Learn the symptoms of each condition and what treatment to expect.
Pain in your chest can be scary — you may even be worried you’re having a heart attack. But the pain you’re experiencing might not actually be coming from one of your organs. The ribs themselves, and the area surrounding them, can also cause discomfort. Here are three conditions that can cause rib cage pain, and the telltale symptoms doctors use to tell them apart.
1. Bruised or fractured rib
Your rib cage provides a crucial function: to protect your heart, lungs and other vital organs. But this may also mean they take the brunt of the damage in the case of trauma, such as a car accident, steep fall, physical assault or even intense coughing. A bruised rib means the bone is not actually cracked, but it still may have sustained damage. Symptoms for bruised and broken ribs are much the same: pain, particularly when breathing or coughing.
Telltale sign: Injured ribs cause pain when breathing, coughing, twisting or bending.
Your doctor may order a chest X-ray to determine if you’ve fractured your rib. If you have, a CT scan will help determine whether your lungs have been injured.
Ribs obviously can’t be put in a cast or immobilized, like other broken bones. Plus, they need to keep moving when you breathe. Even if it hurts, it’s important to breathe deeply, so you can keep your lungs clear. Failing to do so may result in pneumonia. Respiratory complications like pneumonia occur in nearly a third of patients with rib fractures. Your doctor may give you a device to breathe into to help improve your lung function, and pain medications to make breathing easier until your broken or bruised rib heals.
2. Costochondritis
You may not have heard of this condition, but it’s actually a common cause of rib cage pain. All but two of your ribs are attached to your sternum, or breastbone, by cartilage.
“This area where the ribs meet the breastbone, called costosternal joints, can become inflamed,” says Rose Taroyan, MD, a family medicine physician at Keck Medicine of USC and assistant professor of clinical medicine at the Keck School of Medicine of USC.
Taroyan explains that costochondritis causes pain (it can be either sharp or dull) and tenderness in your chest. It may result from a blow to the chest, heavy lifting or hard exercise, or sustained coughing and sneezing.
Telltale sign: When the area where the rib meets the breastbone is pressed, you’ll feel pain.
Your doctor may order an electrocardiogram to rule out any cardiac issues. Depending on whether you have any other symptoms, your doctor may also order additional tests. If you’re diagnosed with costochondritis, though, it usually goes away on its own in a few days to a few weeks.
“You can do stretching exercises, put a heating pad on the painful area a few times a day, and take pain relievers, such as acetaminophen or ibuprofen,” Taroyan says. “And any activity you do that causes or reliably exacerbates the pain should be reduced and/or stopped, at least temporarily.”
3. Pleurisy
Lining the inside of your chest cavity and the outside of your lungs are two layers of tissue called pleura; the area between these layers is called the pleural space. The layers generally glide against each other smoothly as you inhale and exhale.
With pleurisy, the layers become inflamed due to a viral infection, pneumonia or other medical condition, and rub together roughly, causing pain every time you breathe or cough. Fluid may also collect in the pleural space, causing shortness of breath.
Telltale sign: Doctors can actually hear the membranes rubbing together, called a friction rub, when they listen to your chest with a stethoscope.
Based on your symptoms, your doctor may order imaging or blood tests to help determine the underlying cause of the pleurisy and to see if fluid has built up. If it has, the fluid may need to be drained. If the fluid is a result of a bacterial infection, you’ll be given antibiotics. If it’s from a virus, it may have to run its course, but over-the-counter pain relievers may help to reduce your symptoms.
With any rib cage pain, if you can’t breathe, your skin turns blue or you have severe chest pain, call 911 or go to the emergency room right away.
Topics
Pleurisy is a type of chest pain. It affects a part of your body called the pleura.
The pleura is a thin layer of tissue that wraps your lungs. They fit snugly within your chest, which is lined with another thin layer of pleura.
These layers keep your bare lungs from rubbing against the wall of your chest cavity every time you breathe in. There’s a bit of fluid within the narrow space between the two layers of pleura to keep everything moving smoothly.
When you’re healthy, you never notice your pleura at work. But if your pleura has a problem, you’ll feel it.
When the pleurae are swollen and inflamed, they rub against each other in a very painful way each time your lungs expand. When you inhale deeply, cough, sneeze, or laugh, you’ll probably feel a sharp, stabbing pain in the area that’s affected.
Most of the time, pleurisy happens because of an infection. If your doctor treats your infection, that can make it -- and the pain -- go away.
Bacterial infections such as pneumonia often cause pleurisy. It can also be caused by a virus such as the flu or by a fungus.
