Generality
Intercostal pain is a painful sensation that is located in the spaces between one rib and the other, and that can derive from muscular, nervous or osteo-cartilaginous disorders.
The characteristics of the painful sensation - such as intensity or duration - vary according to the triggering morbid condition.
Therapy also depends on this; therefore, each patient must undergo an accurate medical check, useful for understanding the exact origin of the symptomatology.
Anatomical recall on rib cage and ribs
The thoracic cage is the skeletal structure placed in the upper part of the human body, exactly between the neck and the diaphragm, which serves to protect vital organs (such as the heart and lungs) and important blood vessels (aorta, veins, cavities, etc.).
According to the anatomy manuals, it includes:
- Later, the 12 thoracic vertebrae ;
- Latero-anteriorly, 12 pairs of ribs (or ribs );
- Anteriorly, the costal cartilages and a bone called the sternum .
Each pair of ribs is connected to one of the 12 thoracic vertebrae; obviously, the left ribs emerge from the left side of the aforementioned vertebrae, while those on the right from the corresponding right side.
At their front end, the ribs articulate with the costal cartilages.
The space between the overlapping ribs is called the intercostal space .
In the intercostal space reside the so-called intercostal muscles - which play a fundamental role in expanding the thoracic cage, during the respiratory acts - numerous nerve endings (intercostal nerves), arterial blood vessels and venous blood vessels.
What is intercostal pain?
Intercostal pain is a painful sensation localized in the intercostal space, which can result from problems concerning the intercostal muscles, intercostal nerves, ribs or costal cartilages.
Therefore, the term intercostal pain is quite vague and may include several morbid conditions, some of which, as the reader may find out later, are more serious than others.
Causes
The causes of intercostal pain are numerous. Possible triggers include:
- Intercostal neuralgia . It is a very rare condition that occurs due to damage or malfunction of the intercostal nerves.
It can be triggered mainly by: nerve compression of an intercostal nerve, a neuritis with spinal origin (NB: it is an inflammation that starts from the spinal nerves), damage to an intercostal nerve (for example following a trauma or surgery), the state of pregnancy (for reasons of space), infections affecting the ribs and the shingles virus.
The painful sensation that characterizes intercostal neuralgia can be acute and episodic, or dull and constant. Furthermore, it is generally widespread, ie it includes different parts of the rib cage.
- Stretching and tearing of the intercostal muscles . These injuries are quite serious (especially the tears), but they can be repaired with complete rest. Generally, they result from very strong traumas, from exhausting physical exercise (for example, an untrained athlete who exaggerates during a training session) or from episodes of strong and persistent cough.
- Cramps in the intercostal muscles . They are exactly like muscle cramps affecting the muscles of the lower or upper limbs. In general, they appear suddenly and have a short duration (NB: after an hour, usually, the situation is already normalized).
- Rib fractures . These are fairly common injuries, which consist in the rupture of one or more ribs of the rib cage. The most common causes of rib fractures are chest blows received during a sporting activity or a car accident, and intense and / or persistent coughing. Failure to treat one or more fractured ribs may result in pneumonia and / or pulmonary infections.
- Cracking of the ribs . Doctors talk about cracked ribs or cracked ribs when one or more ribs have suffered a traumatic bruise, but have not broken. The cracking of the ribs causes pain just like the fracture, but it heals more quickly (between 4 and 6 weeks, due to cracked ribs, and between 6 and 8 weeks for the broken ribs). Neglecting the treatment of one or more cracked ribs can induce the appearance of pneumonia and / or pulmonary infections.
- Inflammations of the costal cartilages . The most well-known inflammatory diseases of the costal cartilages are Tietze's syndrome and costochondritis. These are two apparently similar conditions; in fact, they have some peculiar characteristics, on which the doctors usually base the diagnosis. For example, Tietze's syndrome has unknown causes, is responsible for a limited painful sensation and leads to swelling of the painful area; on the contrary, costochondritis can have recognizable causes, causes widespread pain and does not involve the presence of any swollen area.
- Joint inflammation (osteoarthritis) . Between the ribs, the costal cartilages and the sternum there are joints, which can ignite exactly like any other joint in the body.
