In the narrow anatomical sense, the costal arch describes a cartilaginous part of the sternum that connects the 8th-10th centuries. Represents rib to sternum. These ribs 8-10 have no direct contact with the breastbone (sternum) and are only indirectly attached to the breastbone via cartilage. In a broader sense, however, the lower part of the bony rib cage is also generally referred to as the costal arch. In general, the arch, which is spanned by a rib on each side between the spine and the sternum, can also be referred to with the word costal arch.

Pain and discomfort in this area can come from the rib bones and muscles, and it can also come from the organs in this area.

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The cartilaginous connection of the 8th - 10th rib to the sternum, the breastbone, is called the rib arch in the anatomical area. The costal arch is part of the lower thoracic aperture (/ opening).

This is formed from the 12th thoracic vertebrae, the 12th pair of ribs and the ends of the 11th pair of ribs, the costal arch and the lower end of the sternum (sword extension, processus xiphoideus). The lower thorax is separated from the abdominal cavity by the diaphragm.

In addition to the lower one, there is also an upper thoracic device, which is formed from the 1st thoracic vertebrae, the 1st pair of ribs and the upper edge of the sternum. The neck closes at the top.

All ribs consist of a rib head, neck and rib body. The head and neck of the ribs are connected to the thoracic spine and are fixed there by ligaments. The ribs are in turn attached to the front of the sternum by cartilage.

The ribs that attach directly to the sternum with their cartilage are called "true ribs" (Costae verae). These are the ribs 1.-7 .. The ribs 8.-10. named because they put their cartilage against the next higher rib and thus indirectly pull to the sternum. These then form the costal arch.

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Humans have a total of 12 pairs of ribs, the 11th and 12th ribs not reaching the sternum and ending freely in the trunk wall without contact with the other ribs. In general, however, the arch that is formed by a rib between the spine and breastbone can also be referred to as the costal arch.


The ribs and the costal arch in general serve to protect and function the lungs and heart, represent an anatomical boundary and are the starting point for important muscles. As part of the lower thoracic body, the actual anatomical costal arch serves to delimit the chest and abdomen.

This means that important organs such as the stomach on the left and the liver on the right are located below the costal arch in the abdomen. The costal arch also serves as a starting point for muscles, such as the diaphragm or one of the abdominal muscles, the straight, perpendicular rectus abdominis muscle.
The width and shape of the rib cage determine the angle in the costal arch.

Pain in the costal arch

Costal arch pain can have many causes. In the most common cases, the pain goes away on its own after a short time and has no life-threatening consequences.

However, if the pain persists, a doctor should definitely be consulted for clarification. It is important that the actual arch, which consists of bone or cartilage, is not innervated by nerves. Thus, the pain is only caused by the irritated overlying skin, which receives and transmits the pain from the abdomen or other areas.

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Many organs are in close proximity to the costal arch. On the left side, the spleen or stomach can cause pain, such as an irritable stomach or an enlarged spleen. On the right side, the liver, gallbladder, pancreas or even the intestines can cause pain. The pain can be triggered by inflammation of the individual organs or constipations (blockages) in the intestines.

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In addition, the muscles attached to the costal arch can be irritated. For example, if the muscles are sore or there may be a torn muscle fiber. Swelling of the organs or the abdomen itself can also lead to pain.

Pain after an accident can range from bruises to multiple broken ribs. What they have in common is that injuries to the ribs are often extremely painful and can be aggravated by deep breathing. Usually the pain can also be aggravated by applying pressure to the painful area. The so-called intercostal neuralgia is nerve pain of the nerves that run between two ribs in the intercostal space and also of the nerve below the last rib. The pain is typically sharp and can be pinpointed by applying pressure. Certain movements lead to peaks in pain. In some intercostal neuralgia, a cause can be found (for example, nerve root irritation near the spinal cord, shingles or a fracture that pinches the nerve. Often, however, the cause remains unknown. Muscle tension can also occur in the area of ​​the costal arch, including with a strong, violent cough .

Read more about this: Pain in the costal arch - how dangerous is that?

Symptoms of pain in the costal arch

Discomfort in the area of ​​the costal arch can have a wide variety of causes. First of all, it must be differentiated whether this pain is due to an accident. If you fall on your chest, you may experience pain in this area. On the other hand, all organs that can be found in this area can also lead to pain of all kinds. A rough distinction is made between colic-like pain, which becomes stronger and weaker again in a wavy course, dull permanent pain, steadily increasing pain and those that can be triggered, for example, by pressure or by deep breathing.

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Do you have pain between your ribs? Read more on the topic: Pain between the ribs - causes and treatment

Inflammation of the costal arch

There are many causes of inflammation on the costal arch.

One type of inflammation is pleurisy (pleurisy). The pleura lies against the ribs from the inside. Opposite it is the lung membrane, which lies directly on the lungs. Together they represent the pleura.
'Both the pleura and the pleura are thin skins that are separated from each other by a gap. This gap holds a small amount of pleural fluid, a type of lubricant that allows the skins to slide smoothly while breathing. A distinction is made between dry and wet pleurisy, which have different causes and express themselves differently in terms of symptoms.

