Read More

Intercostal retractions are the inward movement of the muscles between the ribs as a result of reduced pressure in the chest cavity. The movements are usually a sign of difficulty with breathing.

The chest wall is flexible, which allows for normal breathing. Cartilage that attaches the ribs to the sternum (breast bone) allows free movement of bony structures so that the rib cage can expand and contract.

The intercostal muscles are the muscles between the ribs. During breathing, these muscles contract and pull the rib cage upward, while the diaphragm moves downward. This expands the chest and causes air to fill the lungs.

When the upper airway (trachea) or the small airways of the lungs (bronchioles) become partially blocked, air flow is restricted. As a result, the intercostal muscles are sucked inward, between the ribs. This sucking in of the chest muscles is a sign of airway obstruction. Diseases or conditions that cause restriction of the airway will cause intercostal retraction.

• Anaphylaxis
• Asthma
• Bronchiolitis
• Croup
• Epiglottitis
• Foreign body in the windpipe (See: Foreign object aspiration or ingestion)
• Pneumonia
• Respiratory distress syndrome
• Retropharyngeal abscess

This is an emergency, requiring immediate medical attention.

Seek immediate medical attention if intercostal retractions occur. This can be a sign of airway obstruction, which can quickly become life threatening.

Also seek medical care if the skin, lips, or nailbeds turn blue, or if the person becomes confused, drowsy, or is hard to wake up.

In emergency situations, the health care team will first take steps to help the patient breathe. This may include oxygen, medicines to reduce swelling, and other treatments.

When the person is stable, the health care provider will perform a physical exam to determine the cause of the airway obstruction. Questions will be asked about the symptoms and the person's medical history, including:

• When did the problem start?
• Is it getting better, worse, or staying the same?
• Does it occur all the time?
• Did you notice anything significant that might have caused an airway obstruction?
• Have you or the child been ill, coughing, or complaining of a sore throat?
• Has the child put anything in the mouth that might have been inhaled into the airway?
• What other symptoms are present? For example, did the child turn blue, wheeze, or have a high-pitched sound when breathing (stridor)?

Diagnostic tests may include:

• Arterial blood gases
• Chest x-ray
• Complete blood count (CBC)
• Pulse oximetry to measure blood oxygen level

Retractions of the chest muscles

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.