There are many misconceptions regarding ribs, and the role they can play in back, chest, and shoulder pain.

Anatomically, ribs attach to your thoracic spine (middle back) and the sternum (breast bone). The thoracic spine is made up of 12 thoracic vertebrae with 12 ribs on each side. 

Each rib has a posterior joint at the spine, and the top seven ribs have an anterior joint at the sternum. The ribs connect to the body of the vertebra above, the vertebra below, and the disc between them. Also there are a variety of muscles found between the ribs and there are many muscles overlaying the ribs. There is also a nerve underneath each rib, which extends from the spine to the sternum along the course of the rib. All of these tissues can be damaged by a rib injury.

Many people are also surprised to learn that the top rib is located higher than the collar bone.

Contrary to popular belief, men and women have the same number of ribs. 

Rib dysfunction is a term used by chiropractors to describe a mechanical problem affecting the joint between the rib and the thoracic spine.

Certain injuries can cause the normal smooth gliding motion of this joint to jam and become misaligned causing pain.  The pain may be so severe that you can hardly breathe and sleeping may be next to impossible. The surrounding muscles can go into spasm and can become very tender.  Usually the pain is localized to the affected rib and can be described as sharp or stabbing.  It is not uncommon for people to have thought they were having a heart attack!

If the condition is severe enough the cartilage between the rib and the sternum (breast bone) can become irritated and inflamed. This creates a very sensitive area in the central chest, which is badly aggravated by movement, even breathing.

Sometimes arm and shoulder pain is indirectly a rib problem. An upper rib dysfunction and associated muscle spasm can irritate the nerves traveling to the arm creating numbness in the arm and hand. This effect is usually greatest on the ulnar nerve, creating numbness in the pinky finger.

Also, the upper ribs work in tandem with the shoulder and scapula (shoulder blade).  Full shoulder movement requires the scapula to glide over the ribs, called scapulothoracic movement.  A rib dysfunction can cause restricted scapula mobility with pain on shoulder movements. Disrupted scapulothoracic movement can lead to rotator cuff injury, and should be evaluated when rehabilitating any shoulder injury.