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Overview

In order to determine the cause of pain and numbness in certain areas of the body, one has to know what anatomy is present and which possible tissues may be involved.

Causes and management

If the pain and numbness are experienced over the skin in the area under the rib cage then possible nerve pathology in the spine needs to be investigated further.

The potential issues that could be causing these symptoms include:

  • Entrapment of the spinal nerve root as it exits the spinal cord. This can be caused by pathologies such as inflammation of the facet joints of the spinal bones (vertebrae) where the nerves pass through or due to compression of the nerves by bone processes (bone spurs) that form due to chronic inflammation in this area.
  • Ruptured or herniated disc where the contents of the intervertebral disc either press on or irritate the nerves coming out of the spinal cord.

Since the area affected is just below the rib cage, the area of pathology would most likely be an issue involving the upper part of the thoracic spine (mid-back). 

An MRI scan of the thoracic spine needs to be performed and if there is any nerve-related issue present, this will confirm the diagnosis and the patient will be referred to receive further management for the problem.

In the case of inflammation, treatment options may include steroid injections at the site of the inflamed tissue, epidural injections to help reduce the pain experienced by the patient, or even radiofrequency ablation where the nerve itself is heated up and injured in order to disrupt the pain signals being sent to the brain.

If the pathology involves irritation of the nerve roots then the mentioned therapies can also be performed. If the problem is more severe such as in the case of a herniated disc pressing on a nerve, then surgical intervention will be warranted. Minimally invasive procedures are performed nowadays where the small incisions are made to perform the required surgery but if the problem is more severe then an open procedure will have to be performed.

Another possible cause of pain and numbness under the rib cage could be symptoms referred from inflammation of the joints of the ribs. This is called costochondritis. 

If there is inflammation of the costosternal (rib to sternum) and/or costovertebral (rib to vertebrae) joints, these issues can cause irritation of the intercostal nerves (nerves between the ribs) which leads to localized signs and symptoms. If the lower part of the rib cage is where the symptoms are experienced, then this is the most probable area where the inflammation is taking place.

The pathology can be managed effectively enough by using anti-inflammatory medications such as ibuprofen, diclofenac, or naproxen. Physical therapy techniques and exercises will also help to start mobilizing the rib cage and the muscles associated with it to help prevent issues such as reduced breathing due to inactivity of the ribs. Teaching patients the correct posture also helps to relieve the symptoms and reduce any repeat incidences of the problem. 

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