during the initial contact between the doctor and the patient.

– Secondly, in the area limited by the points of auscultation described above, organs involved in the pathological process in HH (cardiac part and fundus of the stomach, part of the abdominal and thoracic esophagus) are projected onto the anterior chest wall, the pathological motility of which causes the occurrence of the sound phenomenon described above [6].

The identified symptom is characterized by high reproducibility (94%) and can be detected by a doctor when listening to the chest of a patient with a DG phonendoscope if all specified technical conditions are met.

In our study, the axial type predominated in the general population of patients with hiatal hernias. Its prevalence was 97%, which is slightly higher than in the work of K.V. Puchkov and V.B. Filimonov (90%) [7]. The frequency of symptom detection depends on the type of DH. As a result of our study, a new physical sign was most often observed in non-fixed cardiac hernia (84%).

With fixation of a hernia and its paraesophageal location, the frequency of pathological peristalsis of the esophagus and stomach decreased and amounted to 17–50%, which is due, in our opinion, to two factors.

– First, a small number of observations fixed hernias (3-12% depending on size).

– Second, long-term persistence of the disease apparently result in the formation of adhesions periezofagealnyh reduced mobility of the lower esophagus, resulting in a decrease in intensity of his motor skills.

To understand the distribution mechanism of the results and visualize the data obtained, we will construct a four-field table (Table 1), which will allow us to calculate the diagnostic efficiency of the proposed physical symptom.

Table 1. Calculation of the diagnostic value of esophageal-gastro-phrenic noise

916

Notes nie: hiatal hernia – hernia of the esophageal opening of the diaphragm; a – truly positive; b – false positive; c – false negative; d – true negative results.

Applying well-known formulas, we get the following results:

sensitivity of the feature = a / (a ​​+ c) × 100% = 106/127 × 100% = 84%;

trait specificity = d / (b + d) × 100% = 95/100 × 100% = 95%;

predictive value of a positive result = a / (a ​​+ b) = 106/111 × 100% = 96%;

negative predictive value = d / (c + d) = 95/116 × 100% = 82%.

During the study, we analyzed the frequency of clinical manifestations of DH (Table 2).

Table 2. The prevalence of clinical manifestations of hiatal hernias

72

Heartburn was the most frequent symptom which is possibly associated with GER (found in 80% of cases according to FEGS results).Heartburn was registered in 78% of cases in patients with hiatal hernia, which is higher than the results presented in the work of K.V. Puchkov and V.B. Filimonova (2003) [7]. Chest pain was noted in 72% of cases. This is one of the most common signs of DH, which coincides with the data of many authors (45–84%) [1, 2, 8].
The manifestations of dyspepsia, according to a number of researchers, are often associated with GER [9, 10]. Belching, regurgitation and rumination were detected in 52% of cases, which correlates with the experience of observing such patients according to the literature [1, 2].Swallowing disorders were noted in 12% of cases, a feeling of “lump in the throat” – in 4% of cases, which coincides with the results of most scientists [8-10].

Cough is not a frequent symptom in this category of patients and is apparently associated with GER and ingestion of food particles into the upper respiratory tract. This symptom was noted by patients in our observations in 6% of cases. Heart rhythm disturbances, palpitations and shortness of breath were recorded in 45, 8 and 26% of cases, respectively. These complaints, along with pain in the chest, form a tetrad of signs that characterize Bergman’s epiphrenal syndrome, which was described in 1932.and is caused by the tension of the branches of the vagus nerve and chemical burns of the esophageal mucosa with acidic contents during GER [2]. This phenomenon was noted in our study more often after eating and in the horizontal position of the patient.

Normally, a healthy person does not hear any peristaltic noises in the indicated areas of the chest. They are the result of abnormal motility of the esophagus and stomach. Three pathophysiological mechanisms are responsible for the occurrence of this sound phenomenon.

– The first factor that forms pathological peristalsis is the active motility of the esophagus and stomach, which prevents GER. The so-called “cleansing” motility of the esophagus in the process of regurgitation returns the contents back to the stomach, minimizing the time of contact of an aggressive acidic medium with the epithelium of the esophagus, which prevents its chemical burn [11].

