The thoracic spine and ribs are like a no man’s land for many physicians, including spine experts. While many physicians are comfortable treating and diagnosing neck and low back problems when it comes to things like pain around the ribs and back symptoms, they draw a blank. Show
First, let’s define what we mean by pain around the ribs and back. Basically, the pain wraps around the back of the rib — generally at least to the side and at times all the way to the front. There is also upper-back pain that often accompanies this pain. Movement usually leads to intense pain or makes it feel like something is “out of place” and needs to be popped back in place. Sometimes specific motions or activities will make this better or worse. Understanding the Thoracic SpineThe thoracic spine is between the neck (cervical) and the low back (lumbar). Its bones (vertebrae) are numbered 1-12 and the abbreviation ‘T” is used for “thoracic.” Hence, “T6” means the sixth thoracic vertebra (1). What’s unique is that the ribs attach here to the thoracic vertebrae. These two structures both constrain and define which movements are possible by the other. And because they’re connected, what happens in one is often felt in the other. In addition, the thoracic vertebrae act as pivot points for the ribs as you breathe in and out. This is often why patients experience pain when taking a deep breath. There’s an immense amount going on in the thoracic spine. First, there are facet joints where the two vertebrae meet. There is a spinal nerve that exists in this area at each vertebra. The nerve begins as the thoracic spinal nerve and then continues all the way around to the front of the chest as the intercostal nerve. There’s a disc that acts as a shock absorber as well as a multitude of muscles and ligaments. Then there are two areas where each rib attaches to each vertebra (the costotransverse and costovertebral joints) (2). Realize that there can be problems with any one of these structures that can cause pain around the ribs and back symptoms. Find a Regenexx Location Near You 82 clinic locations offering non-surgical Regenexx solutions for musculoskeletal pain. 82 clinic locations offering non-surgical Regenexx solutions for musculoskeletal pain. The Top 5 Causes of Pain In Ribs and BackOur clinic has had a special interest in the thoracic spine for many years. As an example, most spinal interventionalists have only ever performed a handful of thoracic epidural or facet injections. I’ve done hundreds of each. In all of those years helping patients with pain in ribs and back recover, these are the top five medical conditions that we see in our clinic:
How Can The Pain Be Treated? Juan’s StoryJuan’s pain around the ribs and back symptoms with spasms began in 2007, and he presented to our clinic in 2020. Any movement, rotation, or flexion/extension made the pain worse, while rest and medication made the pain better. Previously, he had tried ozone injections, steroid injections, and facet injections, which provided temporary relief. Radiofrequency ablation at the T8-T11 facet joints provided relief for only about six to eight months. He had also developed tingling in his right ring finger and pinkie, pain in his right elbow, and weakness in his right hand. This was likely coming from irritation of the brachial plexus by his ribs. We approached Juan’s problems differently, looking at what was causing all of these issues. In particular, one of the ligaments in the back of his spinal canal (ligamentum flavum) was loose and buckling, which was irritating nerves. Hence, we concentrated his own blood platelets (platelet-rich plasma) to inject into that specific ligament to cause some healing and tightening. In addition, we treated the irritated thoracic nerves by injecting a platelet lysate around the nerves (epidural using X-ray guidance). Finally, his facet joints had previously been treated with radiofrequency, which burns the nerve that communicates pain from the joint. Because of this, nobody had ever tried helping the joint with substances that can promote healing. So again I carefully injected high-dose platelet-rich plasma into those joints using sophisticated image guidance technology. How did he do? He’s reporting 90% relief, with pain only during certain activities. As you can see, there’s quite a bit that can cause pain around the ribs and back symptoms. The first order of business is getting an accurate diagnosis of why you hurt, which is what we did with Juan. Rather than injecting Juan with steroids that could harm tissue or burn nerves, we focused on the root cause of his problems and tried to improve the function of the spine. __________________________________________________ Learn about Regenexx procedures for spine conditions.References(1) Thoracic Anatomy. Physiopedia. https://www.physio-pedia.com/Thoracic_Anatomy. Accessed August 12, 2021. (2) Chopra P. Thoracic Pain. In Smith H. Current Therapy in Pain. Elsevier; 2009:194-201. doi:10.1016/B978-1-4160-4836-7.00026-2 Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile If you have questions or comments about this blog post, please email us at [email protected] NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you. What organ is behind right back ribs?The liver is located under the ribs on the right hand side of the body. It lies just below the lungs, under the top of the diaphragm to which it is attached. The diaphragm is the muscle beneath the lungs which regulates our breathing. The liver is partly protected by the rib cage.
When should I worry about right side back pain?Lower right back pain is sometimes a medical emergency. Call 911 or go to the emergency department if: Your pain is so severe that you can't go about your daily activities. You have pain and incontinence, nausea, fever or vomiting.
Why does the back right side of my ribs hurt?The most common causes of rib cage pain are a pulled muscle or bruised ribs. Other causes of pain in the rib cage area may include: broken ribs. injuries to the chest.
What organ is on the upper right side of your back?The right upper quadrant (RUQ) includes the pancreas, right kidney, gallbladder, liver, and intestines. Pain under the ribs in this area can indicate a health problem affecting one of these organs or the surrounding tissues.
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