Dry inflammation occurs, among other things, as a result of pneumonia with the pathogens jumping over to the pleura, acute bronchitis or inflammation of neighboring organs in the abdomen. Symptoms may include a dry cough or severe chest pain when breathing, which would include rattling, creaking noises when eavesdropping, as the pleura and pleura rub against each other due to the inflammation.
Damp inflammation can occur as a result of dry pleurisy. Fever can be a symptom, as can increased pleural fluid. If the amount of fluid continues to increase, it is called a pleural effusion, which is noticeable with shortness of breath or pain in the shoulder.

You may also be interested in this topic: Periosteum inflammation on the ribs

Rash on the costal arch

A rash is not always the same. It is important to see how the rash develops.

Did the rash suddenly appear or did it creep up, are it red spots, dots, wheals or pustules? Does it itch or hurt without or when you touch it? Is only one side affected or both sides of the body?

Often the cause is harmless, but there can also be illnesses behind it, so a visit to the doctor is recommended. A common reason for a rash is allergies to cosmetics, food or pollen and grasses, for example. In many cases, the rash is accompanied by other symptoms such as itching, coughing, runny nose or the like.

Another reason for red spots on the costal arch is shingles, for example. Shingles can occur, for example, in people who are immunocompromised or who suffer from severe stress.
It is caused by the viruses that cause chickenpox in childhood. After the first illness with chickenpox, the viruses hide along the nerve tracts. They may be reactivated, causing shingles to occur.

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The viruses spread along nerve tracts, which often start from the spine and pull forward towards the chest and abdomen and loop around the body like a "belt". The first symptoms of shingles are itchy, sometimes stabbing pain, after which vesicles appear that are filled with infectious, virus-containing fluid. After a few days, the vesicles break open and become encrusted. Shingles usually heals by itself after a few weeks. If you have symptoms that suggest shingles, you should see a doctor.

Read more about this at: Allergy rash

Swelling of the costal arch

There are several possible reasons for swelling on the costal arch. If the swelling is superficial in the skin, a hair follicle or sebum may be inflamed, or clothing may have rubbed the skin too much. The swelling usually disappears within a few days.

If she does not do this or if you experience pain, you should definitely consult a doctor. Swelling on the costal arch can also have serious causes. A rib could be bruised or cracked from a fall. If the swelling is below the costal arch on the right or left, organs such as the liver or spleen could be affected.

However, an inflammation of the cartilage on the breastbone can also lead to swelling; one speaks of costochondritis, an inflammation of the rib cartilage, which, however, occurs rarely.

For more information on this topic, see: Hair follicle inflammation, clogged sebum - what to do?

Bruise on the costal arch

If you accidentally fall on your chest when falling, you should pay attention because the lungs are located directly below the chest.

A bruise of the ribs manifests itself in a swelling of the area, possible pain, possibly resulting slight restrictions in breathing and a later bruise. The symptoms usually go away on their own. If you suddenly have difficulty breathing or if the pain gets worse, you should urgently consult a doctor. The rib could be broken and damaged the lungs.

Read more about this under: Bruised ribs - what to do?

Torn muscle fiber on the costal arch

Both the abdominal muscles and the auxiliary respiratory muscles that can support breathing have their origin at the costal arch.

The auxiliary breathing muscles are the chest muscles (pectoralis major and minor) and the intercostal muscles, which connect the ribs to one another. If you support your forearms while you breathe in, your chest muscles help you lift your chest. If you tear a muscle fiber in the chest muscles e.g. When exercising too, movement-dependent sharp pain in the chest area can occur.

Muscle fiber tears in the intercostal muscles are rather rare and often a result of rib fractures, e.g. from a fall. Abdominal muscles that are overexerted by frequent abdominal muscle training can lead to a ruptured muscle fiber. The pain can occur on the costal arch or in deeper areas of the abdomen, depending on where the muscle is damaged.

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Further information on this topic can be found at: Torn muscle fiber between the ribs

Spider veins on the costal arch

If the spider veins appear in childhood or early adulthood, the causes are usually harmless. The most common cause is valve insufficiency.
The venous valves actually ensure that the blood is pumped evenly from the lower half of the body to the heart and does not sink into the legs. If a venous valve no longer works properly, it can no longer hold the column of blood in the area and the blood sinks downwards. The built-up column of blood can back up in small veins in alternative ways.

Spider veins on the costal arch or generally in the upper body area can also be indications of organic causes. Disturbances in the heart as well as in the liver can cause the small fine veins on the body surface.
If other symptoms such as sudden drop in performance, chest pain, yellowing of the sclera or even the skin itself occur, a doctor should definitely be consulted for further clarification.

Read more on this topic at:

  • Removing spider veins - this is the best treatment
  • Laser spider veins - what does light therapy do?

Symptoms on the costal arch

Itching on the costal arch

The cause of itching is varied. A contact allergy could be a possibility that can be triggered by detergents or certain textiles on the skin.
It can also be itchy if you sweat profusely and the sweat collects in skin folds.

