What is the most common cause of lateral rib pain?

Most Common Causes of Lateral Rib Pain

Rib fractures are the most common cause of lateral rib pain, occurring in up to 40% of trauma patients and representing the most common serious chest injury. 1, 2

Traumatic Causes

• Rib fractures: Most frequently affect the middle and lower ribs (ribs 3-8), which are most critical for respiratory mechanics and contribute significantly to thoracic volumes 1
• Rib fractures can occur through:
  • Direct blunt trauma to the chest wall 2
  • Focused force to a small area of the chest 2
  • Violent muscle contractions causing avulsion fractures, particularly in athletes 2
• Fractures in the lateral region (between anterior and posterior axillary lines) are common and clinically significant 1

Non-traumatic Causes

Musculoskeletal Causes

• Costochondritis: Inflammation of the cartilage connecting ribs to the sternum 1
• Tietze syndrome: Localized inflammation of costochondral junctions 1
• Slipping rib syndrome: Ribs subluxing from their joint connections 1
• Intercostal myofascial injury: Damage to connective tissues between ribs 1
• Painful rib syndrome: A variant of myofascial pain syndrome characterized by pain in the upper abdomen or lower chest with a tender spot on the costal margin 3
• Muscle strains/spasms: Particularly involving the pectoral muscles 1

Other Common Causes

• Pleurisy: Inflammation of the pleural lining causing sharp chest pain 1
• Pulmonary conditions: Including pneumothorax, pulmonary embolism, and pneumonia 1
• Gastrointestinal causes: Account for 10-20% of chest pain in outpatients, including gastroesophageal reflux disease and esophageal disorders 1
• Nerve entrapment: Particularly the lateral cutaneous branch of the third intercostal nerve 1

Clinical Presentation and Diagnosis

• Lateral rib pain typically presents with:

  • Localized pain that worsens with breathing, movement, or palpation 1, 4
  • Possible tenderness to touch at the fracture or inflammation site 1, 3
  • Pain that may radiate to surrounding areas 1

• Diagnostic approach:

  • Chest radiography is often the initial imaging test but may miss cartilage or soft tissue abnormalities 1
  • Rib series radiographs can better detect rib fractures, especially with radio-opaque skin markers placed at the site of pain 1
  • Ultrasound can detect radiographically occult fractures in up to 29% of cases after negative chest radiography 1
  • CT imaging may be necessary for suspected malignancy or complex cases 1

Management Considerations

• Pain control is essential, especially for rib fractures, to prevent respiratory complications 1, 4
• Treatment options include:
  • Non-opioid analgesics: NSAIDs, acetaminophen 1, 2
  • Regional anesthesia techniques for severe pain: thoracic epidural, paravertebral blocks, erector spinae plane blocks 1, 5
  • Low-dose ketamine as an alternative to opioids with fewer side effects 1
  • Physical support: rib belts or taping for stabilization 2

Special Considerations

• Elderly patients with rib fractures have higher mortality rates, with each rib fracture increasing the risk of pneumonia by 27% and death by 19% 6
• First rib and floating rib (11th-12th) fractures require special attention as they may indicate more serious injury or underlying damage to vital structures 1, 2
• Multiple fractures or flail segments are more concerning and may require surgical stabilization in select cases 1