Shoulder pain from a rib that is out of place can be a real ordeal!
We have seen countless patients who are concerned they have spinal disc or muscle damage, only to discover the cause is rib joint dysfunction.
Do I have rib out of place shoulder pain?
Because the rib cage sits underneath your shoulder blade, having an irritated rib joint can cause shoulder pain.
If your pain is more at the back of the shoulder, and is worse on twisting movements and breathing deeply, your shoulder pain is likely from having a rib out.
First, it’s important to identify whether or not your pain is coming from a rib that’s dislocated, broken, subluxated, bruised, or sprained.
Anatomy Stop:
Your ribs are essential for protecting your vital organs, and they play a role in helping you breathe. Each rib is attached to your spine, and in the front at the sternum, by cartilage.
The first seven pairs of ribs are attached directly to the sternum by costal cartilage. The next three pairs are called “false ribs” because they are only attached to the sternum indirectly, via costal cartilage.
The last two pairs of ribs are called “floating ribs” because they are not attached to the sternum at all.
The shoulderblades (scaupulae) overlie the ribcage.
Thoracic Outlet Syndrome Causing Neck and Shoulder Pain
There are many potential causes of neck and shoulder pain, which we cover extensively in this post. but one often-overlooked possibility is a problem with the first rib or brachial plexus.
The first rib is the one that sits high, more in the area of the neck, and the brachial plexus is a network of nerves that runs from the neck to the shoulder.
In postural syndrome, the scalene muscles are tight and may irritate the brachial plexus, which can be a cause of Thoracic Outlet Syndrome.
We commonly see TOS in patients who are hairdressers, bodybuilders, and asthmatics. This is because of the increased stress and positioning issues at the first rib. Problems here can cause significant pain and discomfort!
In fact, during routine physical exams, we often come across an extra rib, which increases the occurrence of TOS.
Symptoms of a dislocated rib
Intense, sharp pain that is made worse by coughing, deep breathing, or sneezing. Pain that radiates from the front of the chest to the back. Tenderness and bruising in the area of the dislocated rib, and swelling that is palpable.
This type of trauma can be the result of an injury such as a fall, heavy lifting, or a direct blow to the back. Sometimes even a violent sneeze while in an awkward posture, and excessive coughing perhaps from a respiratory illness.
The joints involved here are the costovertebral joint and the costotransverse joint. They are the cartilage joints at the junction with your spine. The joint articulation has been knocked out of its normal position.
Basically, any condition that causes joint hypermobility or cartilage disorders can increase your chances of rib dislocation. Ouch indeed!
Symptoms of a broken rib
This kind of trauma can also cause severe shoulder and upper back pain. The main symptom here is a sharp pain that gets worse with coughing or deep breathing.
You may also have tenderness and bruising in the area of the broken rib, and swelling that is palpable.
A rib fracture tends to be caused more often by direct trauma, such as a fall on your side, or sports injury in contact sports.
A rib fracture is a real consideration for people with osteoporosis, or osteopenia, where bone density is reduced. Recently, a patient in our clinic reported leaning awkwardly over a bench and fracturing her ribcage due to the acute pressure of the bench on her rib.
Symptoms of a subluxated rib
A subluxation means the rib has partially come out of the socket. This can also cause severe upper back and shoulder pain, as well as pain that radiates from the front of the chest to the back. You may also have tenderness and bruising in the area of the subluxated rib, but not necessarily.
There are a few conditions that cause an increased frequency of dislocated, subluxated, or sprained ribs. Just to name a few:
- COPD (Chronic Obstructive Pulmonary Disease): This condition results in weakened muscles and increased pressure on the lungs, which can lead to a dislocated rib from coughing and sneezing.
- HyperKyphosis: This is an exaggerated curvature of the thoracic spine, a hallmark of poor posture. This can put additional pressure on the ribs and cause more rib sprains and subluxation.
- Joint Hypermobility Syndrome: This is a condition where the joints are more “loose” than usual, and therefore more susceptible to sprains and subluxations. According to The Cleveland Clinic:
“The exact cause of joint hypermobility syndrome isn’t known. However, the disorder tends to run in families. The genes that are involved in the creation of collagen are believed to play a role. Collagen is the protein that adds flexibility and strength to your joints, ligaments, and tendons. People with joint hypermobility syndrome have loose joints because they have weak ligaments. They have weak ligaments because of the defect in their collagen.”
ref: https://my.clevelandclinic.org/health/diseases/21763-joint-hypermobility-syndrome
Rib and Shoulder Pain During Pregnancy
Rib and shoulder pain is a common complaint from antepartum and postpartum women. Physiological changes that cause rib and shoulder pain are typically due to hormonal, physical, and postural changes.
Not only do these aches and pains interfere with your daily life and sleep, but the pesky symptoms can persist even after delivery.
Here we will discuss 3 reasons why you might be experiencing rib and shoulder pain, your treatment options, and when to seek medical help.
Hormonal changes
In pregnant women, a hormone called relaxin is produced by the uterus and placenta at levels nearly 10 times greater than in non-pregnant women. The hormone is an important part of maintaining a healthy pregnancy, but it is also responsible for many uncomfortable side effects. Relaxin loosens ligaments and connective tissue. This stretching leads to hyper flexibility, joint instability, and pain.
Physical changes
Pregnant women experience an increase in breast, abdomen, and uterus size. The increased girth and weight place pressure on the rib cage which pulls the shoulders forward. The pain women experience is from both the actual weight applied and from improper posture.
If you’re really lucky, your unborn bundle of joy might be kicking you in the lower ribs, too!
