Pain in the ribs occurs during pathological processes in the bone structures surrounding soft tissues, nerves, and the thoracic spine. It can be dull, sharp, weak, intense, constant, short-term, aching, stabbing, pressing, shooting. Often aggravated by deep breathing, changes in body position. It is diagnosed on the basis of complaints, examination data, results of radiography, CT, and other studies. To eliminate the pain syndrome, analgesics, physiotherapeutic methods of treatment are used.
Bruising of the ribs is manifested by moderate pain, swelling, and sometimes bruising. The pain intensifies 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 pain, which indicates the preservation of the integrity of the ribs. The pain syndrome decreases and disappears in 1-2 weeks.
With a fracture of the ribs, the pain is acute, very intense, aggravated by the slightest movements, coughing, talking, decreasing in the sitting position. Due to the pronounced pain syndrome, patients try to move less, speak quietly, and breathe shallowly. When feeling the affected area, a sharp soreness is determined, sometimes crepitus.
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 sections, respiratory disorders are noted, with multiple injuries, a deterioration in the general condition is observed, and shock is possible. Soft creaking of the subcutaneous tissue, increasing shortness of breath indicate a rupture of the lung.
Pain in the ribs sometimes occurs with myositis of the intercostal muscles, which is the result of hypothermia or overexertion. The pain is not intense, dull, aggravated by sudden movements and deep inspiration. On palpation, a slight increase in pain is determined, a mildly pronounced edema in the intercostal space.
With Tietze's syndrome, there is pain in the region of one or more upper ribs near the sternum. Pain is usually unilateral, occurs acutely or increases gradually, increases with movement, sneezing, coughing, deep breathing, sometimes radiating to the shoulder or arm. The pain syndrome can persist for many years, is prone to an undulating course with alternating remissions and exacerbations. Palpation of the inflammation zone is sharply painful, swelling is detected along the cartilaginous part of the rib.
Aseptic periostitis of the ribs usually results from a bruise. Accompanied by local constant moderate aching pain, aggravated by palpation, slight swelling. Symptoms usually resolve 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 fever, chills.
Osteomyelitis of the ribs is rarely diagnosed; it develops after open fractures, gunshot wounds, operations, and purulent lesions of soft tissues. It is characterized by a rapid increase in pain against the background of fever, deterioration of the general condition, the release of copious purulent discharge or the appearance of a gray coating on the bottom of the wound. The pains are throbbing, bursting, decrease after the formation of a fistula. Palpation of the damaged area is sharply painful.
With pleurisy, pain syndrome is formed in the pleural cavity, but can be mistakenly interpreted as pain in the ribs. Exudative pleurisy is manifested by diffuse dull pain, which is replaced by a feeling of heaviness in the side, shortness of breath, cough, fever. With dry pleurisy, pains are stabbing, aggravated by breathing and movements, weakening in a position on a sore side.
Chondromas usually form in the zone of the osteochondral junction, affecting the upper ribs. The pain syndrome appears several months or years after the formation of a dense "bump". The pain is local, slight 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, intensify with deep breaths.
The clinical picture in 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 poorly differentiated neoplasia, the pain increases rapidly within 1-3 months, and is worse relieved by taking painkillers.
Ewing's sarcoma occurs in children and young adults and presents with mild to moderate undulating pain. The pain syndrome quickly intensifies, becomes intense, constant, worries at night, restricts movement and breathing. Perhaps the development of 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, and local expansion of the veins in the affected area.
The main neurological cause of pain in the ribs is intercostal neuralgia. The pain is unilateral, acute, sudden, felt like an electric shock or backache, localized in the intercostal space, spreading from the spine to the sternum. The attack begins with a tingling sensation, then the pain syndrome grows to unbearable within a few seconds or 1-3 minutes, makes the patient freeze and hold his breath.
Possible irradiation in the heart, scapula, epigastrium. Sometimes, after the attack is over, there is a feeling of crawling or tickling in the intercostal space. In the interictal period, patients try to avoid sudden movements. Intercostal neuralgia occurs in the following diseases and pathological conditions:
In 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, complemented by numbness, tingling, "goosebumps", aggravated both during physical exertion and during a long stay at rest. Sleep disorders develop, often - depression, generalized anxiety disorder.
Algic senestopathies occur with depression, neurosis, hypochondria, and other mental disorders. They are distinguished by extreme diversity and variability, do not fit into the clinical picture of a particular disease. Constant or periodic dull, sharp, burning, drilling, everting pain sensations are possible.
Orthopedic traumatologists are usually involved in finding out 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:
With herpes zoster, an additional examination by a dermatologist is prescribed, with oncological diseases - a consultation with an oncologist. 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. For tumors, a biopsy is performed, followed by a cytological or histological examination.
Multiple rib fractures
With a slight pain syndrome, a satisfactory general condition, it is recommended to limit physical activity for several days, use local anesthetics, warming and anti-inflammatory drugs. If the skin is damaged, ointments and gels should not be applied. With weakness, fever, sharp pains, shortness of breath, cough, hemoptysis, you should urgently seek medical help.
The plan of conservative treatment is determined by the nature of the pathology. In most cases, they recommend rest, prescribe breathing exercises, physiotherapy. In some cases, massage, manual therapy are indicated. Drug therapy may include:
In case of rib fractures complicated by hemo- or pneumothorax, a puncture or drainage of the pleural cavity is performed. Multiple double fractures require osteosynthesis. Purulent periostitis is an indication for opening, draining 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.