Q. I have severe pain in the left middle rib and is worsening. Should I worry about it?

Answered by
Dr. Rahul Goel
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 25, 2019

Hello doctor,

I have been having severe left middle rib pain for about a month and now it is always hurting. I had an upper endoscopy, colonoscopy, left kidney CT scan, gallbladder ultrasound, blood work, and HIDA scan and found nothing, but I have a torturous colon. The pain gets pretty bad and I am worried it is something more serious, but I try reassuring myself that it is not since I have had so many tests. What could this be?! Should I be worrying so much?



Welcome to

From your history, it seems to be an inflammation of one or more of the cartilages that connect the ribs to the breastbone. It is a condition called Tietze syndrome (when there is a swelling over the painful area) or costochondritis (no swelling, only pain). This condition has no known cause although many theories do exist (none proved). The main features are local pain, with or without swelling. It generally resolves in 12 weeks. However, it would be best if you can get a chest x-ray and an ECG (electrocardiogram) to rule out a rib fracture and a heart condition (angina) respectively.


1. Take tablet Asprin 325 mg SOS (whenever you feel pain) up to a maximum of eight tablets a day.

2. Tablet Ranitidine 75 mg once a day. Whenever you take aspirin it reduces the stomach irritation caused by aspirin.

3. Locally apply Diclofenac gel thrice daily.

Investigations to be done:

Chest x-ray PA (posteroanterior) view, ECG (electrocardiogram).

Differential diagnosis:

Angina, rib fracture.

Probable diagnosis:

Tietze syndrome, costochondritis.

Treatment plan:

Oral analgesics for two weeks, hot fomentation, local application of the analgesic gel.

Preventive measures:

Avoid weight-bearing over shoulders or chest, chest exercises or external impact over the area involved.

Regarding follow up:

Review with a doctor after your ECG and chest x-ray is done.

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