Pain beneath the right rib cage, known as right upper quadrant (RUQ) pain, is a common symptom. This area houses portions of the rib cage and vital organs, including the liver, gallbladder, and part of the right kidney. When the pain is aggravated by physical movement, deep breathing, or positional changes, it suggests a mechanical or structural component. However, internal organ issues can also be a factor. Determining the origin requires understanding if the pain is structural (from the chest wall) or organic (from the underlying abdominal viscera).
Causes Related to Movement and Structure
When pain under the ribs is directly triggered or intensified by movement, the cause often lies in the musculoskeletal structures of the chest wall. The intercostal muscles, which span the spaces between the ribs and assist with breathing and trunk movement, are a frequent source of discomfort. A strain or tear in these muscles causes sharp, localized pain that worsens with twisting, bending, coughing, or deep inhalation because these actions pull on the injured tissue.
Inflammation of the cartilage connecting the ribs to the breastbone, called costochondritis, is another mechanical cause triggered by movement. This inflammatory response creates sharp or aching pain exacerbated by chest wall movement, deep breaths, or direct pressure on the joints. Similarly, a bruised or fractured rib, often resulting from trauma, causes concentrated pain that intensifies with any activity mobilizing the rib cage.
Intercostal neuralgia is a neurological source for movement-related pain, involving irritation or compression of the nerves running along the underside of the ribs. This condition produces a sharp, burning, or stabbing pain that often follows a band-like path around the chest or abdomen. Movement, such as a sudden turn of the torso, sneezing, or laughing, can exacerbate the nerve pain due to compression or stretching of the affected nerve pathway.
Internal Organ and Systemic Contributors
While movement is often a direct trigger for structural pain, it can also indirectly worsen discomfort originating from internal organs in the right upper quadrant. The liver, which sits beneath the rib cage, causes pain if it becomes inflamed or enlarged due to conditions like hepatitis or fatty liver disease. This enlargement stretches Glisson’s capsule, the thin connective tissue surrounding the organ, leading to a dull, aching pressure. Movement or position change can compress or stretch this distended capsule, making the underlying pain more noticeable.
Gallbladder issues, such as gallstones or inflammation (cholecystitis), are common organic causes of pain in this area. The pain, often severe, is typically triggered by eating, especially fatty foods, but deep breathing can also intensify the discomfort. This occurs because the inflamed gallbladder sits near the diaphragm, and the downward motion of the diaphragm during inhalation presses against the tender organ, causing a sharp increase in pain.
Irritation of the diaphragm or the tissue lining the lungs can also present as pain under the right ribs sensitive to movement. Pleurisy, inflammation of the lining surrounding the lungs, causes a sharp, stabbing pain that worsens significantly when taking a deep breath, coughing, or sneezing. Kidney stones typically cause severe, cramping pain starting in the back and side, but this pain can radiate forward into the right upper quadrant as the stone moves through the urinary tract.
Recognizing Emergency Symptoms
While many causes of right rib cage pain are manageable, certain accompanying symptoms signal a medical emergency requiring immediate attention. Sudden, crushing, or extremely severe pain that makes it impossible to find a comfortable position is a serious warning sign. This intense discomfort, particularly if it radiates to the right shoulder, jaw, or arm, warrants immediate evaluation.
A combination of pain with systemic symptoms should also prompt an emergency visit. These include a high fever, shaking chills, or jaundice (yellowing of the skin and eyes), which can indicate a severe infection or bile duct blockage. Difficulty breathing, shortness of breath, or pain accompanied by lightheadedness, sweating, or a rapid heart rate could suggest issues like a pulmonary embolism or a cardiac event, even if the pain is felt on the right side.
How Doctors Determine the Cause and Next Steps
The diagnostic process begins with a detailed medical history to understand the pain’s nature, onset, and specific triggers. A doctor will inquire whether the pain is sharp or dull, what activities make it better or worse, and if it is associated with eating or breathing. This is followed by a physical examination, including palpation, where the physician gently presses on the area to check for localized tenderness over the ribs versus deeper organ tenderness.
To investigate internal organ causes, blood work is often ordered to check for signs of infection, inflammation, or abnormal liver and kidney function. Imaging tests are frequently used to visualize internal structures. An abdominal ultrasound is a common, non-invasive tool effective at detecting gallstones, bile duct dilation, and some liver abnormalities.
If a musculoskeletal cause is suspected, X-rays may be used to identify rib fractures or bony abnormalities. For more complex cases or to rule out deep organ issues, advanced imaging like a CT scan might be employed. Once a diagnosis is reached, treatment often involves general management principles. This can include rest, applying heat or ice to the area, and using over-the-counter anti-inflammatory medications to manage pain and reduce local inflammation.