Chronic Pain Beneath Rib Cage On Right Side

Question

Asked by WSUChris

Chronic Pain Beneath Rib Cage On Right Side

I took a nasty fall about 7 months ago and fell on my ribs, and since then I've been dealing with pain under my right rib cage. I've had several tests done, but no doctor has been able to figure it out. The pain doesn't correlate to any certain foods or types of activity, and nothing helps alleviate it. Shouldn't my injured ribs have healed by now?

Answer

Without examining you and getting a detailed history, I am unable to make a diagnosis. So, I will speak in generalities about what this could be.

Injuries to the chest wall can injure bones, muscles, or nerves. So, I would be looking at all of these things on exam. I would ask about pain with breathing, coughing, reaching, pulling, or pushing. Is this pain in the front, side or back? Is there numbness, tinglling, burning, or other abnormal sensations?

One possiblility that comes to mind and is often overlooked is an injury to the Long Thoracic Nerve with innervates the Serratus Anterior muscle (that muscle covers the back of the chest wall and assist the shoulder movements; Michael Phelps has a very well formed Serratus). If this muscle is atrophied (smaller from nerve damage), then the chest wall will look assymetric (deformed) compared to the other (normal) side. The Long Thoracic Nerve can be injured with surprisingly little force like reaching to swat a fly. A Physical Medicine and Rehabilitation (PM&R) specialist can make this diagnosis, sometimes with the help of a nerve/muscle test (electrodiagnostic study).

Another possiblity is a damaged intercostal nerve (nerves that are "between" the ribs). These nerves branch out all over the chest wall and are superficial enough to be easily injured with a fall.

Other possiblities exist but in reality you need a PM&R specialist to look you over. We specialize in post-traumatic injuries of the nervous system and musculoskeletal system. Until you are able to see a specialist, these articles may provide useful information:

The Upsides and Downsides of Inversion Therapy

How Exercise Improves Pain Tolerance