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Rib pain or pain in the chest wall that feels like it comes from a rib may be caused by traumatic injury, muscle strain, joint inflammation, or chronic pain, and ranges in severity. Rib cage pain can be associated with bruising, difficulty taking a deep breath, joint pain, and more. Read more below to learn what may be causing your rib pain and when to seek treatment.
Rib pain symptoms
Rib pain has a variety of causes. Rib pain following traumatic injury may be due to rib fracture, clavicle (collarbone) or sternum (breast bone) fracture, or internal injuries to the chest. Rib pain without traumatic injury may be due to muscle strain, joint inflammation, or chronic pain. Rib pain following traumatic injury should prompt emergent medical evaluation, particularly if the pain is severe or interfering with your ability to take a deep breath. Rib pain symptoms due to muscle strain or joint inflammation may be managed at home with rest and over the counter pain medication. However, if pain persists, seek medical treatment as there are systemic illnesses that cause rib pain that require evaluation and treatment by a doctor.
Common accompanying symptoms of rib pain
If you're experiencing rib pain, it's also likely to experience:
- Chest deformity
- Difficulty taking a deep breath
- Pain with taking a deep breath
- Joint pain
- Difficulty sleeping
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 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.
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.
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.
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
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.
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 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.
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, 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.
Top Symptoms: fatigue, headache, cough, shortness of breath, loss of appetite
Urgency: Primary care doctor
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.
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
When and how to treat rib pain
At-home rib pain treatments
Some causes of rib pain such as muscular strain or joint inflammation can likely be treated at home.
- Over-the-counter pain relievers: If the rib pain is due to a muscle strain or inflammation at the rib cartilage junction, over-the-counter pain relievers such as ibuprofen (Advil, Motrin) may help relieve the pain.
- Rest: If the rib pain is due to muscle strain or inflammation at the rib cartilage junction, rest may help. Refrain from activities that exacerbate the pain for a week or two to allow the inflammation to resolve.
When to see a doctor for rib pain
If pain persists, seek medical treatment, as there are multiple systemic illnesses that can present with rib pain symptoms and require evaluation and treatment by a doctor. He or she may recommend:
- Imaging: If you have a traumatic injury and a doctor suspects a rib fracture or other internal injury in the chest, they may order x-rays, ultrasounds, or CT scans to help diagnose the cause of the rib pain.
- Blood tests: If a doctor suspects that a systemic illness like an autoimmune disorder is the cause of the rib pain, they may order blood tests to help determine the underlying condition.
- Pain medication: Trauma to the chest wall that results in rib fracture, other fracture, or pulmonary contusion is particularly painful. A doctor will likely prescribe pain medications to assist with rib pain symptoms during the healing process.
When rib pain is an emergency
Seek emergency treatment if you have rib pain following a traumatic accident, particularly if the pain is severe or interfering with your ability to breathe. Traumatic causes of rib pain will likely require medical imaging to determine the cause of the pain and rule out underlying damage to the lungs or other organs.
FAQs about rib pain
How do you know if you have a bruised rib?
It is difficult to discern the difference between a bruised or cracked or broken rib. Generally, a bruised rib and cracked rib follow a blow or pressure to the rib cage, may show bruising on the skin, may be accompanied by a sharp pain on inspiration or breathing in and may also be preceded by a cracking noise. Severe constant shortness of breath after a bruised rib warrants immediate medical attention to exclude an underlying lung injury.
Why do my ribs feel bruised for no reason?
The answer to this question depends on which symptom of bruised ribs you are referring to. Sharp pain on inspiration can be a sign of infection and inflammation involving the thin tissues surrounding the lung (pleuritis) or the sac surrounding the heart (pericarditis); a blood clot in the lung (pulmonary embolism); a punctured lung (pneumothorax); or a pneumonia or infection of the lung.
Why do I have pain under my left rib cage?
Pain under the left rib cage may be caused by damage to the spleen because the spleen is on the left side of the body, but pain in that area is more frequently caused by the same conditions that cause pain in the lower chest and upper abdomen on both sides: heart attack, pancreatitis, peptic ulcer disease, gastroesophageal reflux, and gastritis.
What's the difference between a bruised and a broken rib?
A bruised rib is less severe than a fracture. It is an injury to the rib that causes blood and fluid to build up in or around the bone, causing significant discomfort. A broken rib is a break either complete or partial of the cortical region of the bone that causes instability. Generally, if there is evidence of a fracture or gap however small it is considered a break, whereas accumulation of fluid in the absence of a break is a bruise. Severe constant shortness of breath after a bruised rib warrants immediate medical attention to exclude an underlying lung injury.
Why do I get pain in my ribs when I run?
You may be experiencing pain in your ribs when you run because of a cramp of the muscles that help you expand and contract your chest. There are many theories as to why you have developed a "stitch in your side" while running but no confirmed causes. Explanations range from blood flowing through the liver that blocks blood to the muscles of the chest wall, causing cramping, to pulling of the chest wall in and out causing pain and stiffness.
Questions your doctor may ask about rib pain
- Do you have a cough?
- Any fever today or during the last week?
- What makes your chest pain hurt more?
- How would you explain why your chest hurts?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Martin is an Emergency Medicine resident at the University of Washington in Seattle. She received her undergraduate degree from Stanford University where she majored in Human Biology, and received her MD from the University of Pennsylvania. She’s interested in Emergency Medical Services and Flight Medicine, and is currently a resident flight physician with Airlift Northwest. In her free time, she enjoys playing ultimate frisbee, cycling, rock climbing, and trail running!
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