Postural changes
When we experience pain related to the stretching of their ligaments and muscular systems, we compensate by adjusting our bodies into positions that feel more comfortable in the moment. However, those adjustments only meet temporary comfort needs and lead to unsustainable and incorrect body posture causing more pain over time.
Pregnancy Rib and Shoulder Pain Affecting Sleep
Women often experience acute rib and shoulder pain at bedtime and overnight, especially in the third trimester when sleeping on your side to promote adequate blood flow is recommended.
The use of a pregnancy pillow helps to alleviate pressure points and to correct body alignment. Although the symptoms are most significant in the third trimester, a pregnancy pillow can be used throughout the entirety of pregnancy to alleviate discomfort.
Treatment for Rib and Shoulder Pain During Pregnancy
Pregnancy Rib Pain Exercises
The exercises found here can be completed at home and are effective methods for alleviating rib and shoulder discomfort. Using a yoga ball while exercising and stretching can promote good posture. The following pregnancy-safe yoga poses may be used for stretching and muscle toning to reduce rib and shoulder-associated pain.
Posture Management
When sitting, keep your shoulders pointed in the same direction as your attention, feet should be flat on the floor, and adjust your torso weight so that it sits just forward of your sitting bones.
When standing, take care not to slump your shoulders forward. Imagine that you are opening your chest, like superman, by drawing the shoulder blades towards each other along your back.
Support garments
A supportive, not too tight, bra should be worn to help support the weight of your breasts. Belly bands may be worn when active to support the weight of a growing belly.
Chiropractic care
Consider seeking professional chiropractic help to evaluate your posture, problem areas, and treatment options. Check out our site resources to learn about how chiropractic care can help you with your pregnancy-related pain.
When to Seek Medical Help
There are some cases where rib and shoulder pain might indicate a more serious problem. These cases are rare but should be taken seriously.
Seek medical help if you experience any of the following:
Dizziness, blurred vision, and/or headaches: This could be a sign of HELLP syndrome.
Sharp, stabbing shoulder pain occurring in the first trimester of pregnancy. This could be a sign of an ectopic pregnancy.
Can a rib go “out”? Signs and symptoms
Your rib joints can “go out” in the sense that they can sprain or subluxate. These are the most common presentations. It is more prevalent in those with poor posture affecting the shape and flexibility of the thoracic spine.
Rarely will a rib “go out” completely – such as a dislocation, but it does happen!
So, our clients tend to present with sprain and subluxation of the costotransverse joint and/ or costovertebral joint, especially in the mid and upper thoracic spine. They initially describe this “rib out” as back pain or shoulder pain.
Can you self-adjust ribs out of place?
If your symptoms are mild and not from a traumatic injury, you may be able to use self-mobilizations for ribs out of place, e.g rib sprain. Some techniques for this include
- Use of a foam roller (see video below)
- Mobilization of your scapula and rib cage
- Muscle energy techniques
- Trigger point therapy
My simple home remedy for rib dysfunction is as follows:
- First, try some gentle shoulder stretches. If your shoulder is especially stiff, you may simply need to lay down and do some deep-breathing exercises to loosen up the muscles around your ribs.
- Then, lie on your back on a foam roller and roll up and down until you find the tender spot. Apply pressure to the spot for 30 seconds, then release and repeat 3-5 times.
However, we always recommend you get checked at the Chiro, Physio, or Osteo for rib out-of-place shoulder pain or back issues, due to the many factors that contribute to a rib problem. An appropriate treatment plan can include:
- Spine and 1st rib adjustments
- Soft tissue work at the back of your shoulder
- Posture correction work
- Home exercises
- Ergonomic optimization
Thankfully, it is often simple to correct rib sprain with our effective Thoracic Adjustments in our Chiropractic Clinic.
There are some instances where your shoulder pain is coming neither from a rib dysfunction nor the shoulder joint!
Where else could it be coming from?
Causes of Shoulder pain mimicking a rib dysfunction
- Thoracic spine sprain,
- disc herniation
- rotator cuff tear
- bursitis
- tendonitis
- frozen shoulder
- muscle strain from poor posture or overuse
- Heart attack or Blood clot – in severe and rare cases.
Conclusion
If you’re experiencing shoulder pain or chest pain due to a rib that’s out of place, it’s usually due to a sprain or rib subluxation. This can be caused by coughing, sneezing, lifting, or various other movements that put pressure on the rib joint ligaments.
The most common symptom of a rib injury is pain. This can range from a dull ache to sharp, stabbing pains that take your breath away.
The pain may be localized to the area of the injury, or it may radiate out to the back, shoulder, or chest. You may also have difficulty breathing or coughing due to pain in the injured area.
More severe symptoms could mean the injury is a rib dislocation, bruise, or fracture. These require expert medical advice and imaging, so please head straight to your Medical professional if your pain is more than an ache, or if you’ve recently been in an accident or suffered an injury!
Author Bio
Dr. Jason Whealing is a Chiropractor with extensive experience across the UK and Australia. He is passionate about family care and injury management. The cases Jason works with daily include back pain, neck pain, jaw pain, sciatica, knee pain, shoulder pain, headaches and migraine.
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Sources:
- Schröder G, Kundt G, Otte M, Wendig D, Schober HC. Impact of pregnancy on back pain and body posture in women. J Phys Ther Sci. 2016 Apr;28(4):1199-207. doi: 10.1589/jpts.28.1199. Epub 2016 Apr 28. PMID: 27190453; PMCID: PMC4868213.
- physio-rib-pain-in-pregnancy_jan22.pdf (royalberkshire.nhs.uk)
- Relaxin Hormone During Pregnancy- Everything You Need To Know – Being The Parent
- Yoga Poses Every Pregnant Woman Should Know – Being The Parent