Sharp pain on right side under ribs when breathing

Learn the symptoms of each condition and what treatment to expect.

Pain in your chest can be scary — you may even be worried you’re having a heart attack. But the pain you’re experiencing might not actually be coming from one of your organs. The ribs themselves, and the area surrounding them, can also cause discomfort. Here are three conditions that can cause rib cage pain, and the telltale symptoms doctors use to tell them apart.

1. Bruised or fractured rib

Your rib cage provides a crucial function: to protect your heart, lungs and other vital organs. But this may also mean they take the brunt of the damage in the case of trauma, such as a car accident, steep fall, physical assault or even intense coughing. A bruised rib means the bone is not actually cracked, but it still may have sustained damage. Symptoms for bruised and broken ribs are much the same: pain, particularly when breathing or coughing.

Telltale sign: Injured ribs cause pain when breathing, coughing, twisting or bending.

Your doctor may order a chest X-ray to determine if you’ve fractured your rib. If you have, a CT scan will help determine whether your lungs have been injured.

Ribs obviously can’t be put in a cast or immobilized, like other broken bones. Plus, they need to keep moving when you breathe. Even if it hurts, it’s important to breathe deeply, so you can keep your lungs clear. Failing to do so may result in pneumonia. Respiratory complications like pneumonia occur in nearly a third of patients with rib fractures. Your doctor may give you a device to breathe into to help improve your lung function, and pain medications to make breathing easier until your broken or bruised rib heals.

2. Costochondritis

You may not have heard of this condition, but it’s actually a common cause of rib cage pain. All but two of your ribs are attached to your sternum, or breastbone, by cartilage.

“This area where the ribs meet the breastbone, called costosternal joints, can become inflamed,” says Rose Taroyan, MD, a family medicine physician at Keck Medicine of USC and assistant professor of clinical medicine at the Keck School of Medicine of USC.

Taroyan explains that costochondritis causes pain (it can be either sharp or dull) and tenderness in your chest. It may result from a blow to the chest, heavy lifting or hard exercise, or sustained coughing and sneezing.

Telltale sign: When the area where the rib meets the breastbone is pressed, you’ll feel pain.

Your doctor may order an electrocardiogram to rule out any cardiac issues. Depending on whether you have any other symptoms, your doctor may also order additional tests. If you’re diagnosed with costochondritis, though, it usually goes away on its own in a few days to a few weeks.

“You can do stretching exercises, put a heating pad on the painful area a few times a day, and take pain relievers, such as acetaminophen or ibuprofen,” Taroyan says. “And any activity you do that causes or reliably exacerbates the pain should be reduced and/or stopped, at least temporarily.”

3. Pleurisy

Lining the inside of your chest cavity and the outside of your lungs are two layers of tissue called pleura; the area between these layers is called the pleural space. The layers generally glide against each other smoothly as you inhale and exhale.

With pleurisy, the layers become inflamed due to a viral infection, pneumonia or other medical condition, and rub together roughly, causing pain every time you breathe or cough. Fluid may also collect in the pleural space, causing shortness of breath.

Telltale sign: Doctors can actually hear the membranes rubbing together, called a friction rub, when they listen to your chest with a stethoscope.

Based on your symptoms, your doctor may order imaging or blood tests to help determine the underlying cause of the pleurisy and to see if fluid has built up. If it has, the fluid may need to be drained. If the fluid is a result of a bacterial infection, you’ll be given antibiotics. If it’s from a virus, it may have to run its course, but over-the-counter pain relievers may help to reduce your symptoms.

With any rib cage pain, if you can’t breathe, your skin turns blue or you have severe chest pain, call 911 or go to the emergency room right away.

Topics

costochondritis

Dr. Rose Taroyan

fractured rib

pleurisy

Tina Donvito is a freelance writer covering health, culture, travel and parenting.

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