Why Do My Ribs Hurt? 23 Causes of Rib Cage Pain

By Lynne Eldridge,

Non- Musculoskeletal Causes

Rib cage pain can be caused by an injury, inflammation, or autoimmune condition.

Rib fractures or bruises from injury can cause intense pain, and swelling may occur.

Costochondritis is a common inflammatory condition that can mimic heart attack pain.

Rib cage pain can arise from various causes, including injuries, inflammation, or autoimmune conditions. Understanding these causes helps in identifying the right treatment and addressing any serious underlying issues, including cancer.1

National Kidney Foundation. Kidney stones.

1. Injury

Muscle strains can occur from injuries or actions like coughing or bending, leading to intercostal muscle spasms and sharp, localized rib cage pain.

Rib fractures are common and can cause intense pain, while ribs can also be bruised without breaking.

Although the breastbone (sternum) is rarely fractured, chest trauma can lead to issues such as flail chest, where three or more ribs have multiple fractures.3 With osteoporosis, ribs might fracture easily from minimal trauma.4

Fractures typically cause localized tenderness and pain, especially when touched, and may also lead to swelling.

2. Costochondritis

Costochondritis is a common inflammatory condition affecting the cartilage connecting the ribs to the sternum, sometimes mimicking heart attack pain.5

Pain from costochondritis is most commonly felt when pressing on the ribs to the left of the sternum in a specific area. It can also be a complication of lupus, an autoimmune disorder that causes inflammation throughout the body.6

3. Fibromyalgia

Fibromyalgia is a relatively common cause of rib cage pain, but it can be difficult to diagnose and treat since it’s often diagnosed by ruling out other conditions. Individuals with fibromyalgia may feel pain from even gentle pressure.7

Besides pain and morning stiffness, people with this condition often experience memory problems, fatigue, and other symptoms.7

4. Rheumatoid Conditions

Rheumatoid conditions like rheumatoid arthritis (RA) and psoriatic arthritis can cause rib cage pain.8 RA is a chronic condition that can lead to bone thinning, including in the ribs, a situation that can also be exacerbated by steroid medications used for treatment.

If your healthcare provider suspects a rheumatoid condition, they may conduct laboratory tests to find markers of these conditions.9

5. Intercostal Neuralgia

Intercostal neuralgia is a condition in which nerve pain (neuropathic pain) arises from an injury, nerve impingement, and other causes. It can be challenging to diagnose and treat.

With intercostal neuralgia, pain may be felt over the whole chest or along one rib. You may feel a sharp pain when your healthcare provider presses on the area between the ribs.10

6. Slipping Rib Syndrome

Slipping rib syndrome (also called lower rib pain syndrome, rib tip syndrome, or 12th rib syndrome) is thought to be underdiagnosed and can cause significant pain in the lower ribs (the floating ribs).

In this condition, it’s believed that overly mobile floating ribs slip under the ribs above and pinch the intercostal nerves, nerves that supply the muscles that run between the ribs.11 Your ribs may hurt when touched.

7. Thoracic Spine Conditions

Conditions involving the thoracic spine can cause chest pain in the front of the rib cage. Some of these conditions include:12

Muscle strains and sprains

Nerve compression in the thoracic spine

Thoracic disc herniation13

8. Sternalis Syndrome

Sternalis syndrome causes pain over the front of the rib cage. Touch can cause the pain to radiate to both sides of the chest.14 It is caused by spasms in abnormal muscle fibers in the front of the chest.15

9. Xiphoid Syndrome

Xiphoid syndrome is characterized by pain in the lower part of the breastbone (the xiphoid process) and surrounding areas.16 The pain can radiate to other parts of the body, including the chest, abdomen, back, arms, and neck. Xiphoid pain can occur after an injury or because of inflammation in the xiphoid process.17

Rib Cage Pain in Pregnancy

Rib cage pain, especially in the upper ribs, is relatively common in pregnancy. Most of the time it’s thought that the pain is due to the positioning of the baby or related to the round ligament.

Much less commonly, and after the 20th week of gestation, pain on the right side felt under the lower ribs is sometimes a sign of preeclampsia or HELLP syndrome, a medical emergency.18

10. Rib Stress Fractures

Rib stress fractures are an overuse injury commonly seen with activities such as backpacking or rowing.19 These injuries can cause pain or tenderness with touch.

Rib stress fractures can be challenging to diagnose, so it is important to let your healthcare provider know what type of exercises and sports you participate in.

11. Tietze Syndrome

Tietze syndrome is similar to costochondritis but less common. Unlike costochondritis, there is swelling that accompanies the inflammation of the cartilage connecting the ribs to the sternum.20

With Tietze syndrome, the pain occurs in the chest area and can be especially pronounced when touching the ribs or applying pressure to them.

12. Cancer

A number of cancers, including lung cancer, can lead to rib cage pain.21 Lung cancer, in particular, may irritate nerves that lead to pain that feels like it originates in the rib cage.

Multiple myeloma is a blood-related cancer that may occur in the bone marrow of the rib cage and other bones and can also cause rib cage pain.

Pain may be due to the presence of the tumor in bone (bone metastasis). Both lung cancer and breast cancer commonly metastasize to bones, including those of the rib cage.

