Abdominal and Sternal Pain, Tenderness Under Right Ribcage

Rudy Asked:

I have had abdominal pain now for 10 years. It is to my right side of the xiphoid process and extends under my right ribcage. When I apply pressure to the area, their seems to be a shifting of ligaments that kind of pop back and forth. It is tender but not painful.

I have no symptoms when I sleep, but it starts in the late morning and lasts all day. I have had an endoscopy four years ago that revealed H.Pylori, which I had taken medication for. I have taken Prevacid and other GERD medication without any relief. I have taken a breath test this year to see if H.pylori is back and it came back negative. I have had an abdominal ultrasound as well that showed all my organs are fine.

My doctor thinks that it could now be an old sports injury, and has booked me for an abdominal CT scan. He says that there might not be anything that he can do if the CT scan comes back alright.

Can you let me know what you think, as I am finding it hard to believe that we can’t find a cure for this.

This question was posted under the Causes of Breastbone Pain article.

Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.

Dr. Chris Answered:

Hello Rudy

The fact that this abdominal pain has persisted for 10 years, without any other signs or symptoms developing in this time, usually means that the cause is most likely benign (not dangerous or progressive). Your doctor seems to have conducted all the necessary investigative techniques thus far and an abdominal CT scan is definitely warranted.

You have mentioned an old sports injury and this appears to be the most likely cause from the information you have provided. Depending on the nature of your injury, there may have been significant strain on the rib cage and this could have contributed to injury to the costal cartilage (which connects the ribs to the sternum) or the ribs or sternum itself.

In terms of the costal cartilage which articulates with the ribs and sternum, there could be slight subluxation (partial dislocation) of the costochondral (costal cartilage-rib) or sternocostal (costal cartilage-sternum) joint. The rib cage which is always moving because of breathing, apart from other movements in our daily activity, may contribute to this persistent partial dislocation. The cartilage and possibly even the joints itself may be inflamed and this is known as costochondritis.

Further degradation associated with wear-and-tear over the years, age related changes and any other contributing factors at this point in your life may be making the symptoms more pronounced.

Since you have mentioned that there is a popping sensation, or possibly even a sound (refer to the article on Popping Sternum) increases the likelihood of this condition being related to the costochondral and sternocostal joints. This is further confirmed by the fact that your symptoms ease upon lying flat. The costal cartilage between the rib and and sternum is very flexible on its own and may seem ‘strange’ to the touch as it is not as soft as the soft tissue and organs, yet not as hard a bone.

This assessment is purely based on the information you have provided and there could be other possible conditions contributing to your symptoms. Given the lack of concomitant signs and symptoms and the fact that no abnormalities have been picked up as yet, costochondritis or other chest wall injuries may be a good point to focus upon for now. Refer to the articles on Bone Chest Pain and Muscle Chest Pain as well.

If further investigations focused at your old injury are inconclusive then your doctor may consider other tests to confirm or exclude any liver, gallbladder or pancreas disorders, a duodenal ulcer or conditions related to your large colon and so on. These, however, would only be considered if there are other findings to suggest that conditions affecting these organs may be causing your pain. Refer to the articles on Causes of Right Side Abdominal Pain and Acute and Chronic Right Upper Abdominal Pain.

Your doctor will be in the best position to guide the evaluation and make the final diagnosis as he is fully aware of your entire condition and past medical history. If it is related to costochondritis, and given the time span for which it has been present, it may not be a matter of ‘curing’ the condition but rather managing it appropriately so that you are not experiencing constant and severe discomfort.



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