Another cause of constantly scratching yourself can be neuralgia. Fine nerves run from the spine, beginning below a rib, towards the sternum, these are the intercostal nerves. If these nerves are inflamed or irritated, faulty impulses can travel along the nerve pathways, making it appear itchy.

If small pustules appear in addition to the itching, it may be shingles.

For more information, see:

  • Excessive Sweating - What Causes It?
  • This will prevent you from sweating excessively

Cramps in the costal arch

Depending on the location and type of cramp or persistent pain, different causes can be considered.

Harmless causes of pain in the costal arch can be: heartburn, vertebral blockages of the cervical and thoracic vertebrae, where the pain radiates into the region, gallstones or an inflammation of the pancreas or even tension and sore muscles.
Serious illnesses such as angina pectoris (tightness in the chest), heart attack, pneumonia, pleurisy, pericarditis or cardiac arrhythmias can also be the cause of cramp-like pain.

If breathlessness occurs, the pain radiates into the shoulder, arm, jaw or - especially in women - the upper abdominal region or you feel a stinging in the heart, you should consult a doctor as soon as possible.

Read more about this under: Pancreatitis - How dangerous is it?

Numbness of the costal arch

The so-called intercostal nerves run under the ribs. If such a nerve fails, numbness can occur in the affected area.
Intercostal nerve failure can be caused by a herniated disc in the thoracic spine or multiple sclerosis.

Therapy of injuries to the costal arch

As diverse as the causes of pain in the costal arch area can be, so is the therapy. Injuries after an accident are very painful in most cases, regardless of the cause. A bruised rib can cause as much pain as a rib fracture. After ruling out severe consequences, such as major bleeding, nerve damage, or injury to the lungs from a broken rib, broken ribs and bruises are treated in a similar way.

The first and most important point is adequate pain therapy, which is started with classic painkillers such as ibuprofen and diclofenac (Voltaren). Depending on the severity of the pain, the dosage and the drug must be weighed. Sufficient pain medication is particularly important because the pain when breathing automatically keeps the depth of breath shallower. This also carries the risk of developing pneumonia. Especially in older people and people with other pre-existing illnesses that increase the risk of pneumonia, breathing exercises or breathing therapy can also be useful. The person concerned learns with a physiotherapist how to breathe with as little pain as possible while at the same time breathing deeply enough. In general, after injuries in the area of ​​the costal arch, you should take a break from exercising and exercise rest.
In the case of pain caused by a so-called intercostal neuralgia, a triggering cause should first be looked for and, if possible, eliminated. For example, shingles can prevent severe disease through appropriate therapy with acyclovir. When a nerve is trapped by a broken rib, the pressure must be relieved from the nerve.

In addition, muscle relaxants (so-called muscle relaxants) are used. If exactly one nerve is affected and / or a clear trigger point is found, spraying the nerve and its root with a local anesthetic can help relieve the pain. Physiotherapy, classic massages and electrotherapy are also used here.

Diagnosis of an injury to the costal arch

In order to find out the cause of pain in the costal arch, a detailed medical history is necessary. In general, there are a number of possible differential diagnoses for chest pain that must first be ruled out (for example, a heart attack and other diseases of the heart and the vascular system, lung diseases, diseases of the esophagus such as reflux and stomach). In the following, the diagnosis of pain caused by the costal arch will be discussed.

In terms of medical history, a distinction must be made between pain after an accident (for example, a collision while exercising or a fall on the chest) and pain that has occurred for no apparent cause. The medical history should then be completed with an examination of the costal arch and the entire upper body. Particular attention is paid to bruises, bad posture, but also other skin changes (e.g. blisters in shingles).

By palpating the costal arch, painful regions can be identified and possible trigger points found. Listening to your lungs and possibly your heart can provide clues about other causes of the chest pain and suggest complications from a broken rib.

If a rib fracture is suspected, X-ray diagnostics can help, although this is not generally necessary as the treatment of a bruise and a simple fracture does not differ. It can be particularly important if there is a suspicion of injuries to the lungs as a result of a spike, although clinical evidence of this is usually already evident. Rib fractures can also occasionally be visualized using ultrasound.

In so-called intercostal neuralgia, trigger points often appear. These should be found during the examination and can be a starting point for therapy.

Prognosis for an injury to the costal arch

The prognosis is generally good for the diseases described. If there are no complications, broken ribs usually heal within about 6 weeks, so that the pain subsides significantly. The exact duration of healing depends on the type of fracture, the age of the person affected and any previous illnesses. After these 6 weeks, the fracture is usually so stable that it can withstand normal movements. The entire healing process, however, takes much longer with adaptation and remodeling changes. The rib is already resilient during this time.

Bruised ribs also usually heal in about four weeks if they go well.

In intercostal neuralgia, the courses vary greatly in length. Rapid healing up to lengthy courses are possible.

Prophylaxis of an injury to the costal arch

Most of the diseases mentioned are difficult to prevent. In general, falls and accidents are to be avoided if possible. Treatment can also help if you have osteoporosis to prevent broken ribs.

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