From the Guidelines
Inflammation of the nerve running between the ribs is called intercostal neuralgia, and diagnosis typically involves a combination of physical examination, medical history, and imaging tests to rule out other conditions. The diagnosis of intercostal neuralgia can be challenging, as the symptoms can be similar to those of other conditions, such as musculoskeletal chest pain or rib fractures 1. However, a thorough physical examination and medical history can help identify the underlying cause of the pain. Some key points to consider in the diagnosis of intercostal neuralgia include:
- The location and nature of the pain, which can be sharp, stabbing, or burning, and is typically localized to the area between the ribs
- The presence of any underlying medical conditions, such as shingles or diabetes, which can increase the risk of developing intercostal neuralgia
- The presence of any trauma or injury to the chest wall, which can cause intercostal nerve damage
- The results of imaging tests, such as chest X-rays or CT scans, which can help rule out other conditions, such as rib fractures or lung disease 1. A diagnosis of intercostal neuralgia is typically made based on a combination of these factors, and treatment is usually focused on managing the underlying cause of the pain and reducing symptoms. It's worth noting that, the American College of Radiology Appropriateness Criteria recommends that evaluation with standard chest radiographs is usually sufficient for the diagnosis of rib fractures, and further imaging is generally not appropriate as there is little data that undiagnosed isolated rib fractures after minor blunt trauma affect management or outcomes 1. In addition, the use of opioids in chronic pain management, including intercostal neuralgia, should be carefully considered, as the evidence for their effectiveness is limited, and they can have significant side effects and risks 1.
From the Research
Diagnosis of Intercostal Neuralgia
The diagnosis of intercostal neuralgia is primarily clinical, relying on the exclusion of other causes of pain 2. The condition is characterized by pain associated with the intercostal nerves along the rib, chest, and upper abdominal wall 3.
Symptoms and Presentation
Symptoms of intercostal neuralgia can include neuropathic pain along the distribution of the intercostal nerve, which can cause debilitating pain and interfere with daily activities 4. The pain can range from mild to severe and may be accompanied by other symptoms such as hypoesthesia 5.
Diagnostic Considerations
Diagnosis of intercostal neuralgia involves:
- Clinical evaluation to identify the source of pain
- Exclusion of other causes of pain
- Consideration of the patient's medical history and physical examination findings
- Imaging studies or other diagnostic tests may be ordered to rule out other conditions 2