Pain occurring simultaneously in the rib cage and back is a common diagnostic challenge due to the region’s anatomical complexity. The thoracic spine, ribs, and surrounding soft tissues are tightly integrated, meaning an issue in one area can easily manifest as pain in another. Understanding the source of this discomfort is important, as causes range widely from minor musculoskeletal strain to serious internal organ pathology.
Structural and Skeletal Causes
Structural issues in the mid-back frequently cause pain that wraps around to the rib cage due to the direct connection between the ribs and the thoracic spine. A common mechanical source is thoracic radiculopathy, which occurs when a spinal nerve root becomes compressed or irritated. This irritation, often caused by a herniated or bulging disc, sends pain signals along the nerve’s path, creating a sharp or burning sensation around the chest or side.
Rib fractures or severe contusions resulting from trauma, coughing, or repetitive stress cause localized tenderness worsened by movement, deep breaths, or sneezing. Pain from a fractured rib is particularly severe because the bone moves with every breath. Even a minor misalignment of the costovertebral or costotransverse joints, where the ribs meet the vertebrae, can cause sudden, sharp pain exacerbated by twisting or inhaling deeply.
Inflammation of the rib cartilage, known as costochondritis, typically causes pain where the ribs attach to the breastbone, but it can also be felt in the back due to the mechanical link with the thoracic spine. This pain is often described as aching or sharp and may be mistaken for a cardiac issue because it worsens with chest wall movement. Degenerative changes like spinal osteoarthritis or the formation of bony spurs can also narrow the space where nerves exit the spine, leading to chronic nerve compression and associated rib pain.
Muscular and Connective Tissue Sources
Pain may originate in the soft tissues surrounding the rib cage and back, often due to overuse or poor biomechanics. A frequent cause is a strain of the intercostal muscles, the thin layers between the ribs that assist with breathing. These muscles can be overstretched or partially torn by sudden, forceful motions like heavy lifting, twisting, or severe, prolonged coughing or sneezing.
The resulting intercostal strain leads to sharp, localized pain that intensifies when taking a deep breath, laughing, or moving the torso. Strains in the larger back muscles, such as the rhomboids or erector spinae, from improper lifting or prolonged exertion, can cause deep aching pain that radiates toward the ribs. Poor posture, particularly the rounded-shoulder, forward-head position common with desk work, creates chronic tension in the upper back musculature.
Constant postural fatigue can lead to muscle spasms and the development of trigger points, which are hyperirritable spots within the muscle fascia. In Myofascial Pain Syndrome, these trigger points can cause referred pain felt in distant areas, including the rib cage. Widespread conditions such as fibromyalgia also commonly include tender points in the upper back and rib cage area, presenting as chronic, generalized musculoskeletal pain.
Referred Pain from Visceral Organs
When pain originates in an internal organ but is perceived in the back or rib area, it is known as referred pain. Conditions affecting the kidneys, located high in the back beneath the lower ribs, frequently cause flank pain. Kidney stones or a severe kidney infection (pyelonephritis) can produce a constant, dull ache or sharp, wave-like pain felt on one side under the rib cage, often accompanied by fever or urinary changes.
Issues with the lungs and pleural lining also manifest as pain in this region. Pleurisy, an inflammation of the membranes encasing the lungs, causes a sharp, stabbing pain that is worse with deep inhalation, coughing, or sneezing and can radiate to the back and shoulder. Infections like pneumonia can cause similar inflammation and pain patterns, sometimes accompanied by fever and shortness of breath.
Gastrointestinal problems can also refer pain to the back and ribs. Acute pancreatitis, an inflammation of the pancreas located behind the stomach, causes intense upper abdominal pain that often radiates through to the upper back or left shoulder blade. This pain may be worse when lying flat on the back or after eating a fatty meal. In a medical emergency, a sudden, severe, and unrelenting “ripping” or “tearing” sensation in the chest and upper back can be a sign of an aortic dissection.