rib pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Many different conditions can cause rib pain.

• Bruised, cracked, or fractured rib
• Costochondritis (inflammation of cartilage near the breastbone)
• Osteoporosis (mostly in women)
• Pleurisy (the pain is worse when breathing deeply)

With a broken rib, the pain is aggravated by bending and twisting the torso. With pleurisy (swelling of the lining of the lungs), it is not.

• Costochondritis and Tietze's syndrome are both associated with tenderness of one or more of the costochondral joints. Although there is some controversy over whether these two disorders are truly distinct, in this discussion the term Tietze's syndrome is used for the combination of pain, tenderness and swelling, while costochondritis is use used when swelling is absent.
• Sternalis syndrome is a rare disorder characterized by localized tenderness found over the body of the sternum, often with tenderness that causes radiation of pain bilaterally.
• Xiphoidalgia or Xiphoidynia is also a rare syndrome with localized pain and tenderness over the xiphoid process.
• Sternocostoclavicular hyperostosis is a syndrome characterized by a unique arthropathy that frequently involves the anterior chest wall and is associated with a spectrum of neutrophilic skin lesions. The acronym SAPHO syndrome has been proposed as a unifying term to include the various features that may occur: synovitis; acne; pustulosis; hyperostosis; and osteomyelitis.
• Lower rib pain syndromes go by many different names such as slipping or clicking rib syndrome, rib-tip syndrome, or twelfth rib. Pain can be diffuse or localized, and is accompanied by tenderness on the costal margin that reproduces the pain.
• Fibromyalgia is a common chronic musculoskeletal pain syndrome that presents with diffuse myalgias, multiple tender points, sleep disturbance, and fatigue. Many patients report tenderness over the second costochondral junctions.

Rib pain may also be referred from internal organs.

Rest and immobilization are the best cure for a rib cage fracture.

Follow your physician’s instructions for treatment of the cause of rib cage pain.

Medical history questions documenting rib cage pain in detail may include the following:

• When did the pain develop?
• Is it present all the time?
• Is it getting worse?
• How would you describe the pain?
• Is it a sharp or stabbing sensation?
• Does it feel like pulling or grabbing?
• Does it ache like a bruise?
• Is it a crushing pain?
• Does it feel like pressure or heaviness? (This may be a sign of (angina or heart attack)
• Exactly where is the pain?
• Is it only on one side?
• Is it the same on both sides?
• Is the pain worse when bending or twisting?
• Is it worse when coughing?
• Is it worse when breathing deeply?
• Has there been an injury to the chest?
• What other symptoms are also present?

Physical examination may include emphasis on the lungs and chest cavity.

Diagnostic tests that may be performed include the following:

• Chest x-ray
• Bone scan (if there is known history of cancer or it is highly suspected)