Other things that can cause pleurisy are:
Chest pain from pleurisy has signs that can make it easy for your doctor to know that you have it. You’re likely to notice these things:
Your doctor will ask you to describe the type of pain you feel when you breathe or cough, and they’ll ask whether it gets better or worse as the day goes on. They’ll listen to your lungs with a stethoscope to see if they’re making any strange noises. (Doctors often can hear the pleurae rubbing against each other.)
You may also need to have tests, such as:
- Imaging. If your doctor wants to rule out other problems, they may send you for an X-ray, a CT scan, or an ultrasound. These images can show if it’s pleurisy that’s causing your pain.
- Blood tests. These may show if an infection is the culprit. It may also reveal if you have an autoimmune disease like lupus or another problem.
- EKG. An electrocardiogram of your heart might show that your chest pain is caused by a heart problem, not pleurisy.
- Thoracentesis. A technician looks at a sample of your pleural fluid under a microscope for problems like infections or cancer.
- Thoracoscopy. Your doctor uses a thin, flexible tube called a thoracoscope to look inside your chest cavity.
In order to treat your pleurisy the right way, your doctor needs to know what’s causing it:
- If it’s bacteria, antibiotics can make you better.
- If it’s a fungus, they’ll probably give you an antifungal drug.
- If it’s a virus, you’ll get better on your own in a few days or weeks.
Some people with pleurisy have too much fluid built up between their two layers of pleura. Your doctor may need to remove some of the fluid. They may insert a thin needle into the space between your pleura to do this.
Painkillers and steroid medications can help while you’re getting better.
If coughing hurts too much, your doctor might prescribe medication (codeine) that can make you cough less.
You might feel better if you lie on the side that’s causing you pain. As the pain starts to go away, try to breathe more deeply and cough up any phlegm you have.
Complications of pleurisy can be serious. They include:
- Lungs that are blocked or can’t expand the way they should (atelectasis)
- Pus in your pleural cavity (empyema)
- A sudden drop in blood flow (shock)
- A dangerous reaction to infection (sepsis)
Inflammation can also make fluid build up in your pleural cavity. This is called pleural effusion. You might have less pain, but it can be hard for you to breathe. Your doctor might give you medications like diuretics, or you might have a procedure to drain the fluid.
Question: For the last few weeks, whenever I cough or sneeze, my sides hurt a little. I told my doctor and he told me that it was from a muscle strain and to take two Advil for relief. That helps, but the pain keeps coming back. Is it anything to worry about?
Answer: With a limited history, it's tough to know for sure what's causing your pain. It certainly could be a muscle strain, and if so, it should resolve soon. I don't think it's a rib fracture because the pain is on both sides, there's no complaint of pain with breathing, and your pain is described as mild at worst. Pleurisy, an inflammation of the lining of the lungs, would cause a lot of pain with breathing, something you didn't describe.
If your pain lingers beyond the several-week healing time of a muscle strain, I'd suggest that you get a chest X-ray just to be sure something isn't overlooked. If your mild chest pain remains persistent despite all tests being normal, a visit to a chiropractor might be the answer. You may have ribs that are "out of adjustment." Called "subluxation," it can happen following a bout of persistent coughing or sneezing, or simply twisting one's torso in an odd way. Subluxation of ribs is a common and easily treatable problem.. Q: I am taking Crestor, Lovaza, and Trilipix for a high cholesterol/high triglyceride problem, but despite taking three drugs and watching my fats like a hawk, my LDL cholesterol is still above 160. Is there anything being worked on by the drug companies that might work better than what I'm taking now? A: As a matter of fact, there is a completely new method of treating high cholesterol in development, especially for people like you who are already taking cholesterol drugs and are still not to goal. It involves a fully human "monoclonal antibody" injection twice a month that binds (i.e., blocks) to a specific enzyme in liver cells that breaks down LDL ("bad") cholesterol receptors. LDL receptors are needed to bind/collect LDL "bad" cholesterol particles from the blood so that enzymes in the liver can break them down. The more LDL receptors the liver has, the more LDL cholesterol particles are broken down. That results in lowering the LDL cholesterol in the bloodstream.
In Phase II investigational trials involving 183 patients with an LDL cholesterol above the target of 100 milligrams per deciliter despite an average of 7 years of Lipitor statin therapy, LDL cholesterol levels fell by as much as 72 percent at 12 weeks — and this is above and beyond the LDL lowering effect from Lipitor. The most effective dosing regimen required one subcutaneous injection (akin to an insulin injection) every two weeks.
In Phase III, the drug will be self-administered subcutaneously using a fixed-dose pen. Drug companies Sanofi and Regeneron are sponsoring the research.