– The second mechanism that causes the occurrence of a sound phenomenon (an objective sign of DH) is an increase in gastric motility, resulting from a violation of its architectonics during deformation in case of passage through the hernial orifice.In this case, the tension of the branches of the vagus nerve and its irritation cause increased motility as a result of activation of the neurohumoral link [2].

– The third reason that determines the appearance of a sound phenomenon is pathological motility of the esophagus and stomach, which is caused by changes in the secretion and metabolism of NO in hiatal hernias. It is known that about 5% of all preganglionic neurons innervating the digestive organs are nitroergic. Nitric oxide determines the tone of the walls of the esophagus and stomach and serves as that neurotransmitter, the excessive secretion of which contributes to the development of GER in DH, and the deficiency causes pylorospasm and achalasia of the cardia [12, 13].

Based on the results of the study, a patent for an invention was obtained [14].

Conclusions

1. In the course of the observation, a new objective sign of hiatal hernias was discovered, described and substantiated, which has a high sensitivity (84%) and specificity (95%).

2. A new symptom of hiatal hernia will help fill the current “diagnostic gap” between patient complaints and additional examination methods.

3. The proposed physical technique can be used as a method for the diagnosis of diaphragmatic hernias in the daily professional activities of general practitioners, cardiologists and therapists, thoracic surgeons and gastroenterologists, as well as for the differential diagnosis of one of the most important cornerstones of clinical medicine – chest pain syndrome …

The authors declare no conflicts of interest related to the presented article.

90,000 Chest pain – heart or something else? Causes of pain

Chest pain is a rather unpleasant sensation that can be life threatening.It is important to react in time to prevent a catastrophe. The main causes of chest pain are: heart, respiratory system, muscle and bone problems. Let’s take a look at all the possible options.

When pain is deadly

The cause of chest pain is the heart

Why else it can hurt in the chest

Useful VIDEO on chest pain

Diagnosis of chest pain

When pain is deadly

The most dangerous are painful sensations associated with diseases of the heart and lungs.This condition can be recognized by the following signs:

1. The painful sensation lasts more than 5 minutes.
2. Sharp burning pain behind the breastbone, which gradually spreads to the neck, shoulders and back.
3. There is a feeling of pressure and tightness in the chest.
4. The heartbeat becomes very frequent, the patient becomes difficult to breathe, shortness of breath appears.
5. The person is thrown into cold sweat, dizziness begins, weakness and nausea with vomiting appear.

If any of these symptoms occur, call an ambulance immediately.

Cause of chest pain – heart

The following pathologies can provoke the onset of pain in the heart:

1. Heart attack. A condition that results from a blood clot that blocks one or more arteries that supply blood to the heart. With a heart attack, there is a sharp sharp and burning pain behind the breastbone.
2. Cardiomyopathy. This pathology includes a number of diseases, which are united by one symptom – the heart muscle begins to weaken, as a result of which difficulties begin with pumping blood.Pain in cardiomyopathy can occur after eating or exercising.
3. Aortic rupture. The aorta is the largest artery in the human body, which receives blood directly from the heart. Over time, from a heavy load, the walls of the aorta begin to thin out and aneurysmal sacs appear, with which a person can live for a long time without any signs of aneurysm. But sometimes the walls of the aorta cannot withstand, as a result of which dissection or rupture can occur.This condition is mortally dangerous for a person, therefore, in case of sudden acute pain in the chest that does not subside, accompanied by dizziness and profuse cold sweating, as well as rapid breathing, it is necessary to urgently call an ambulance.

Why else it can hurt in the chest

Chest pain can be associated with the respiratory, digestive and muscle organs.

