Rib Cage

What is the rib cage?

Your rib cage is the cage-like structure of bones that frames your chest cavity (thoracic cavity). It’s also called your thoracic cage. Your 24 ribs (12 on each side) wrap around the sides of your torso from front to back. They connect to your thoracic spine in the back and your sternum (breastbone) in the front.

What is the purpose of the rib cage?

Your rib cage surrounds and protects the vital organs in your chest cavity, your heart and lungs. It expands with your lungs when you breathe. As part of your axial skeleton, your rib cage helps form the trunk of your body. It also serves as an attachment point for core muscles, like your diaphragm.

What are the parts of the human rib cage?

As part of your skeletal system, your rib cage is made up of bones and the joints that connect them.

The bones include:

• 24 ribs (12 on each side). Your ribs are the curving, horizontal bones that wrap around the sides of your torso, connecting your sternum (breastbone) in front to your spine in the back.
• 12 thoracic vertebrae (T1 – T12). Vertebrae are the individual, interlocking bones that form your spinal column. Thoracic vertebrae make up your thoracic spine (the part behind your chest).
• Sternum. Your sternum is the vertical bone that runs down the front of your chest.

The joints include:

• 20 costal cartilages. These cartilage tips extend from the ends of your first 10 ribs on each side, connecting them to your sternum.
• 20 costochondral joints. These joints connect each rib to its corresponding costal cartilage tip.
• 10 interchondral joints. These joints connect the costal cartilage tips of your middle ribs (6-10 on each side) to each other.
• 24 costovertebral joints. These joints connect the head of each rib to its corresponding vertebra.
• 24 costotransverse joints. These joints form a second connection point between your ribs and vertebrae. That point is a bony bump on the side of the vertebrae called the transverse process.

Types of ribs

Healthcare providers may use some of these terms when referring to certain ribs.

• True ribs (vertebrosternal ribs). Ribs one through seven on each side (the top ribs) are called “true” ribs because they attach directly to your sternum by their costal cartilage extensions.
• False ribs (vertebrochondral ribs). Ribs eight to 10 on each side are called “false” ribs because they don’t connect directly to your sternum. Instead, they attach to the front of your rib cage only by the interchondral joints, which connect each of your lower ribs to the one above it.
• Floating ribs (vertebral ribs or free ribs). Your lower ribs 11 and 12 on each side are called “floating” ribs because they have no interchondral joints or constochondral joints, and don’t connect to the front of your rib cage at all. Instead, they end within your abdominal muscles.
• Typical ribs. Typical ribs have a predictable structure. They have a wedge-shaped head, a neck with a bony nodule (tubercle) on it, and a curved body. Ribs three through nine are “typical.”
• Atypical ribs. Atypical ribs have variable structures with different features that aren’t common to the others. Ribs one and two and ribs 10 through 12 are considered “atypical.”
• Cervical rib. Not part of your rib cage, this is an extra bone that some people have in their necks at birth. It starts from the lowest bone in your cervical spine and may extend to your top rib.

What are the common conditions and disorders that can affect your rib cage?

Musculoskeletal conditions that may affect your rib cage include:

• Rib fractures.
• Rib contusions.
• Slipping rib syndrome.
• Osteoporosis.
• Costochondritis.
• Tietze syndrome.
• Ankylosing spondylitis.
• Rheumatoid arthritis.
• Pectus excavatum.
• Pectus carinatum.
• Chest wall tumors.
• Flail chest.

What symptoms might indicate a rib cage problem?

If you have a condition affecting your rib cage, you might have:

• Musculoskeletal chest pain. Musculoskeletal chest pain is different from cardiac chest pain or angina. It doesn’t have the same squeezing, clenching or heavy quality. You might feel more pain when your rib cage moves, like when you cough or breathe deeply, making it expand.
• Visible deformity. Injuries or birth defects may cause the bones in your rib cage to look out of place. This is a sign to see a healthcare provider, who will examine you and order imaging tests.

What tests are used to examine the rib cage?

Your healthcare provider might order imaging tests of your rib cage, like a:

• Chest X-ray.
• Ultrasound.
• CT scan (compute tomography scan).
• MRI (magnetic resonance imaging).
• DXA scan.

How do healthcare providers treat rib cage conditions?

Treatment for rib cage conditions depends on the type and the cause. Many rib injuries can heal with time, rest and pain relievers, but a visible deformity may require surgery. Arthritis treatments include medications, therapeutic injections and physical therapy. Some severe cases may require surgery.