- Tumors with original site in the ribs or bone metastases . Metastases are the cells of a malignant tumor that have spread elsewhere through blood and lymphatic circulation.
- The after-effects of thoracic surgery . Cardiac or pulmonary surgical procedures are somewhat invasive and involve the realization of different skin incisions on the chest. These often cause pain, at least as regards the first phase of post-operative recovery.
INTERCOSTAL PAIN RISK FACTORS
They are more predisposed to intercostal pain:
- The elderly, because more frequently subject to osteoarthritis.
- Individuals with herniated disc . The herniated disc is one of those nerve conditions that begin at the spinal level and can affect the intercostal nerves.
- Athletes, because they often suffer injuries to the ribs or intercostal muscles.
- Smokers, because they cough often and violently and this, as has been stated, is a possible cause of rib fractures or intercostal muscle problems.
- Individuals with chronic lung diseases because these are usually cause of intense and frequent coughing.
Characteristics of intercostal pain
The intensity, precise location and duration of intercostal pain vary depending on the causes. For example, the painful sensation caused by a cramp in the intercostal muscles is less intense and of a much shorter duration, compared to that induced by a tear of the same muscles.
WHEN DOES THE SYMPTOMS DROP?
Intercostal pain tends to worsen when the patient breathes deeply, coughs, sneezes, twists with the chest or presses the painful anatomical area.
Possible consequences of a deep breathing difficult
Avoid breathing deeply, for example because this action accentuates intercostal pain, can lead to the onset of pneumonia and / or pulmonary infections. This is why rib fractures and cracks require proper treatment; in fact, otherwise, the pain they cause makes the act of deep breathing very painful, almost unbearable, which predisposes to the appearance of inflammatory or infectious lung problems.
WHEN TO REFER TO THE DOCTOR?
Since among the causes of intercostal pain there are also serious conditions, doctors advise a specialist consultation whenever the painful sensation is intense, lasting and associated with other suspicious signs.
Diagnosis
Intercostal pain is a symptom that the patient generally reports during an objective examination.
The task of the doctors, in such circumstances, is to trace the causes of the pain sensation, evaluating the presence of other symptoms or associated signs and prescribing more detailed instrumental examinations.
Only a correct diagnosis of the triggers allows planning the most appropriate therapy.
IMPORTANCE OF THE OBJECTIVE EXAM
The physical examination can provide very useful information for several reasons.
First of all, the doctor observes if the patient shows particular signs, such as swelling or bruising at the thoracic level.
Then he asks the patient about his symptoms; the most frequently asked questions in this regard are:
- What is the pain?
- When did the pain appear? Did it trigger any particular event?
- What movements or gestures sharpen it?
INSTRUMENTAL EXAMINATIONS: WHAT ARE THEY?
To investigate the causes of intercostal pain, the instrumental examinations to which the doctors mostly use are:
- Chest X-ray (or chest X-ray)
- TAC (Computerized Axial Tomography)
- Nuclear magnetic resonance (RMN)
- Bone scintigraphy
- The electrocardiogram.
Treatment
Therapy for the complete resolution of intercostal pain depends on the triggering causes. For example, a tumor that originates in a rib deserves a treatment that will surely be different from that prescribed in the event of a rib fracture: surgical removal of the tumor, chemotherapy and radiotherapy, in the first case; rest, anti-inflammatory, analgesic and ice, in the second.
Readers have the opportunity to learn about treatments carried out in the presence of broken ribs, cracked ribs, costochondritis and Tietze syndrome, by referring to the various reference articles to which this text refers.
SOME REMEDIES VALID IN GENERAL
In general, in the presence of any intercostal pain of a certain relevance, doctors advise to avoid all those movements that accentuate the painful sensation and to take anti-inflammatory and analgesic drugs.
Furthermore, remember that always wearing the appropriate sports equipment, using the seat belt when driving a car, not smoking, not making excessive efforts and always warming up thoroughly before a sport activity, are useful behaviors to prevent the occurrence of the most common causes of intercostal pain.
