Uneven rib cage

Dear Alice,

In Nov 2007, I noticed that there was a rotation of my rib cage. My front left rib cage is at least three cm forward of my right rib cage — this is most noticeable when I lie down with my back facing the bed. One month ago, when I woke up, I had this acute pain at the back rib and spine joint. I have gone for a CAT scan. The radiologist reading was the following: “mild convex rightward mid/upper thoracic scoliosis.” I feel a pinching pain almost half the day. Pain starts where the back rib and spine join and it spreads through the rib to the front. I am thinking the reason scoliosis occurred is due to my rib cage.

Please let me know if my rib cage has to do with the pain. Also will I have to get treated ASAP? If not, will this lead to any complications down the road?

Dear Reader,

According to your radiologist, it seems most likely that you have scoliosis. Background information including causes, symptoms, available treatments, and complications of scoliosis can be found in Snap, crackle, pop — Scoliosis and back cracking. You asked if your uneven rib cage caused the scoliosis.  It's most likely the other way around. However, this is a rather twisted tale, for an uneven rib cage may have a few possible causes. These include:

  • Scoliosis, a sideways curvature of the spine that occurs most often during the growth spurt just before puberty
  • Uneven growth caused by an underlying lung abnormality (for example, one lung is much smaller than normal)
  • When the ribs and their attachments have developed unevenly
  • Genetics are suspected to contribute to spinal curves, though this has not been proven

Having a chest x-ray may be a good place to start. That way, your health care provider can get a good view of your rib cage, as well as all the organs that are protected inside. Your provider can then determine whether it's advisable to seek treatment for scoliosis, or even see a pulmonologist. They may also recommend additional tests to get a better picture, including magnetic resonance imaging (MRI), computerized tomography (CT) scans, or a bone scan.  

When left untreated or unchecked, your uneven ribs have the potential to cause some major maladies. These include lung and heart problems, as well as chronic pain in your spine, shoulder blades, and ribs. In regards to scoliosis, most cases are mild. However, severe scoliosis can cause back pain and difficulty breathing. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly.

Your uneven rib cage may leave you feeling twisted around, but have no fear. It appears that multiple remedies can turn you in the right direction. The decision to begin treatment is always made on an individual basis. Factors to be considered include gender, severity, pattern, and location of your body's rotation, and bone maturity (comes with age). Treatments include:

  • Back braces — usually prevents further progression of the curve or spinal rotation. Most are worn day and night, and are recommended for children who are still growing and people with moderate scoliosis. Effectiveness increases with the number of hours that it is worn. There are both underarm braces and full-torso braces.
  • Surgery — also known as spinal fusion, reduces the severity of a spinal curve and prevents it from getting worse. Spinal fusion surgery connects two or more of the bones in your spine (vertebrae) together with new bone. Surgeons may use metal rods, hooks, screws or wires to hold that part of the spine straight and still while the bone heals (similar to how a broken bone heals). Complications may include bleeding, infection, pain, nerve damage or failure of the bone to heal.

Now that the information has been aligned for you, it is possible to find a solution to set you straight!

Last updated Apr 07, 2015
Originally published Dec 17, 2010

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