- The Rib Cage
- The Right Side of the Rib Cage
- Causes of Pain Elicited Beneath the Right Rib Cage
- Gallbladder Illnesses
- Irritable Bowel Syndrome
- Crohn’s Disease
- Hepatic Injury
- Pulmonary Diseases
- Renal Diseases
- Characteristics and Associated Symptoms
- Diagnosing Right Rib Cage Pain
- Managing Pain Under the Right Rib Cage
The Rib Cage
The human rib cage, otherwise known as the thoracic cage, consists of twenty four ribs, its costal cartilages, a sternum, the xiphoid process, and twelve thoracic vertebrae.
It makes up the thoracic wall, along with the skin, muscles, and fascia. Their functions are to contain the thorax, hold up the pectoral girdle, and provide appendages and insertions for muscles of the neck, chest, abdomen and back. 
Image 1 : An illustration of the rib, or thoracic, cage.
- It encloses the cardiovascular system, to which the heart is a part of. Thus, any pain associated with this thoracic cage should be dealt with accordingly. It can be as simple as a spontaneously resolving muscle pain or an inflammation of one of the vital organs of the human body.
- Numerous diseases and disorders can attribute to the tenderness felt and elicited under the rib cage. Hence, the pain felt is further subdivided according to the area where the symptom is localized: either right or left side.
- It is the pain on the right side of the rib cage, this article aims to further discuss on.
The Right Side of the Rib Cage
The right area of the thoracic cage mainly houses the organs: right lung, liver, right kidney, and the gallbladder. The key functions of these organs provide enough evidence why eliciting the specific root of pain under the right rib cage is of utmost importance. 
Image 2 : The rib cage and the organs within.
Causes of Pain Elicited Beneath the Right Rib Cage
As mentioned, causes of right rib cage tenderness vary from simple musculoskeletal pain to severe organ injury. Below are some of the common causes of this particular pain.
These types of diseases are usually attributed to severe gallbladder inflammation from deposition of stones, which may be bile salts, cholesterol, and calcium. Usually insidious in onset, these conditions manifest as sharp pain localized on the area beneath the right upper quadrant of the abdomen and the right rib cage. 
Image 3 : Gallstones can cause pain underneath the right rib cage.
Even with such a huge function, the thoracic cage is still as delicate as any other bone of the skeletal system. Fractures, even a tiny injury like hairline rib crack, can bring about pain chest tenderness, particularly beneath the rib cage. [4, 5]
Image 4 : Rib fractures can also elicit pain beneath the rib cage.
This is the most common cause of pain localized under the rib cage. Inflammation of the thoracic cage muscles can also lead to pain under the right rib cage, specifically on the area of attachment of the breastbone and the rib cage. This condition usually originate from persistent coughing bouts, viral respiratory infections, and even from infectious mononucleosis. Pain from costochondritis is usually felt while breathing. [4, 6]
Image 5 : Costochondral pain felt at the costochondral junctions, not only nest to the breastbone, but also beneath the right rib cage.
Irritable Bowel Syndrome
This condition can be attributed to stress and certain reaction of the colon to different types of food. It consists mainly of symptoms such as cramping abdominal pain (mostly at the upper region, but can also be at the area underneath the right rib cage), and alteration of bowel habits, particularly loose bowel movement and constipation. 
Image 6 : Components of irritable bowel syndrome: alteration of bowel habits and abdominal pain, which can be felt beneath the right rib cage.
A type of inflammatory bowel syndrome, Crohn’s disease is characterized by the inflammation of the digestive tract lining. It usually affects the bowel tissues, hence a severe pain on the underside of the right rib cage can be elicited. Other manifestations associated with the illness include loose bowel movement, excessive gas in the stomach, and bloody stools. 
Ulcerative lesions in the intestines are those sores which are usually the roots of gastrointestinal bleeding due to either excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs) or Helicobacter pylori infection. Inflammation and scarring of intestinal lining brought about by ulcers subsequently lead to severe tenderness on the area below the rib cage. 
Image 8 : Ulcerative lesions in the gastrointestinal tract cause pain in the right rib cage.
An inflamed pancreas can be characterized by pain, dull in character, localized on the right side, beneath the rib cage. This pain can extend and be referred laterally and towards the back. It usually occurs alongside fever, vomiting, nausea, jaundice and tachycardia. Alcohol consumption and heavy meals can aggravate and lead to sharp, more severe pain. 
Image 9 : Pancreatitis can produce symptoms such as fever, jaundice, vomiting, nausea, and pain on the right side of the rib cage.
Being located at the right side of the abdomen, liver infection or injury may lead to pain at the underside of the right rib cage. Pain may be associated with other manifestations, depending on the severity of the hepatic disease. 
Image 10 : Hepatocellular carcinoma can elicit severe right rib cage pain.
Lung illnesses like pneumonia and pleurisy can cause pain extending to the area of the rib cage. Aside from these, forcible coughing bouts and difficulty of breathing can also cause chest discomfort and pain. 
Image 11 : Severe coughing bouts in pneumonia can also bring about tenderness under the right rib cage.
Inflammation of the appendix occurs mostly in children and adolescents. In this condition, the pain in the appendiceal area, at the right lower quadrant, can extend and be referred to the right rib cage. 
Image 12 : Inflammation of the appendix can cause referred pain to the underside of the right thoracic cage.
Because of the fact that the right kidney is partly covered by the thoracic cage, renal diseases usually cause either back pain or tenderness below the right rib cage. These renal illnesses include kidney stones, ascending urinary tract infections, renal hemorrhage, polycystic kidney disease, and hydronephrosis. 
Image 13 : The presence of kidney stones can also cause an associated pain under the right rib cage.
Characteristics and Associated Symptoms
The intensity and character of pain varies according to its etiology. It may be dull in character, like that on a case of beginning pancreatitis, or severe, such that of hepatic carcinoma. It can be constant, like a fractured rib, or intermittent, like a gallbladder disease. [4, 6, 8]
Other associated manifestations may also differ with each cause. Patients with biliary diseases tend to experience not only pain on the right rib cage, but also vomiting and nausea. Pneumonia patients, on the other hand, are more likely to experience difficulty of breathing and cough, alongside the pain, also on the right rib cage. [3, 8]
Diagnosing Right Rib Cage Pain
Aside from a comprehensive physical examination, thorough history taking of a patient experiencing pain on the right rib cage should include the questions “Was it lingering or just a fleeting type of pain?” and “Was it cramping or stabbing in character?”, among others. It should also elicit any factors that might have triggered the said pain, along with the patient’s usual diet. 
Further assessment of this manifestation focuses in discovering its actual etiology. Thus, diagnostic tests such as blood, urine and stool analyses, biopsies, ultrasounds, radiographic films, computed tomographic scans, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography (ECRP) are usually requested. 
Managing Pain Under the Right Rib Cage
Treatment depends on the underlying cause of pain. If the cause is that of a muscle inflammation or musculoskeletal strain, pain relievers such as nonsteroidal anti-inflammatory drugs may be of use. In cases of stones, either of the gallbladder or kidneys, removal or stone dissolution is required. For hepatic pathologies, management modalities range from supportive treatment to liver transplantation.