The pain can also be due to fractures that result in weakened bones (pathologic fractures). In some cases, rib cage pain may be the first symptom of cancer.

Tumors may also grow directly into the rib cage and cause pain.

Your healthcare provider may want to order imaging tests to help rule out a malignancy. Bone scans can show bone metastases, and a PET scan may be used to find other types of cancer. A bronchoscopy and/or a CT scan of the chest can help diagnose lung cancer.

13. Anxiety

Anxiety can cause chest pain that may feel like it’s coming from the ribs. This type of pain can happen when the body releases adrenaline, expanding the airways and redistributing blood to your muscles.22

14. Shingles

Shingles is a condition in which the chickenpox virus (which remains in the body after the initial infection) reactivates.23

Symptoms include fever, chills, and rash distributed on one side of the body. However, pain, sometimes around the rib cage (which can be severe), often occurs before these other symptoms, making shingles difficult to diagnose. The pain can feel like burning and can occur even with a very slight touch.

15. Heart Disease

Heart disease may cause pain that is felt in the rib cage.

The possibility of a heart attack should always be considered in a person who has any form of chest-related pain. Pericarditis, an inflammation of the membrane that lines the heart, is also a potential cause.24

If your healthcare provider suspects heart disease, they may order tests such as an electrocardiogram (ECG) or an echocardiogram (ultrasound of the heart).

16. Enlargement of the Aorta

Enlargement of the large artery (aorta) in the chest may cause rib cage pain. Risk factors include the condition Marfan’s syndrome as well as cardiovascular disease. Sleep apnea may also play a role.25

17. Lung Conditions

Lung conditions may also cause pain in the ribs. Pulmonary emboli, or blood clots in the legs (deep venous thromboses) that break off and travel to the lungs are a serious cause of rib cage pain. Pneumonia can also be a cause.

If you have a lung condition, you may have breath sounds (like wheezes) that will help your healthcare provider diagnose your condition.

18. Pleural Conditions

Inflammation of the pleura (pleurisy) or the build-up of fluid between the two layers of the pleura can cause rib cage pain.26 This may cause pain when touched or with a deep breath. Certain positions may be more painful than others. Pleurisy can be a complication of lupus.27

A pleural friction rub is a breath sound that may be heard with inflammation of the lining of the lungs (the pleura).

19. Enlargement of the Spleen

Spleen enlargement, such as with some blood-related conditions or cancers, may cause rib cage pain and pain or tenderness with touch.28 The spleen may also become enlarged (and sometimes rupture with mild trauma) with infectious mononucleosis.

20. Liver Conditions

Inflammation or scarring of the liver, such as with hepatitis or cirrhosis, may cause pain just below the ribs.29

21. Digestive System Conditions

Gastroesophageal reflux disease (GERD) often causes heartburn, but can also cause other types of chest pain.30 Peptic ulcer disease or gastritis are other potential causes.

22. Referred Pain From Outside the Rib Cage

Organs outside of the rib cage may also cause pain that feels like it arises in the rib cage. Some of the organs that can be associated with rib cage pain include:31

Gallbladder: Gallstones or cholecystitis (infection of the gallbladder)

Pancreas: Pancreatitis or pancreatic tumors

Kidneys and ureters: Kidney stones may sometimes cause referred pain that’s felt in the rib cage (and is often severe).

23. Other Less Common Conditions

Other potential causes of rib pain that occur less often include:

A sickle cell crisis32

Infections in joints in the rib cage (septic arthritis)33

Polychondritis

Sternoclavicular hyperostosis34

When to See a Healthcare Provider

If you are experiencing rib cage pain that does not have an obvious explanation, it’s important to make an appointment to see your healthcare provider.

Symptoms that should alert you to call 911 include:35

Chest pressure or tightening

Pain in the rib cage that radiates into your arm, back, or jaw

Heart palpitations

Cold, clammy, or sweaty skin

Shortness of breath, especially of sudden onset

Pain that is severe

Sudden onset of sweating

Lightheadedness

Mental confusion

You also should let your healthcare provider know if you experience nausea, have trouble swallowing, or cough up blood.

Diagnosis

To determine the cause or causes of rib cage pain, your healthcare provider will ask you about your medical history, the history of your pain, where it hurts, and what the pain feels like. They will also ask if there’s anything that makes your pain worse or better.

On physical examination, your healthcare provider will look for pain and signs of swelling or rash. They may also ask you to do a range of motion tests. Additional lab or imaging tests may be necessary if they suspect that there is a cause unrelated to your muscles or bones.

Treatment

The treatment of rib cage pain will depend on the underlying cause. Sometimes this simply entails advice to avoid activities and movements that aggravate the pain. You may try some at-home measures to stop your ribs from hurting, including:36

Rest and restricted motion

Cold compresses

Over-the-counter pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs)

For muscle or bone-related causes, your healthcare provider may consider pain medication (including steroid injections). Exercise and physical therapy, as well as complementary practices such as massage or acupuncture, also may help.

Rib fractures cause pain that persists for several weeks. Healthcare providers often opt for conservative treatments such as wrapping the rib cage, but surgery to stabilize the rib cage also may be needed.36

If an underlying problem or disease is the cause of rib pain, it will need to be treated.