Pain under the ribs, or more precisely, pain in the chest, is one of the most common complaints. Diagnosis and treatment in such cases are difficult, since pain can be caused by 40-50 reasons.
Most often, pain in the ribs is caused by vertebrogenic pathologies, these are:
- thoracalgia – muscle pain in the back;
- costal chondritis (Tietze syndrome) – caused by an inflammatory process of the cartilage between the ribs and sternum;
- malignant and benign neoplasms that cause compression of nerve endings;
- diseases of the internal organs of the chest;
- pain as a result of injury (bruises, rib fractures) or surgery;
- diseases of the spinal column.
For different pathologies, the pain syndrome has different severity, localization and subjective sensations.
Rice. 1. Anatomical structure of the chest
With costochondritis, pain occurs suddenly, is characterized by a gradual increase in severity and resembles an attack of angina. But unlike pain in the heart, it intensifies when pressing on the ribs, taking a deep breath, and certain movements.
Patients complain of algia of varying intensity:
- tingling in the chest;
- dull, pulling;
- aching;
- piercing;
- sharp, dagger (after surgery or injury);
- burning.
In addition, pain can be superficial, for example, with myalgia, neuralgia, ossalgia, or deep, for example, with pathologies of the lungs, heart, stomach. Painful manifestations can increase with physical activity, movement, deep inspiration, be paroxysmal or occur constantly (chronic).
Causes of pain under the ribs
Pain syndrome differs not only in severity, but also in localization. Judging by the location of the algia, a specialist can make a diagnosis with a high degree of probability.
Pain under the ribs on the right occurs with biliary colic or an attack of cholelithiasis. It begins, most often in the evening, then radiates to the posterior bone structures. In women, algias due to gynecological diseases can radiate from behind to this area. Pain occurs in the right ribs when:
- pneumonia;
- pleurisy;
- renal pathologies;
- hepatic colic;
- cholecystitis;
- disruption of urine outflow;
- obesity.
Painful symptoms under the ribs on the left are caused by:
- heart diseases;
- gastritis;
- ulcer of the upper stomach;
- intestinal diseases;
- pathology of the spine;
- intercostal neuralgia.
Back pain under the ribs on both sides can be caused by osteochondrosis, scoliosis, neuritis, intervertebral hernia, physical overload or physical inactivity. Pain under the ribs on both sides (girdling) also occurs with:
- pancreatitis;
- herpes zoster.
A rib bruise causes pain on the injured side. When your ribs hurt in the back or on any side, you should immediately see a doctor. Sometimes such pain is caused by malignant diseases of internal organs and the spinal column.
Nature and location of pain
Pain in the ribs can be one-sided or affect both sides of the back.
Discomfort in the back often does not have an exact localization. In some cases, it appears on both sides under the ribs or remains only around the thoracic spine. According to the nature of the pain syndrome, it can be divided into several types.
- Aching. Usually occurs in diseases of the spine: osteochondrosis, pinched nerve, etc. It is localized in the lumbar region and can affect the left and right side of the back. Sometimes the patient suspects the development of kidney disease.
- Shooting. It occurs suddenly and can affect the thoracic and lumbar spine. Most often radiates to the arm. Symptoms typically appear in the evening or during heavy lifting.
- Spicy. The patient cannot bend over; when changing body position, the pain only intensifies. Sometimes it becomes more difficult to take a breath. Typically this type of pain occurs under the ribs on the right. The cause is most often radiculitis, intervertebral hernia.
The discomfort may be intermittent or constant. Any long-term pain syndrome must be diagnosed. The sooner the cause is clear, the easier it is to cope with the disease.
Pain under the ribs on the right
To suggest the causes of pain in this part of the chest, you need to know what is located on the right under the ribs.
Pain on the right under the rib can be caused by various factors - from infection to physical overload or systemic pathologies.