Respiratory problems

1. Pneumonia. Inflammation of the lungs is a complication after suffering the flu or other colds.The patient develops shortness of breath and severe pain when trying to inhale.
2. Lung collapse. Pneumothorax, or lung collapse, occurs when air is trapped between the lungs and the ribs. At the same time, the patient develops shortness of breath and severe pain.
3. Pleurisy. A disease characterized by inflammation of the pleura. Pain in the chest of a patient with pleurisy occurs during each attempt to inhale.
4. Lung cancer. Painful sensations can occur even at rest.This is often accompanied by a wet cough with blood in the sputum.

Digestive problems

Pathologies of the gastrointestinal tract also cause chest pain:

1. Heartburn. This condition occurs when gastric juice enters the esophagus. Often, with heartburn, there is a burning sensation behind the breastbone.
2. Diseases of the pancreas and gallbladder. Gallstones or inflammation of the gallbladder can cause pain in the right side of the chest.
3. Dysphagia. Pathology characterized by problems with swallowing. In some cases, it can cause severe chest pain.

Problems with muscles and bones

Muscle and bone problems causing chest pain:

1. Rib injury. Painful sensations occur with fractures or bruises of the ribs and soft tissues.
2. Fibromyalgia. The disease is characterized by dull pain in the muscles, the nature of which is still unknown. The pain caused by fibromyalgia can last for several months.
3. Costochondritis. A disease in the development of which the cartilage that connects the chest and ribs becomes inflamed. The signs of costochondritis resemble a heart attack.

Useful VIDEO on chest pain

Diagnosis of chest pain

In order to make a correct diagnosis explaining the causes of pain, it is necessary: ​​

• Seek advice from a cardiologist
• To pass a blood test – general and biochemical, in addition, it is necessary to check the blood for markers of myocardial infarction
• In case of severe cough, sputum analysis should be done
• Make an electrocardiogram
• If necessary, supplement with a study of ultrasound of the heart

When chest pain occurs, a diagnosis cannot be made based on knowledge obtained from the Internet.It is necessary to consult a doctor who will identify the exact cause and prescribe adequate treatment.

90,000 When to see a doctor?

Pain in the area of ​​the heart is one of the most common reasons people seek emergency help. Heart pain is not always heart pain. It is often not associated with heart problems. However, if you are experiencing chest pain and do not know about the state of your cardiovascular system, the problem can be serious and it is worth taking the time to find out the cause of the pain.

The reasons

Pain in the area of ​​the heart has many causes, they can be divided into 2 large categories – “cardiac” and “non-cardiac”.

“Heart” reasons

Myocardial infarction – a blood clot that blocks the movement of blood in the arteries of the heart can cause pressing, constricting chest pains that last more than a few minutes. The pain can radiate (radiate) to the back, neck, lower jaw, shoulders and arms (especially to the left).Other symptoms may include shortness of breath, cold sweats, and nausea.

Angina pectoris.

Over the years, fatty plaques can form in the arteries of your heart, restricting the flow of blood to your heart muscle, especially during exercise. It is the restriction of blood flow through the arteries of the heart that causes attacks of chest pain – angina pectoris. Angina is often described by people as a feeling of tightness or tightness in the chest. It usually occurs during exercise or stress.The pain usually lasts about a minute and stops at rest.

Other cardiac causes.

It can be pericarditis – inflammation of the heart shirt, while the pains are most often acute, stabbing in nature. Less commonly, the cause of pain is a dissection of the aorta, the main artery in your body. The inner layer of this artery can be separated by blood pressure and the result is sharp, sudden and severe chest pain. Aortic dissection can result from chest trauma or a complication of uncontrolled hypertension.

“Non-heart” reasons

Heartburn is the throwing of stomach contents into the esophagus, often combined with a sour taste and belching. Chest pain with heartburn is usually food-related and can last for hours. This symptom most often occurs when bending or lying down. Eases heartburn by taking antacids.

Panic attacks – manifested by attacks of gratuitous fear, combined with chest pain, heart palpitations, hyperventilation (rapid breathing) and profuse sweating, you may suffer from “panic attacks” – a kind of dysfunction of the autonomic nervous system.

