What Can Cause Pain Under the Left Ribs?

Pain under the left rib cage can arise from any organ in the left upper abdomen or chest, spine, or the left ribs themselves. In otherwise healthy people, spleen irritation and gas built in the colon are main causes of pain under the lower left ribs. Pain can be also psychological, for example from neurotic heart, but physical causes have to be excluded first.

Spleen Irritation

During or after running, walking or other physical activities, irritation of the spleen capsule can cause side pain under the lower left ribs. Pain usually goes away after some rest.

Gas in the Colon – Splenic Flexure Syndrome

Gas trapped in the bend of the colon lying near the spleen (splenic flexure) can cause pain in the left upper abdomen or in the left lower chest. Other symptoms and signs of the so called splenic flexure syndrome include:

  • Distension of the upper abdomen, which can be tender to touch or not.
  • Drum-like sound when tapping upper abdomen with the hand
  • Pain in the upper left abdomen when bending or twisting the upper body. Pain is also often triggered by sitting down and relieved by standing up.
  • Constipation, diarrhea, abdominal cramps or excessive gas may be present in persons diagnosed with irritable bowel syndrome (IBS) .

Some people try to get rid of trapped gas by leaning over the back of a chair, or fence. It is important you find a cause of trapped gas, which may be:

Costochondritis

Sharp or dull, gnawing pain near the breastbone, affected by deep breathing, cough or moving the upper body may be due to costochondritis (costosternal syndrome). Costochondritis is an inflammation of cartilages that connect the ribs with the breastbone. The exact cause is not always clear, but trauma, fibromyalgia or infection can be included.

Costochondritis may be confused with heart attack. Pain from costochondritis is localized in small area on one or both sidesof the breastbone, and is tender to touch, while pain from heart attack or angina pectoris comes from under the breastbone and is not tender to touch.

Doctor can suspect costochondritis from symptoms and signs found during physical examination; costochondritis is not shown on X-ray of the chest.

Costochondritis usually heals on its own in a week or two. Rest and anti-inflammatory drugs, like aspirin or ibuprofen can help.

Pinched Nerve in the Thoracic Spine

Bulging or herniated disc, osteoporosis, rheumatoid arthritis or spondylitis can result in pinched nerve(s) in the neck or chest part of the spine (from C7 to Th8), which innervate the muscles and skin of the chest wall. Pain, burning, numbness or tingling, usually only on one side of the chest, can be affected by different body positions. Diagnosis is made by CT of the chest spine.

Broken Rib

Broken or fractured rib(s) on the left side causes pain during deep breathing and moving of the upper body. The main cause is trauma. Diagnosis is made by chest X-ray, but still some fractures can be missed since a broken rib may be only a crack in the rib, which does not necessary fall apart in two pieces. Elastic wraps to “immobilize” the chest are not used anymore. Simple cracks heal in a month or two, complicated fractures require surgery. Painkillers are recommended to enable deep breathing without pain.

Herpes Zoster (Shingles)

Shingles is an inflammation of one of the spinal nerves due to reactivation of infection with Herpes zoster (varicella) virus. Burning pain extending as a stripe from the back toward the breastbone, and itchy rash that often appears some days after pain has started, are main symptoms. Shingles heal on its own in few weeks. Painkillers may be needed.

Pleuritis, Pneumonia, Pneumothorax, Lung Cancer…

Inflammation of the lung membrane (pleuritis) on the left side can cause stabbing pain around the lower ribs. Pain is usually affected by deep breath and cough. Pneumonia(bacterial, viral or caused by mycoplasma or other microbes) affecting the left lung can cause cough, left side chest pain and fever.

Pneumothorax is a collapse of the lung (usually on one side only) due to a break in the lung membrane. Pneumothorax may be caused by trauma or can be spontaneous – the later usually affects young skinny males. Vague, not necessary sharp pains around the chest and back, affected by breathing and body movements, are typical. Diagnosis is made by X-ray; treatment is with surgery.

Other lung causes of pain under the left ribs:

  • Tuberculosis or other lung infection
  • Lung cancer
  • Pleural effusion
  • Lung infarct
  • Mesothelioma

Heart Attack and Angina Pectoris

Heart attack causes a sudden pain of various intensity behind the breastbone or slightly to the left. Angina pectoris, is a chronic pain, caused by various heart disorders, and usually triggered by physical effort or stress. Check other heart disorders.

Pancreatitis and Pancreatic Cancer

Pancreatitis or pancreatic cancer may cause pain in the middle or left upper abdomen. Diagnosis is with CT and blood tests.

Spleen Disorders and Enlarged Spleen

Liver disease, systemic lupus erythematosus (SLE), spleen rupture, spleen infarct, infectious mononucleosis, malaria or other infections, lymphoma, leukemia, sickle cell anemia and other blood disorders, or certain (rare) genetic metabolic disorders can cause pain in the spleen.

Other Disorders Causing Pain Under the Left Rib Cage

Other possible causes of pain under the left rib cage include:

  • Stretched or torn muscle or muscle spasm in the chest or abdominal wall
  • Chest or abdominal trauma
  • Gastric ulcer
  • Kidney diseases, including urinary stones in the kidney or left ureter
  • Pericarditis – an inflammation of the heart sac
  • Aneurysm or dissection of abdominal aorta
  • Henoch Schönlein purpura, inflammation of arteries affecting various organs

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Article reviewed by Dr. Greg. Last updated on December 4, 2011