The main causes of pain on the right under the ribs:
- viral infections, lung diseases, pleurisy; Algia with this pathology is aching, intensifies with a sharp movement of the chest;
- gastritis, inflammation of the stomach walls provoke acute pain in the abdomen and torso on the right;
- diseases of the gallbladder and biliary system also cause a pain response in the right side of the body; pain intensifies after eating fatty foods;
- back pain on the right under the ribs accompanies most diseases of the spinal column - scoliosis, spondylosis, intervertebral hernia; episodic pain in this area often occurs due to prolonged forced positioning or incorrect posture; muscles and nerve endings are compressed by bone structures, which is why discomfort occurs;
- if something seems to be interfering with the right under the ribs, then intercostal neuralgia can be assumed; inflammation of the nerves is characterized by a dull, aching pain that compresses organs and limits movement in the ribs;
- intestinal diseases are accompanied by pain on the right side, caused by irritation of the walls of the gastrointestinal tract;
- pain under the ribs on the right with inflammation of the liver and hepatitis;
- injuries to the cervical spine, fractures, bruises of the ribs cause severe pain on the right side of the body;
- tumors of the breast, lungs, inflammation of the mediastinum can cause pain on the corresponding side of the lesion.
It hurts on the right under the rib and with external influences - stress, physical overload, as a side effect of taking anthocyanins, muscle strain. If pain occurs, you should consult a doctor, since many causes of pathology make diagnosis difficult and only a specialist can say that it hurts on the right side under the ribs.
Possible reasons
Pain in the ribs is provoked by disorders in the internal organs or bone tissue.
Diseases with the appearance of back pain can be identified by its location. Pain syndrome may be accompanied by similar concomitant symptoms, and localization will help to more accurately describe what is causing the unpleasant sensation. The main factors that provoke the appearance of symptoms are:
- diseases of the respiratory and cardiovascular system;
- gastrointestinal pathologies;
- kidney diseases and hernias;
- women's health problems;
- intercostal neuralgia;
- cancerous tumors;
- osteochondrosis, radiculitis, arthrosis;
- diseases of a neuralgic nature.
If we talk about specific pathologies, be sure to pay attention to which area the pain appeared.
Pain on the left under the ribs
With pancreatitis, the pain is girdling and affects the lower ribs from the back.
A discomforting feeling under the left side of the chest may indicate the development of the following health problems:
- Pancreatitis. If the pathology is chronic, the pain is of moderate intensity and often radiates under the scapula. During an exacerbation, discomfort intensifies or appears suddenly. A characteristic sign that accurately indicates pancreatitis is the occurrence of pain after eating salty, sweet or fatty foods. Sometimes you can observe cyanosis of the skin, which indicates general intoxication of the body.
- Malignant tumor of the pancreas. The pain is completely unrelated to eating and is aching in nature. As the tumor grows, it occurs suddenly, and there is a feeling of fullness in the chest on the left side of the back and in the area of the solar plexus.
- Myocardial infarction is accompanied by an uncomfortable burning sensation in the left side of the back (under the shoulder blade) if the posterior wall of the heart muscle is affected. Typically, such pain radiates to the collarbone, elbow joint and phalanges of the fingers.
The appearance of pain in the area of the left ribs is typical during nervous breakdowns and serious diseases such as lymphoma, lupus erythematosus, arterial hypertension.
Left-sided pain should be diagnosed urgently. In most cases, delay in contacting a specialist leads to death.
Pain on the right side under the ribs
With hepatitis, the skin and whites of the eyes turn yellow.
Pain on the right side can also indicate various pathologies of the body. The most common are the following:
- Liver problems such as cirrhosis, hepatitis, congestion and malignant tumors. When pathologies develop, liver failure is diagnosed based on test results. A characteristic symptom is jaundice (clearly visible on the skin and eyeballs).
- Stones in bile. This is a pathological process, accompanied by acute pain in the back, on the right under the ribs and in the area of the diaphragm. An accompanying symptom is the appearance of vomiting. When the stone leaves the bile canal, the pain disappears until the next exacerbation.
