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Lower right rib protruding and painful

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For the past 3 years now I have noticed one of my lower ribs on my right (which I believe to be the 9th rib) is protruding and is very painful. It is most painful with physical activity and the more I do the more pain I am in. I have also noticed that when I sit down for long periods of time it is extremely uncomfortable and sometimes I feel a click or pop when I sit down almost as if the rib pops inward. You can noticeably see and feel that the rib protrudes and it is very tender. I first saw a NP 3 or so years ago for this because my MD was out of the office and she thought maybe my muscles were hypertrophic on that side and told me to baby that side for awhile because I was at risk of "slipping a rib". I have seen my MD many times since then and he sent me for a bone scan about year or so ago that was normal and over the past 4 months I have had 2 CT scans, one to rule out appendicitis and discovered a large ovarian cyst that lead to a laparotomy, and another after my surgery to diagnose a seroma. Neither of the CT results mentioned anything about my ribs, however they were not concerned with any of that at the time so I do not know if it makes a difference on whether they would have found something. I have started to give up on finding an answer and just deal with the pain as best I can because my doctor does not seem to be able to find an answer. What could be causing this?

My pain from day to day is usually exactly over the protruding rib on right side, the pain is usually exactly over the visibly protruding on my torso, but I had an incident at work on Thursday that caused me to jerk really hard with my right arm and since then the pain been terrible and today it has started radiating to my back. From day to day the pain can reach a level of about 5-6 on a scale of 1 to 10, but since my incident at work it hurts to move at all and the pain is closer to an 8. The 2 CT scans I have had within the past few months were for the ovarian cysts, but a few years ago I had both a bone scan and an MRI for my rib pain. I have not been to see a doctor about my rib pain in a year or so because no one could seem to find an answer, but it has never gone away and now it is worse than before. Is it possible these scans could have missed something? Should I be concerned my pain has increased so drastically since my incident at work?

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Patient replied :

I can appreciate that ribs are hard to count as I am an RN, so it could be the 10th, I have always thought it to be the 10th, but it is 2nd to last rib you can feel from the anterior portion of my torso.

My pain is usually subject to physical activity and to positioning of my torso, however yesterday I jerked pretty hard with my right arm to open something at work and ever since then I have been in constant pain. Is it possible my rib my have slipped?

Also, is is possible that "floating rib syndrome" could be missed on both a bone scan and MRI?


Hello,

Could you please tell me the exact location of the maximum pain ? (As in anteriorly near the sternum or posteriorly near the spine )

Was the scans done for this concern or for the ovarian cyst. The reason I am asking this is because floating rib is a normal phenomenon. The last two or three ribs are floating in all individuals. But in very few individuals this can be a 'painful floating rib' which is abnormal. So MRI/CT might show 2 or 3 floating ribs, which is a normal phenomenon. The Radiologist will not further look deep into it unless requested for. Also there need not be any radiologically visible features in most of the cases.

You can reply as a followup.
Thank yu


Patient replied :

I can appreciate that ribs are hard to count as I am an RN, so it could be the 10th, I have always thought it to be the 10th, but it is 2nd to last rib you can feel from the anterior portion of my torso.

My pain is usually subject to physical activity and to positioning of my torso, however yesterday I jerked pretty hard with my right arm to open something at work and ever since then I have been in constant pain. Is it possible my rib my have slipped?

Also, is is possible that "floating rib syndrome" could be missed on both a bone scan and MRI?



Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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