Rib pain can be both frustrating and debilitating. For those experiencing discomfort in the chest or rib area, pinpointing the source of the pain is crucial. One diagnostic tool that I use is Schepelman’s Sign, a simple test that helps identify the root cause of rib-related pain, including conditions like costochondritis and intercostal neuritis. Today, we’ll explore what Schepelman’s Sign is, how it works, and its role in diagnosing and treating rib pain.
What Is Schepelman’s Sign?
Schepelman’s Sign is a clinical test used to evaluate rib pain and distinguish between different conditions affecting the intercostal spaces, such as:
Costochondritis: Inflammation of the cartilage connecting the ribs to the sternum.
Intercostal Neuritis: Irritation or inflammation of the nerves running between the ribs.
This test’s simplicity makes it a valuable tool in assessing rib-related discomfort and guiding treatment plans.
How to Perform Schepelman’s Test
Schepelman’s Sign is straightforward and requires minimal equipment. Here’s how it’s done:
Patient Position: The patient is seated or standing in a relaxed posture.
Movement: The patient is instructed to laterally bend—lean to the side—first to the left and then to the right.
Observation: The clinician observes for any pain and notes its location and quality.
Interpreting the Results
Pain on the concave side (the side the patient bends toward): This suggests intercostal neuritis, muscle strain, or nerve irritation.
Pain on the convex side (the side the patient bends away from): This is often indicative of costochondritis or inflammation in the rib structures.
Common Conditions Identified with Schepelman’s Sign
Schepelman’s Sign is particularly useful in identifying the following conditions:
1. Intercostal Neuritis
Intercostal neuritis occurs when the nerves running between the ribs become inflamed or irritated. Common causes include viral infections like shingles, trauma, or even postural strain. Symptoms often include sharp, radiating pain along the rib cage.
2. Costochondritis
Costochondritis is the inflammation of the cartilage where the ribs attach to the sternum. It typically presents as localized pain, often mistaken for heart-related issues. Movements that stretch the chest wall, like leaning or deep breathing, may exacerbate the discomfort.
Limitations and Considerations
While Schepelman’s Sign is a helpful diagnostic tool, it has limitations. It is not definitive and should be used as part of a broader evaluation. Here are some key considerations:
Additional Testing: Imaging studies, such as X-rays or MRIs, may be needed to rule out fractures, tumors, or infections.
Clinical Context: Patient history, physical examination, and other tests are crucial for accurate diagnosis.
Pain Complexity: Rib pain can have many causes, including musculoskeletal, cardiac, and gastrointestinal origins, so a thorough assessment is essential.
Treatment Options for Rib Pain and Costochondritis
Effective treatment begins with understanding the underlying cause. Common options include:
1. Chiropractic Care
Chiropractors can assess and address musculoskeletal imbalances that may contribute to rib pain. Gentle adjustments and mobilizations can help restore proper alignment and reduce inflammation.
2. Stretching and Strengthening
Exercises that improve posture and strengthen the core can relieve strain on the ribs and intercostal muscles. Gentle stretching may also help alleviate tension in the chest wall.
3. Anti-Inflammatory Measures
Applying ice or heat, along with over-the-counter anti-inflammatory medications, can reduce pain and swelling.
4. Lifestyle Modifications
Activities that exacerbate rib pain, like heavy lifting or repetitive movements, should be minimized during recovery. Maintaining good posture and ergonomic workspaces can also prevent future issues.
Conclusion
Schepelman’s Sign is a valuable tool for identifying rib pain and its potential causes, such as costochondritis or intercostal neuritis. However, it is just one part of a comprehensive diagnostic process. If you’re experiencing rib pain, seeking professional care is essential to determine the cause and receive personalized treatment.
At MyChiro, I specialize in evaluating and treating musculoskeletal issues, including rib pain. Email, call, or text if you have any questions!

Comments