Rib Pain: Inflammation, Tumors, and Treatment Options

Costochondritis? Osteoma?

I have been experiencing rib pain since I was 17 years old.
At that time, the doctor only mentioned it was growing pains.
Two years ago, the pain in my costal cartilage became more severe, even affecting my sleep.
After getting an X-ray, the doctor said there were no visible issues with the cartilage but noted that my ribs were protruding (without specifying which area).
The final diagnosis was inflammation, and I was prescribed a muscle pain relief ointment and advised to engage in core strengthening exercises to reduce the burden on my ribs.
I do not have a habit of exercising, and the physical therapist mentioned that my joints are quite loose.
After a few months of rehabilitation, I have not continued the exercises for over a year.

I have the following symptoms and questions:
1.
The cartilage at the lower edge of my left rib (about a palm's distance above the navel) feels particularly loose.
When I take a deep breath, I can feel a significant feedback sensation when pressing down and releasing, and there is a small protrusion about the size of a fingertip that bulges to the side.
This area does not cause me any discomfort.

2.
The cartilage in the middle of my left rib (next to the xiphoid process) protrudes about 2 centimeters to the side (toward the xiphoid process) and backward (toward the internal organs).
When pressed down, I can clearly feel the cartilage rubbing against the xiphoid process, with a feedback sensation.
I often experience unexplained pain, especially after lying on my side for a long time, and there is a feeling of pressure in my chest when lying flat (this area is currently the most concerning for me; hugging a pillow while lying on my side does not help, and I can only rely on the ointment for relief).

3.
The third rib from the top on my left side (upper right area of my left chest) feels particularly swollen (I suspect this is what the doctor was referring to).
It is not visibly noticeable, but since it is right above the breast, I cannot determine the extent of the swelling.
This year, I have occasionally felt a slight sharp pain near the center of my chest, occurring about once every few days, and the pain lasts particularly long when entering an air-conditioned room in the summer.

I have attached a reference image, with the red area indicating the protruding cartilage: https://i.imgur.com/Giod6Kj.png.

Focusing entirely on the left side makes me feel uneasy.
I am concerned that these protrusions could potentially develop into malignant tumors.
If this is just a common issue, can I only rely on core exercises and ointment to alleviate the discomfort? (I want to consider surgery, but my family advises against it.) I have heard that long-term use of ointments can burden the kidneys; is it really okay for me to keep applying the ointment?

Nìmíng, 20~29 year old female. Ask Date: 2020/10/14

Dr. Chen Bochen reply Orthopedics

Hello,
1.
First, it's important to understand that a problem that has troubled you for many years will not be resolved by a single method, nor will a quick online inquiry suddenly provide clarity.

2.
Maintaining a regular exercise routine can enhance your body's self-repair and adaptability.
If you're unsure about what exercises to do, I recommend brisk walking, jogging, swimming, or finding a trainer at a gym.

3.
Continuous pressing and rubbing can exacerbate local inflammation, potentially prolonging your discomfort.
I suggest you refrain from touching the painful area for three months.

4.
Unless there is a confirmed diagnosis, surgery is unlikely to resolve the issue.

5.
Topical anti-inflammatory ointments have minimal impact on kidney function, unless applied over the entire body at once.

6.
Instead of overthinking, consider opting for a self-paid MRI scan.
If no malignant tumors are found, focus on exercising, relaxing, and finding peace with your body.

Reply Date: 2020/10/14

More Info

Rib pain can be a complex issue, especially when it has persisted for many years, as in your case. It is understandable to feel anxious about the symptoms you are experiencing, particularly with concerns about potential malignancies. Let's break down your situation and explore the possible causes, treatment options, and the importance of a thorough evaluation.

Understanding Rib Pain
Rib pain can arise from various sources, including inflammation, injury, or even tumors. In your case, it seems that the initial diagnosis was related to growth pains, which is common in adolescents. However, as you have noted, the pain has evolved into more significant discomfort, particularly in the cartilage areas of your ribs.

1. Costochondritis: This is an inflammation of the cartilage that connects a rib to the sternum. It can cause localized pain that may worsen with certain movements or pressure. Your description of the pain and the feedback sensation when pressing on the affected areas aligns with this condition.

2. Rib Subluxation: The feeling of a rib being "out" or protruding could indicate a subluxation, where the rib is not in its normal position. This can lead to pain and discomfort, especially during movement or pressure.

3. Muscle Strain: Given that you have been advised to strengthen your core, it is possible that muscle strain or weakness in the surrounding muscles could contribute to your rib pain. Weak core muscles can place additional stress on the rib cage, leading to discomfort.

4. Tumors: While it is natural to worry about the possibility of tumors, it is essential to note that rib tumors, whether benign or malignant, are relatively rare. If your X-rays and other imaging studies have not indicated any abnormalities, the likelihood of a tumor is lower. However, if you have persistent concerns, further imaging, such as an MRI or CT scan, may be warranted to rule out any serious conditions.

Treatment Options
1. Physical Therapy: Continuing physical therapy focusing on core strengthening and flexibility can be beneficial. A strong core supports the rib cage and reduces strain on the ribs and surrounding muscles.

2. Pain Management: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage pain and inflammation. However, long-term use of topical analgesics should be approached with caution, as they can have side effects, including potential kidney strain if used excessively. It is advisable to consult with a healthcare provider about the best pain management strategy for your situation.

3. Activity Modification: Avoiding activities that exacerbate your symptoms is crucial. If certain positions or movements cause pain, try to modify them to reduce discomfort.

4. Surgery: Surgical intervention is typically considered a last resort and is usually reserved for cases where conservative treatments have failed and there is a clear structural issue that needs correction. If your family is hesitant about surgery, it may be worth discussing the potential benefits and risks with a specialist.

5. Regular Monitoring: Given your long history of rib pain, regular follow-ups with a healthcare provider are essential. They can monitor your symptoms and adjust your treatment plan as necessary.

Conclusion
Your concerns about rib pain and the potential for serious underlying issues are valid, especially given the duration and nature of your symptoms. It is crucial to maintain open communication with your healthcare provider, who can guide you through diagnostic processes and treatment options. While conservative management, including physical therapy and pain relief, is often effective, do not hesitate to seek further evaluation if your symptoms persist or worsen. Remember, your health and well-being are paramount, and addressing these concerns proactively is the best approach.

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