Rib Injuries

rib injuries

Rib injuries 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, get medical advice urgently. This information is not for severe rib injuries where patients require hospital admission. It does not cover severe or multiple injuries where in-patient treatment is needed. Injuries with more than three broken ribs may be the severe type.

What is rib injury?

A rib injury generally means rib fracture (a break in one or more of the ribs). But ribs sometime are not broken, but there is bruising of ribs or nearby muscles. This occurs when the chest is hit by some force for example during a fall, road accident or assault. If there is an inherent weakness in ribs like osteoporosis (thinning of ribs), the ribs are known to get injured by there own muscles like forceful cough, by straining, or heavy sports.

Who are affected by rib injuries?

Children and babies are less likely to fracture ribs because their bones are more elastic. So, if a young child or baby has a rib fracture with no apparent cause possibility of child abuse should be considered.

How do you diagnose rib injuries?

Diagnosis of rib injury is made from the history (that is what you tell a doctor about what happened), plus a doctor's examination. If the ribs are fractured the ribs are very painful, particularly with movement, like during deep breaths or coughing. The injured area also hurts when touched. Chest X-ray would show (but not always) rib fractures, but they are generally done to diagnose complications associated with rib fractures. So if complications are not suspected then x-rays are not required, especially in pregnant females (due to radiation hazard).

How do you treat rib injuries?

Treatment of rib fractures includesgood pain relief. Good pain relief will prevent shallow breathing, which would result lack of coughing and chest infections.

For pain relief three types of painkillers can be used:

  • Paracetamol.
  • Codeine-type painkillers, known as codeine, codeine phosphate or dihydrocodeine. They come in different strengths. Sometimes they are combined with paracetamol as co-codamol or co-dydramol.
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac.

Painkillers for rib injuries are taken on a regular basis and not wait for pain to become severe .As the ribs heal, one can gradually cut down on the painkillers. Painkillers are taken according to doctor or nurse advice, but general advice is:

For mild-to-moderate pain, take paracetamol.

For moderate-to-severe pain, take paracetamol OR codeine OR paracetamol plus an anti-inflammatory painkiller.

Side effects of painkillers should be known before taking them.

DO NOT take anti-inflammatory painkillers if you are taking anti-clotting medicines such as warfarin, heparin or similar medication.

Take the advice of doctor or nurse before taking anti-inflammatory painkillers if:

  • You are aged over 60.
  • You have a history of stomach ulcer or stomach bleeding.
  • You have asthma, high blood pressure, kidney disease or may be pregnant.
  • You are already taking drugs like aspirin (including low-dose aspirin) or clopidogrel.

If a person is taking painkillers for long periods, like over two weeks continuously, you may ask your doctor for a different painkiller or a medicine to protect the stomach. Be aware of the symptoms of stomach ulcer or bleeding, which are: pain in the upper part of the abdomen, lethargy and weakness, or black coloured stools (faeces). If you have any of these symptoms see a doctor urgently.

DO NOT wrap a bandage tightly round your chest. Although this may help the pain, it stops the lung from expanding and can lead to pneumonia.

Depending on your job and the severity of the injury, you may need time off work.

Complications of rib injury occur if internal organs are damaged by the sharp end of a broken rib.

  • Pneumothorax occurs if the membrane around the lung gets damaged allowing air to enter, which then forms an air pocket trapped around the lung, which squashes the lung. Symptoms include shortness of breath or pain on breathing - sometimes pain near the shoulder. It is diagnosed on a chest X-ray. The treatment includes removal of trapped air under local anesthetic.
  • A pneumothorax is generally noticed soon after the injury, but it could occur later, even several days afterwards. So one should be alertfor above-mentioned symptoms. Urgent medical opinion is sought if these symptoms occur.Rarely, a dangerous pneumothorax can occur where air is trapped under pressure. It compresses the lungs and causes increasing difficulty breathing. This is called a tension pneumothorax and is a medical emergency. Note: anyone who has difficulty breathing or who feels more breathless than usual needs immediate medical help.

  • Air under the skin is also another complication, which occurs when a sharp fractured rib can let air from the lung to get underneath the skin. This leads to a swollen or bubbly area, which may crackle when pressed. It is called surgical emphysema. It will clear up gradually. Surgical emphysema can sometimes be linked to a pneumothorax, and the pneumothorax may need treatment.

  • Haemothorax, is similar to a pneumothorax except that there is blood, not air, trapped around the lung. The blood collects at the base of the lung, so may cause shortness of breath or pain in the lower part of the chest. It is treated by putting in a drain in the pleural space and draining off the trapped blood.

  • Abdominal injuries, occur if the lower ribs are near the liver, spleen and kidneys. Rib fractures can cause internal damage to these organs. Symptoms are pain in the abdomen or back (rarely, pain may travel to the shoulder). If there is internal bleeding then you will feel faint or very unwell. Urgent surgery is needed.

  • Chest infections, occur due to difficulty in breathing due to pain .This can make it difficult to clear mucus in the chest, leading to chest infections. Good pain relief helps to prevent chest infections. Even with good painkillers, some people may get a chest infection following a rib injury. If you have symptoms such as cough, fever, chest pain, shortness of breath or increasing sputum (phlegm), see a doctor urgently.

Complications are more likely if the injury involved a large force, and if the injured person is frail or has other medical problems. If you suspect a complication, get urgent advice.

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