Orthopedics-Online

Pinched nerve on the rib

Introduction - What is a pinched nerve on the rib?

When one speaks colloquially of a pinched nerve, it often means irritation or inflammation of the nerve. Nerves can rarely be really pinched. On the ribs, the spinal cord nerves (intercostal nerves) can be irritated. These are the nerves that run from the thoracic spine to the front between the ribs towards the sternum (breastbone).

If these intercostal nerves are irritated, sudden stabbing pain can occur or symptoms that become more severe over time, this is generally called intercostal neuralgia (intercostal neuralgia).

causes

There are many causes for irritation or inflammation of the nerves. An underlying spinal disease such as osteochondrosis (bone and cartilage degeneration), spondylitis (inflammation of the spine) or a tumor on the spine that builds up (osteoplastic) or degrades (osteolytic) the bone may be possible. A change in the ribs such as a fracture, pleurisy (pleurisy) or periostitis (inflammation of the periosteum) can also be possible causes. Nerve pain in the rib area can also occur after shingles (herpes zoster virus) has been overcome and healed. A herniated disc in the thoracic spine area can irritate the nerve tracts and cause symptoms. Diseases of the spinal cord or nerve tracts themselves can also cause symptoms. Inflammation of the lungs (pneumonia) or other diseases of the lungs with, for example, a strong cough, can cause irritation of the intercostal nerves. In rare cases, organic reasons can also be the cause, such as inflammation of the gallbladder (cholecystitis), gallstones, stomach problems or diseases of the heart.

By coughing

If one coughs heavily and / or frequently, there is massive movement of the chest. The intercostal muscles that lie between the ribs are tensed and relaxed alternately over the dimensions. Since the intercostal nerves lie directly below the ribs and are therefore in close spatial relationship to the muscle fibers, this can lead to irritation of the nerve fibers. If the cough continues, the intercostal muscles can cramp over time, which also irritates the nerves. The relieving posture that one takes due to the solidified muscles also promotes the pain symptoms in further coughing attacks.

Find out more about the topic: Pain in the costal arch caused by coughing

By back pain

Back pain can have many causes. The most common causes are the herniated disc, osteoporosis (bone loss), osteomalacia (softening of the bones), psychosocial factors such as professional or private stress, overuse of the spine and muscles due to, for example, heavy carrying, sliding of the vertebrae (spondylolisthesis), inflammatory osteoarthritis, narrowing of the spinal canal. but also inflammation of nerve fibers, intervertebral discs or vertebrae caused by viruses or bacteria. Depending on where the defect is, pain can occur there. For example, if a herniated disc occurs on the 10th / 11th of November. Thoracic vertebrae, muscle failure of the intercostal muscles belonging to the dermatome can occur, as well as loss of sensitivity at the level of the navel.

These symptoms indicate a pinched nerve on the rib

One symptom that most likely suggests a pinched nerve on the rib is the rather pointed, stabbing, easily localized pain. If pain occurs when coughing or during deep inspiration or expiration (inhalation / exhalation), this most likely indicates irritation of the intercostal nerves. It can happen that the intercostal muscles cramp at times, as irritated nerve fibers can also send action potentials that cause the muscle fibers to contract.

If you feel pain when you tilt your upper body in a certain direction or rotate it into a certain position, this can be a sign of irritation or irritation of the nerves in the thoracic spine.

If the pain radiates along a rib, it could be a neuralgia of the nerve fiber, i.e. a nerve pain that can result from pressure on the fibers, for example, or a previous illness with herpes zoster viruses (shingles). Sensory disturbances along a defined area of skin can also be caused by a pinched nerve. More rarely, restricted mobility or muscular stiffness can be signs of irritation of the nerve.

Find out more about the following: Pinched nerve on the chest

Treatment and therapy

Depending on the cause of the symptoms, one tries first of all a causal therapy. If, for example, it is a question of muscle hardening that is so strong that a nerve is irritated, you can first try to release the tension by means of heat and massage and thus relieve the nerve pain.

If the pain occurs in the ribs when coughing and becomes increasingly severe, one should first try to relieve the cough so that the irritation of the nerves is less. Further possible therapy options are physiotherapy, manual therapy, electrotherapy or, as already mentioned, therapeutic massages.

In some cases, however, the pain is so severe or the causal cause cannot be identified or poorly treated, so that symptomatic therapy with painkillers is in the foreground. For this purpose, non-steroidal anti-inflammatory drugs (NSAIDs) are initially suitable as the primary therapy. Muscle relaxants can be considered as a possible increase in therapy and - as an escalation of therapy - opioids or infiltration of the nerves with local anesthetics. Surgery can also be considered to take pressure off the nerves, for example when treating a herniated disc.

diagnosis

It is important for the doctor to know what symptoms are present and when they first appeared. Do you feel a tingling sensation or does it feel numb, do you have mobility restrictions or are you less sensitive to touching the skin?
Was the pain the first time in a particular situation?
Was it sudden or creeping?
Where exactly is the pain point or is it radiating into a region?

Various movement tests may be done to further diagnose because certain nerves have control muscles that they innervate. This can be used to find out which nerve is most likely to be affected. The possible damage to the nerves can also be tested with the help of the survey of the reflex status, in which a reflex hammer is tapped on the roots of the muscles. With the help of imaging methods such as computed tomography (CT) or magnetic resonance therapy (MRT), an entrapment of nerve tracts along the spinal canal can be shown.

Another possibility of diagnosis is the measurement of the nerve conduction velocity. Electrodes are glued to the skin, which on the one hand can measure the nerve impulse and on the other hand can stimulate muscle fibers and thus the associated nerve fibers with a certain (harmless) current strength. The values determined can be used to calculate the nerve conduction velocity and estimate whether there is any nerve damage in the measured area.

Duration

The duration of the pain differs depending on the location, cause, degree of inflammation and the condition of the person. As a rule, it helps to start pain-relieving therapy at an early stage in order to relieve the psychological stress the pain brings with it. For example, in the case of intercostal neuralgia caused by bronchitis, you can expect the pain to improve once the bronchitis has subsided.

If the neuralgia is due to herpes zoster viruses, the pain can recur in the area of the blisters even after the shingles have healed. In general, it can be said that the pain should decrease as soon as the causal cause is found and treated.

These alternative diseases produce comparable symptoms!

There are some diseases of the internal organs that can also cause pain in the ribs or intercostal muscles. A possible cause could be a rib bruise or rib fracture, which could have damaged the nerve. However, you would also have pain at the bruise mark or fracture and possibly a hematoma and would most likely have had an accident beforehand.
Read more about the topic: bruised ribs or rib fractures?

Another differential diagnosis can be a pneumothorax (collapsed lung), which is noticeable in sudden stabbing unilateral pain and a feeling of shortness of breath.

In addition, pneumonia can cause breathing-dependent pain. Inflammation of the pleurisy (pleurisy) also causes breath-dependent, mostly unilateral pain, but this may decrease as the disease progresses and is usually related to a previous or simultaneous pneumonia (pneumonia). Furthermore, a herniated disc or spinal stenosis can cause radiating movement-dependent pain.