What causes pain when pressing on left ribs?

If you feel pain when pressing on your left ribs, you should be alert to costochondritis, a disease common among young women. It is often difficult to cure and has a great impact on daily life. Costochondritis can also radiate to the breasts and cause breast pain.

1. Symptoms of costochondritis

1. Costochondritis is more common in women aged 20 to 30, with a male to female ratio of 1:9. The lesions are mostly located at the 2nd to 5th costal cartilages in the chest, with the 2nd and 3rd costal cartilages being the most common. The lesions may also invade the manubrium sternum, the inner side of the clavicle and the anterior and inferior costal cartilages. The affected costal cartilage may be felt as dull or sharp pain in the chest, with tenderness and swelling. The pain may worsen with deep breathing, coughing or movement of the affected upper limb, and may sometimes radiate to the shoulder or back. They may not even be able to raise their arms. However, there is no change in the local skin. The pain varies in severity and often lingers, affecting the patient's work and study.

2. After the pain disappears, the swollen costal cartilage may even last for months or even years. Sometimes the pain will occur after fatigue. The onset may be acute or slow. The acute one may occur suddenly, with a feeling of stabbing pain, throbbing pain or soreness in the chest; the insidious one develops slowly, making the junction of the ribs and costal cartilage bow-shaped, swollen and dull pain without being noticed, sometimes radiating to the shoulders, back, armpits, neck and chest, sometimes with chest tightness and shortness of breath. The pain is relieved by resting or lying on the side, and the pain is aggravated by deep breathing, coughing, lying flat, chest straightening and after fatigue.

3. Most women with costochondritis seek medical treatment for breast pain because the pain of costochondritis often radiates to the breast. Therefore, costochondritis can easily be confused with breast pain. However, identification is not difficult. If it is a disease of the breast itself, lumps or cord-like objects can often be felt in the breast, or the local skin of the breast may become red. The pain of costochondritis is often aggravated by coughing, deep breathing, raising arms and leaning sideways, but breast pain is not affected by these factors.

2. Etiology and Pathology

Cartilage itself has no blood vessels, and its blood supply mainly comes from the perichondrium. After the perichondrium is infected, the cartilage necrotizes due to lack of blood supply, causing the infection to persist and penetrate the skin to form sinuses. Infectious costochondritis is caused by infection of the costal perichondrium, leading to ischemic necrosis of the cartilage, and is associated with insensitivity to antibiotics. Due to the anatomical characteristics, the 1st to 4th costal cartilages exist independently and generally do not spread to the adjacent costal cartilages after infection. The 5th to 10th costal cartilages are connected to each other by the adjacent cartilages and are connected to the opposite side through the xiphoid process of the sternum. After infection, the inflammation can spread mutually, affecting multiple costal cartilages on the same side, and can spread to the opposite side through the xiphoid process, expanding the scope of infection.

Pus and granulation tissue form around the infected costal cartilage. The surface of the ischemic and necrotic costal cartilage is not smooth and has a worm-eaten appearance. Some become thinner and resemble rat tails, while others can be completely absorbed. Infectious costochondritis is mostly secondary, and currently the most common costochondritis is caused by infection after thoracic surgery. The pathogens are mainly pyogenic bacteria. This requires emphasis on prevention, strict aseptic operation, and trying to avoid or reduce damage to the costal perichondrium to reduce its occurrence.