Tietze’s syndrome. Sometimes the cartilaginous parts of the ribs, especially the cartilage that attach to the sternum, can become inflamed. The pain in this disease can occur suddenly and be quite intense, mimicking an attack of angina pectoris. However, the location of pain may vary. In Tietze syndrome, pain may worsen when pressing on the sternum or ribs near the sternum. Pain in angina pectoris and myocardial infarction does not depend on this.

Osteochondrosis of the cervical and thoracic spine leads to the so-called vertebral cardialgia, which resembles angina pectoris.In this condition, there is intense and prolonged pain behind the sternum, in the left half of the chest. Irradiation to the hands, interscapular region may be noted. The pain increases or decreases with changes in body position, head turns, arm movements.

Diseases of the lungs.

Pneumothorax (collapsed lung), high pressure in the vessels supplying the lungs (pulmonary hypertension), and severe bronchial asthma can also present with chest pain.Muscle diseases.

Pain caused by muscle diseases, as a rule, begins to bother when turning the body or raising the arms. Chronic pain syndrome such as fibromyalgia. May cause persistent chest pain.

Rib injury and nerve entrapment. Bruises and fractures of the ribs, as well as entrapment of the nerve roots, can cause pain, sometimes very severe. With intercostal neuralgia, pain is localized along the intercostal spaces and increases with palpation.

Shingles. This infection, caused by the herpes virus and affecting the nerve endings, can cause severe chest pain. Pain can be localized in the left side of the chest or be shingles in nature. This disease can leave behind a complication – postherpetic neuralgia – the cause of prolonged pain and increased skin sensitivity.

Diseases of the gallbladder and pancreas. Gallstones or inflammation of the gallbladder (cholecystitis) and pancreas (pancreatitis) can cause pain in the upper abdomen, radiating to the heart and more.

Since chest pain can be due to many different causes, do not self-diagnose or self-medicate or ignore severe or prolonged pain. The cause of your pain may not be as serious – but it should be checked by a specialist to determine it.

When should you see a doctor?

If you experience acute, unexplained, and prolonged chest pain, possibly in combination with other symptoms (such as shortness of breath) or pain that radiates to one or both arms.Under the scapula – an urgent need to see a doctor. Perhaps it will save your life or calm you down if no serious health problems are found.

What to do with pain in the heart?

1. Take it easy. At rest, the heart consumes less oxygen, so if there is damage to the heart muscle, there will be less chance of serious complications.

2. Stop the provocative load – stop, if you are walking, sit down.If you are in a noisy stuffy room, go outside if the exit is not far away and you do not need to go up / down stairs.

3. Take any sedative at hand: phenazepam, corvalol, motherwort, valerian, etc.

4. Think about the nature of the pain. If the stitching pains, aggravated by a deep breath or twisting of the trunk, as well as by pressing with a finger, then most likely the pains are not of cardiac origin. If the pain is dull, compressing, localized behind the sternum, and not in the armpit, then there is a likelihood of developing an attack of angina pectoris.

5. If there are signs of an angina attack – dull, squeezing, pressing pain behind the breastbone, then it is better to call an ambulance. Waiting for an attack of angina pectoris is an unacceptable negligence to your health, which can lead to the development of myocardial infarction, especially if you have never experienced chest pains before.

6. If there is a suspicion of the development of an attack of angina pectoris, it is necessary:

• Stop work immediately, try to sit down or lie down;
• Unbutton the collar, unfasten the belt;
• put a nitroglycerin tablet or a validol tablet under the tongue, take 30 drops of valocordin or corvalol;
• If after that the pain persists for 5 minutes, put a second nitroglycerin tablet under the tongue, ask your family or colleagues to call an ambulance immediately.
• When calling an ambulance, tell the operator the most detailed description of the pain: the nature, location (place) where it is given, the duration of the attack, whether the patient has heart disease, what medications he is taking.

7. If there is no suspicion of angina pectoris – pain in the chest is not intense, stitching, intensified with a deep breath, turning, bending of the body, given to the back, then take an anesthetic and call a doctor at home.