- Cancerous growths appear on both the left and right sides of the back. Typically the tumor occurs in the stomach and pancreas. With the growth of malignant cells, compression of the nerves occurs, this process is accompanied by pain.
Chronic cholecystitis can also create a feeling of discomfort on the right side. Additional signs of this condition include vomiting and bitterness in the mouth.
Pain under the ribs in the middle
Perforation of a stomach ulcer localizes pain in the middle part of the ribs.
Median discomfort occurs in the event of a stomach or duodenal ulcer. Regardless of the nature of the pathology, accompanying signs appear:
- Black stool indicates bleeding.
- Vomiting occurs when the body is intoxicated.
- Body weight decreases.
- The pain is paroxysmal in nature and becomes smoothed out only when choosing the optimal body position.
With a gastrointestinal ulcer, there is necessarily weakness, apathy and dissatisfaction.
If you have pain in the middle part of the abdomen or between the ribs in the back, problems with the diaphragm can be suspected. They have severe discomfort, which can be aggravated by incorrectly chosen body position.
Such signs do not exclude the appearance of a cancerous tumor in the stomach. As it grows through the walls of the organ, severe pain occurs, requiring effective analgesics. The tumor puts pressure on other organs and metastasis begins. In the initial stages, it manifests itself as a slight feeling of squeezing and heaviness.
Pain has different localization
An accompanying symptom of pain in the ribs during pneumonia is increased body temperature.
In such cases, the development of the following pathologies is suspected:
- right- or left-sided pneumonia in the lower part of the lungs;
- inflammation of the lining of the lung tissue;
- injuries to internal organs: ruptures of the spleen or liver.
With any of these diseases, severe, increasing pain occurs. It can be caused by the accumulation of blood in the internal organs.
Retroperitoneal hematomas
Internal hemorrhages occur most often due to injuries. As a rule, the adrenal glands and duodenum are affected. In such cases, pain occurs suddenly, and blood pressure may drop sharply along with it. Pallor and weakness always appear with internal hematomas.
Intercostal neuralgia
The syndrome with intercostal neuralgia is piercing and burning in nature. At the moment of exacerbation of the disease, a person cannot take a deep breath or change body position. It usually goes away after a few minutes of being at rest. It can radiate to the lower back, under the shoulder blades. Initially it pierces the area between the lower ribs.
The factor that provokes the development of intercostal neuralgia is most often stress, uncomfortable posture or hypothermia.
Autonomic disorders
The most common cause of pain in the ribs is intercostal neuralgia.
In such cases, back pain appears suddenly and has no prior cause. Associated symptoms include:
- dyspnea;
- irritable bowel syndrome;
- insomnia;
- dissatisfaction.
Even the most unexpected pathologies can cause pain in the hypochondrium. Moreover, this syndrome is often physiological in nature. For example, it appears after fatigue.
Pain under the ribs on the left
Pain on the left under the ribs is primarily caused by heart disease. This pain is pronounced and is described by patients as sharp, stabbing, dagger-like. With ischemia, heart attack, acute heart failure, pain occurs that cannot be tolerated, so you should immediately call emergency help rather than try to attempt self-treatment.
Diseases of the paired organs cause the same symptoms on the left side as on the right side of the torso. Pain on the left side under the ribs is caused by:
- pathologies of the lungs, pleura;
- intercostal neuralgia;
- injuries - cracks in bones, displacement of fragments;
- mastopathy, breast cancer;
- diseases of the spine.
If it hurts on the left under the rib after running or intense exercise, this may be due to dysfunction of the spleen. Pain in the spleen is also caused by:
- infectious diseases;
- injuries;
- parasitic diseases;
- spleen abscess;
- cirrhosis of the liver;
- blood pathologies;
- benign/malignant neoplasms.
In addition to abnormalities of the spleen, the lower left rib hurts when pressed in the case of inflammatory and ulcerative lesions of the stomach walls.
