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What's the difference between bruised ribs and broken ribs?

Rib injuries are common and usually heal themselves in a few weeks. Good painkillers are important so that you can breathe and cough comfortably while the injury heals. After a rib injury, if you feel unwell or more breathless than usual, seek medical advice immediately.

Chest Anatomy

The chest, also called the thorax, contains several key anatomical structures and organs. The ribcage protects important organs like the lungs and the heart. The organs contained in the thoracic cavity, those found in the adjacent abdominal cavity, as well as the spine are also vulnerable to injury as the result of chest trauma.

The ribcage contains 12 ribs total on each side, divided into three different types. The first seven ribs attach to a bone in the front of the chest called the sternum or breastbone. Three ribs (numbers 8-10) are calledfalse” ribs because they attach to the cartilage (not bone) of the ribs above them. Ribs 11 and 12 are known as “floating” ribs as they aren’t attached to the sternum or to other ribs. Rather, their point of attachment is only at the back of the chest or the girdle.

Bruised Ribs

Bruised ribs or a rib contusion occurs following a direct impact to the torso. This may be because of a fall or direct impact from a hard object, but the most common cause is a car accident. Chest pain and difficulty breathing are two main symptoms that can be helped with rest and ice. The injury should be assessed to confirm it is not a more serious condition.

Symptoms

The most obvious symptom of a bruised rib or contusion will be a sudden pain on impact. A direct blow to the chest or to the ribs themselves may cause the ribs to bruise, break or separate from the breastbone. Bruising can appear over the following hours and the ribs will most likely be tender to touch. Coughing or sneezing can also be painful.

While bruised ribs are extremely painful, in most cases they heal completely. The injury is referred to as bruised ribs but majority of the pain is caused by injury to the surrounding muscle and rib cartilage.

Symptoms will include tenderness and pain over the injured area. You will also feel pain when you breathe, move, laugh or sneeze.

Treatment

Rib injuries are difficult to treat. Seek medical attention to rule out rib fractures and complications such as pneumothorax or a collapsed lung. Resting and restricting your activities are the main treatment options for bruised ribs. Ice may help relieve some of your pain and swelling.

Since bruised ribs cause pain when you inhale causing you to take more shallow breaths, your doctor may prescribe medication to help manage your pain. Long-lasting anesthetic injections near the site of the bruise may also help temporarily keep your nerves there from relaying pain signals to your brain.

Broken/Fractured Ribs

A rib fracture is common in contact sports and usually occurs following a hard impact to the chest by an elbow or similar. Breathing will often be painful and there will typically be especially tender points on the ribs. It is possible that the fracture may cause internal damage so seeking medical advice is recommended, especially if the pain is severe.

Symptoms

One of the most persistent symptoms of a broken rib is chest pain when taking a breath. Inhaling deeply hurts even more. Laughing, coughing, or sneezing can also send sharp pains shooting from the site of the break. You may also notice swelling and redness around the break. In some cases, you might also see bruising on the skin near the break.

Depending on the location of the fracture, bending over or twisting your upper body may also trigger sudden pain. Striking or pressing on the fracture will cause pain for at least several weeks.

Treatment

Simple fractures will usually heal by themselves. Doctors may recommend resting to facilitate this. People should avoid activities that involve pulling, pushing, or lifting, as they might make the pain worse or cause more damage to the ribs.

If a person has more than one fractured rib, severe damage, or flail chest, they may need surgery. During the operation, a surgeon will use plates and screws to fasten the broken ribs together. Surgery will also repair any damage to internal organs, nerves, or blood vessels.

Serious Symptoms

In some cases, a bruised or broken rib can result in other health conditions that could even be life-threatening.

If a person with a recent bruised or broken rib experiences any of the following symptoms, they should seek medical attention right away:

  • Severe pain that continues to get worse
  • Increasing shortness of breath or trouble breathing
  • High fever
  • Coughing up blood or yellow-green mucus (phlegm)

Diagnosis

If your doctor suspects a rib fracture, he will want to get images of your chest. If the broken rib is caused by blunt trauma or a serious accident, he will want to make sure there’s is no other serious damage to internal organs.

Your doctor might order one or more of these:

  • X-ray: About 75% of all broken ribs are detected through x-ray. They can also show other problems, like a collapsed lung.
  • CT Scan: This type of image shows fractures that do not appear on X-rays. Your doctor will want you to get one if he thinks the X-ray missed something. It can also show damage to soft tissue and organs, like your lungs, liver, spleen or kidneys.
  • MRI: Like a CT scan, these images can show fractures that X-rays miss. They can pinpoint damage to soft tissue and organs.
  • Bone Scan: If you have a stress fracture to a rib, or a history of prostate cancer, this may do a better job of showing where the damage is.

Treatment

The primary treatment for rib injuries is time. Most broken ribs take about 6 weeks to heal.

While you are on the mend:

  • Take a break from sports to allow yourself to heal without hurting yourself again.
  • Put ice on the area to relieve pain.
  • Take pain medicine like acetaminophen or ibuprofen. If you need something stronger, your doctor may prescribe something for you.
  • Take deep breaths to avoid pneumonia. A lung infection is the most common thing you can get with rib fractures. Your doctor may give you a simple device to encourage you to breathe deeply.
  • Do not wrap anything tightly around your ribs while they are healing. You do not want anything to limit your breathing.

If you have a more serious injury, you may need additional treatment or possibly surgery. For example, if your lung has been punctured by the sharp end of one of your ribs, you may need to have a procedure done to remove air or blood from inside your chest. Some people whose ribs are badly injured might need to have them repaired with metal plates, but this is rare.

Daily Adjustments

The pain and discomfort from rib injuries can be managed, though a person might need to make some temporary adjustments, even taking time off of work, during the first few days after the injury is sustained.

Sit Upright

Some patients notice that the pain and tenderness increases at night when they are in bed trying to go to sleep. In these cases, it can be helpful to avoid lying completely flat. Try sleeping sitting up in a chair to ease the pain. Upright positions can also help with breathing. When coughing, some people find it helpful to hold a pillow against their chest to absorb the sudden movement and steady the torso.

Breathe Normally

The pain of rib injuries may make a person breathe more shallowly and avoid coughing. However, breathing normally and coughing when the need arises are important for preventing complications. Doing breathing exercises throughout the day can also help.

Avoid Smoking

Reducing or stopping smoking will benefit the healing process after a rib injury, especially if breathing is affected.

If you are concerned about your bone health or think you may have a broken rib, call us to set up an appointment. To schedule an appointment with one of our specialists, call us at 800-698-1280.

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