Pain in the ribs

Pain in the ribs occurs during pathological processes in the bone structures, surrounding soft tissues, nerves, thoracic spine. It can be dull, acute, weak, intense, constant, short-term, aching, stabbing, pressing, shooting. It often increases with deep breathing, changing the position of the body. It is diagnosed on the basis of complaints, examination data, X-ray results, CT, other clinical studies. To eliminate the pain syndrome, analgesics and physiotherapeutic methods of treatment are used.

Causes of pain in the ribs
Traumatic injuries
Inflammatory diseases
Oncological lesions
Neurological causes
Other reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of pain in the ribs
Traumatic injuries
Bruising of the ribs is manifested by moderate pain, swelling, and sometimes bruising. The pain increases with pressure on the affected area, deep breaths. When pressing on the ribs away from the affected area, squeezing the chest in the anteroposterior direction, there is no soreness, which indicates the preservation of the integrity of the ribs. The pain syndrome decreases and disappears after 1-2 weeks.

With a rib fracture, the pain is acute, very intense, increasing with the slightest movements, coughing, talking, decreasing in a sitting position. Due to the pronounced pain syndrome, patients try to move less, talk quietly, breathe superficially. When feeling the affected area, sharp soreness is determined, sometimes crepitation.

Palpation of the rib at a distance and compression of the chest cause acute pain at the fracture site. With fractures of the anterior and lateral divisions, respiratory disorders are noted, with multiple injuries, a deterioration in the general condition is observed, shock is possible. Soft creaking of subcutaneous tissue, increasing shortness of breath indicate a rupture of the lung.

Inflammatory diseases
Pain in the ribs sometimes occurs with intercostal muscle myositis, which is a consequence of hypothermia or overexertion. The pain is not intense, dull, increasing with sudden movements and deep breathing. Palpation determines a slight increase in soreness, mild swelling in the intercostal space.

With Titze syndrome, there is soreness in the area of one or more upper ribs near the sternum. The pain is usually unilateral, occurs acutely or increases gradually, increases with movements, sneezing, coughing, deep breathing, sometimes radiates into the shoulder or arm. The pain syndrome can persist for many years, is prone to a wave-like flow with alternating remissions and exacerbations. Palpation of the inflammation zone is sharply painful, swelling along the cartilaginous part of the rib is revealed.

Aseptic periostitis of the ribs usually results from a bruise. It is accompanied by local constant moderate aching pain, which increases with palpation, minor edema. Symptoms usually go away within 5-7 days. With purulent periostitis, which occurs against the background of inflammatory foci, infected wounds of the soft tissues of the chest, the pain is acute, intense. They appear suddenly, quickly intensify, become twitching, bursting, accompanied by an increase in temperature, chills.

Osteomyelitis of the ribs is rarely diagnosed, develops after open fractures, gunshot wounds, operations, purulent soft tissue lesions. It is characterized by a rapid increase in pain syndrome against the background of fever, deterioration of the general condition, the release of abundant purulent discharge or the appearance of gray plaque at the bottom of the wound. Throbbing, bursting pains decrease after the formation of a fistula. Palpation of the injury zone is sharply painful.

With pleurisy, pain syndrome is formed in the pleural cavity, but can be mistakenly interpreted as soreness in the ribs. Exudative pleurisy is manifested by a diffuse dull pain, which is replaced by a feeling of heaviness in the side, shortness of breath, cough, fever. With dry pleurisy, the pain is stabbing, increases with breathing and movements, weakens in the position on the sick side.

Oncological lesions
Chondromes are usually formed in the area of the bone-cartilaginous junction, affecting the upper ribs. Pain syndrome appears a few months or years after the formation of a dense “bump”. The pain is local, minor or moderate, dull, aching. Despite the good quality, chondroma can germinate the pleura. In this case, the intensity of pain increases, they become sharp, stabbing, and intensify with deep breaths.

The clinical picture of chondrosarcoma is determined by the degree of malignancy of the neoplasm. With highly differentiated tumors, the pain is insignificant, gradually progressing over several years, intensifying at night, decreasing, but not disappearing after taking non-narcotic analgesics. With low-grade neoplasia, the pain increases rapidly within 1-3 months, is worse relieved by taking painkillers.

Ewing’s sarcoma occurs in children and young people, manifested by mild or moderate wave-like pain. The pain syndrome increases rapidly, becomes intense, constant, worries at night, restricts movement and breathing. It is possible to develop hemoptysis, respiratory failure. With chondrosarcomas and Ewing’s sarcomas, along with pain in the ribs, there are violations of the general condition, weight loss, weakness, local expansion of veins in the affected area.

Neurological causes
Intercostal neuralgia is considered to be the main neurological cause of pain in the ribs. The pain is unilateral, acute, sudden, feels like an electric shock or a lumbago, localizes in the intercostal region, spreads from the spine to the sternum. The attack begins with a tingling sensation, then the pain syndrome increases to unbearable within a few seconds or 1-3 minutes, forcing the patient to freeze and hold his breath.