What is on the left under the ribs can be seen in Fig. 2. but algia is caused not only by disease of the organs located on the left. Algia is reflected, radiating, phantom, so it is possible to say for sure that only a specialist can hurt in the left side under the rib after an examination.
Diagnostic methods
Before seeing a doctor if you have back pain on the right or left side above the lower back in the rib area, you need to diagnose:
- determine localization;
- set irradiation;
- evaluate the nature of the manifestations;
- note the frequency and time of exacerbation.
After visiting a specialist, laboratory tests and instrumental diagnostics may be prescribed: MRI, ultrasound, x-ray. These methods will help indicate whether there are serious disorders in the internal organs. The doctor must carry out palpation himself, during which he will assess the condition of the area in which the pain is localized.
When your back hurts in the area of the ribs at the back, the cause must be reliable. The need for treatment and its effectiveness depend on this. It is not recommended to take any medications on your own, since a medical examination may have false negative results.
How to determine that pain under the ribs is related to the spine?
Differential diagnostics at the Clinic of Manual Medicine “Galia Ignatieva MD” is used to determine the exact cause and exclude pathologies with a similar nature of symptoms. The specialist examines the medical history, anamnesis, and conducts neurological tests. Acute pain in the left side under the ribs can be caused by pathology of internal organs or musculoskeletal structures. To determine the cause of algia, the following instrumental studies are prescribed:
- X-ray allows you to assess the condition of bone structures, identify the consequences of injuries, the presence of pathology of the vertebrae and respiratory system;
- Ultrasound, MRI, CT make it possible to visualize the condition of internal organs, soft tissues, and identify neoplasms;
- if a cardiac cause of the pathology is suspected, an ECG is prescribed;
- intercostal neuralgia is diagnosed using myelography, which allows you to determine the condition of the nerve fibers.
In addition, back pain on the left under the ribs is a consequence of impaired renal function, so extensive urine tests are prescribed to clarify the diagnosis.
Pain in the right side from the back under the ribs, in addition to pathologies of the spine, is caused by diseases of the biliary system. To differentiate them, liver tests are prescribed. If gastrointestinal abnormalities are suspected, gastroscopy is indicated.
If the cause of pain is pathology of the spinal column, then you need to consult an osteopath. A good specialist has a comprehensive effect on the body – the musculoskeletal system and internal organs. Drug treatment is usually symptomatic. Manual therapy affects the cause of the disease and, if treatment is started in a timely manner, is more effective than other conservative methods of therapy.
Diagnostics
Orthopedic traumatologists are usually involved in determining the cause of pain in the ribs. To determine the nature of the pathology, objective methods and additional studies are used. The diagnostic search program includes:
- Survey.
The doctor clarifies the time and conditions for the onset of pain, the duration and dynamics of pain, and their relationship with external circumstances. Identifies other complaints (difficulty breathing, weakness, fever). - Physical examination
. Includes external examination, palpation, percussion and auscultation of the chest. Allows you to determine the localization of pain, the presence of deformation, swelling, local hyperemia, skin changes, other disorders, assess breathing, and the boundaries of the lungs. - X-ray of the ribs.
Indicated for injuries and tumors of the ribs. Confirms fractures, changes in bone structure. If there is a suspicion of concomitant damage to the chest organs, it is supplemented with chest X-ray, the results of which can detect focal and diffuse pathological processes in the lungs and pleural cavity. - Neurological examination
. Recommended for neurological origin of the disease. Allows you to localize the source of pain impulses, diagnose diseases of the nerves and spinal column, and determine the further direction of the examination.
In case of herpes zoster, an additional examination by a dermatologist is prescribed; in case of oncological diseases, a consultation with an oncologist is prescribed. To clarify the nature of changes in bones, cartilage and soft tissue structures when radiography is insufficient, a CT or MRI of the chest is performed. For tumors, a biopsy is performed followed by cytological or histological examination.
Multiple rib fractures