Possible irradiation in the heart, scapula, epigastrium. Sometimes, after the end of the attack, there is a feeling of crawling goosebumps or tickling in the intercostal space. In the inter-approach period, patients try to avoid sudden movements. Intercostal neuralgia occurs in the following diseases and pathological conditions:

Hypothermia, overload. Neuralgia occurs against the background of previous exertion, prolonged stay in an uncomfortable position, wearing clothes out of season, being in a draft.
Injuries. Pain is detected after a chest injury or rib fracture, accompanied by manifestations of the underlying pathology.
Diseases of the spine. Intercostal neuralgia develops with osteochondrosis, intervertebral hernias, thoracic spondylosis, curvature of the spine (scoliosis, kyphoscoliosis).
Shingles. A distinctive feature of this type of neuralgia are pink spots that form 2-4 days after the onset of pain, transform into bubbles, and then open with the formation of crusts.
Other reasons
With fibromyalgia, pain in the ribs is combined with unpleasant or painful sensations in other parts of the body. Patients complain that “it hurts everywhere.” The pains are constant, burning, diffuse, supplemented by numbness, tingling, “running goosebumps”, they increase both with physical exertion and with prolonged rest. Sleep disorders develop, often depression, generalized anxiety disorder.

Algic senestopathies occur with depression, neurosis, hypochondria, and other mental disorders. They differ in extreme diversity and variability, do not fit into the clinical picture of a certain disease. Permanent or periodic dull, sharp, burning, drilling, wrenching pain sensations are possible.

Diagnostics
Finding out the cause of pain in the ribs is usually done by orthopedic traumatologists. Objective methods and additional studies are used to determine the nature of pathology. The diagnostic search program includes:

Survey. The doctor specifies the time and conditions of the appearance of pain syndrome, the duration and dynamics of pain, their relationship with external circumstances. Identifies other complaints (difficulty breathing, weakness, fever).
Physical examination. It includes external examination, palpation, percussion and auscultation of the chest. It allows you to determine the localization of pain, the presence of deformation, edema, local hyperemia, skin changes, other disorders, assess breathing, lung boundaries.
Radiography of the ribs. It is indicated for injuries and tumors of the ribs. Confirms fractures, changes in bone structure. If concomitant damage to the chest organs is suspected, it is supplemented by radiography of the OGC, according to the results of which it is possible to detect focal and diffuse pathological processes in the lungs and pleural cavity.
Neurological examination. It is recommended for the neurological genesis of the disease. Allows you to localize the source of pain impulses, diagnose diseases of the nerves and spinal column, determine the further direction of the examination.
In case of shingles, a dermatologist’s examination is additionally prescribed, in case of oncological diseases, an oncologist’s consultation is prescribed. To clarify the nature of changes in bones, cartilage and soft tissue structures with insufficient effectiveness of radiography, CT or MRI of the chest is performed. In case of tumors, a biopsy is performed followed by cytological or histological examination.

Multiple rib fractures
Treatment
Help before diagnosis
With a slight pain syndrome, a satisfactory general condition, it is recommended to limit physical activity for several days, use local painkillers, warming and anti-inflammatory drugs. If the skin is damaged, ointments and gels cannot be applied. With weakness, fever, the appearance of sharp pains, shortness of breath, cough, hemoptysis, it is necessary to urgently seek medical help.

Conservative therapy
The conservative treatment plan is determined by the nature of the pathology. In most cases, rest is recommended, breathing exercises and physiotherapy are prescribed. In some cases, massage and manual therapy are indicated. Drug therapy may include:

Analgesics. With moderate pain syndrome, tableted drugs are used, with severe pain, medications are administered intramuscularly. In the late stages of cancer, narcotic drugs are required.
Antibiotics. With pleurisy, purulent periostitis, osteomyelitis, antibiotic therapy is indicated. Initially, broad-spectrum medications are used, then the therapy regimen is adjusted taking into account the sensitivity of the pathogen.
Hormonal agents. Pain in intercostal neuralgia and Titze syndrome are successfully eliminated by blockades with corticosteroids. Blockades are performed when other methods are ineffective, the course includes no more than 3 injections of the drug.
Cytostatics. Medications are prescribed for malignant tumors, destroy cancer cells, slow down the growth of neoplasms. They can be used in the form of monotherapy or a combination of several means.
Surgical treatment
In case of rib fractures complicated by hemo- or pneumothorax, puncture or drainage of the pleural cavity is performed. Multiple double fractures require osteosynthesis. Purulent periostitis is an indication for opening, drainage of the abscess. In osteomyelitis, sequestrectomy or rib resection is performed. Oncological lesions are an indication for radical surgical interventions with the removal of bone, soft tissues, and lymph nodes.

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