Have you just had a fall or felt a rib snap after a blow on the chest, and you think you have broken one or more of your ribs. Are you wondering about treatment and recovery tips?
I will address your questions using my knowledge as a diagnostic radiographer and draw on date from medical studies, all references at the end of the article.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Oct 2024. Written by Juliet Semakula a diagnostic radiographer
Summary: Most rib fractures are not life threatening and are treated nonoperatively. Most heal within 3 to 6 weeks on their own.
The pain will be severe in the first few weeks but 4 months or often earlier, it has completely disappeared in most people.
▶️Rib anatomy:
Let’s first delve into a little bit of the rib anatomy.
♦️There are a total of 12 pairs of ribs in the chest region.
♦️The first 7 ribs attach anteriorly to the sternum and posteriorly to the spinal column.
♦️ Rib numbers 8 through 10 join similarly but connect to the costal cartilage of the sternum anteriorly.
♦️Ribs 11 and 12 have the name of “floating” ribs as they only attach posteriorly but do not attach anteriorly.
️Underneath each rib lies the intercostal nerve, artery, and veins which supply blood supply and innervation.
Kuo 2023:
Image of the chest rib region showing the 12 pairs of ribs
▶️What is the difference between a bruised rib and a broken rib?
Broken and bruised ribs are different injuries, but they can both cause pain especially when you breath
1️⃣Broken ribs means the bones of the rib and sometimes the sternum have been fractured either particularly or completely.
2️⃣Bruised ribs mean the supportive muscles, cartilage, tendons, fascia, and other soft tissues surrounding the rib cage have been injured.
Apart from falls or a blow to the chest, sometimes ribs just break with no trauma or due to pathologic factors because of cancer metastasis from other organs.
Kuo 2023:
Elderly patients do sustain blunt chest trauma with rib fractures have twice the mortality and thoracic morbidity of younger patients with similar injuries
▶️How do you tell if you’ve broken your ribs or bruised it?
Most people who come to x-ray with broken ribs usually complain of chest, torse, abdomen and back pain. They always wonder if it could be a sign of a broken or cracked rib.
You will only confirm if you have fractured or bruised your rib after a full physical examination.
The symptoms of a broken and a bruised rib are more the same.
🟣When you have broken or bruised a rib you will feel a strong pain in your chest area, particularly when you breathe in or cough.
🟣You may see some swelling or tenderness around the affected ribs.
🟣Sometimes bruising on the skin, feeling or hearing a crack if it’s a broken rib.
🟣Sometimes a visible deformation of the ribcage.
▶️Are you wondering if you should go to the emergency department for a broken rib?
Most rib fractures are not life threatening and are treated nonoperatively
As a diagnostic radiographer I see so many requests from doctors requesting x-rays for broken ribs, but the truth is with broken ribs you do not need an x-ray because:
•Ribs cannot be easily splinted or supported like other bones, so they’re usually left to heal naturally.
You will only have an x-ray If there is suspicion for multiple rib fractures or significant trauma with underlying organ damage.
However, chest x-rays are limited and can only diagnose about 50% of isolated rib fractures. Having an x-ray will be exposing you to unnecessary radiation.
(Kuo 2023)
You may need to go to hospital if you think you have broken a rib for a physical examination because of the following reasons:
🟩Rib fractures can have life-threatening complications if you have pain and tenderness around your ribs and chest and have trouble breathing.
🟩If you touch the spot where your rib is broken, it will hurt more especially when you take a deep breath.
🟩The pain will get worse if you twist your body.
🟩Coughing or laughing will cause pain. There may also be bruising, depending on the cause.
It is important to be checked, and in some cases, you may require an x-ray or CT scan to rule out any other lung or chest damage.
x-ray image showing an example of normal fractures and surgical ribs on the right side of the chest.
▶️What is the usual treatment for a broken or cracked rib?
Most people who come for x-ray with rib fractures are sent home with advice on how to take care of themselves.
To give you some reassurance in most cases, a fractured rib will heal on its own in about 2 to 6 weeks. By the 3rd month your pain should have disappeared.
♦️Conservative therapy will help you to relieve back and rib pain.
You will be advised to follow the following conservative steps to help with your recovery.
⚫You will be given painkillers, such as paracetamol or ibuprofen tablets if needed to help with the pain.
Pain control is essential for not only primary pain relief but also preventing secondary complications such as atelectasis or pneumonia as well as the transition to chronic pain
Pain management also aims to avoid the negative effects of opioids on minute ventilation and the maintenance of airway patency.
⚫You can apply an ice pack, or a bag of frozen peas wrapped in a tea towel to the affected ribs regularly in the first few days to bring down swelling
⚫Try to have enough rest and take time off work if you need to.
⚫You should try to breathe normally and cough when you need to this will help to clear mucus from your lungs to prevent chest infections
⚫You can hold a pillow against your chest if you need to cough
⚫Try to walk around and move your shoulders to help you breathe and clear mucus from your lungs
⚫Regularly take slow, deep breaths to help clear your lungs
⚫Try to sleep more upright for the first few nights
Protocol from the National health services (NHS) United Kingdom
Before doctors used to prescribe compression rip taping for rib fractures. But because they can restrict breathing, leading to pneumonia, or even a partial lung collapse they are no longer prescribed.
Most patients complain of severe pain in the back, yet ribs are at the front of the chest.
This is because the ribs insert into the spine (the back) and the complex interaction of nerves, muscles and protective reflexes in the body surrounding the ribs.
Having pain in the back with a rib fracture is, therefore, something common; it is not a sign of a complication. With treatment a significant pain reduction is observed immediately.
♦️Surgical option
When conservative management fails or for more severe rib fractures, surgical stabilisation can be an option.
Surgical operation using open reduction and internal fixation (ORIF) of affected ribs, may be indicated.
Internal plate and screw fixation of 5 consecutive right sided ribs. Image retrieved from radiopaedia by Knipe 2014
Caution! You will require inpatient monitoring if you have multiple rib fractures or displaced rib fractures for respiratory failure especially if you are having breathing problems.
▶️Why is my broken rib pain getting worse after 1 to 2 weeks?
Most rib fractures tend to heal within 3 months, but occasionally this is not the case.
Some people complain of pain either increasing or remaining constant with no signs of reduction.
Here are some reasons why pain might intensify during this period.
1️⃣This is due to a condition called mal-union or bad healing of the rib fracture
2️⃣Inflammatory response peaks sometimes cause pain
3️⃣Delayed onset of pain
4️⃣Activity levels when they increase your pain may increase.
Most of these pains are rarely a sign of a complication, but if you are worried you can always see your doctor for a check-up.
▶️Can you still walk with a broken rib?
Yes, I have seen patients with rib fractures walk around and it is even recommended, but if anything causes you severe pain while walking and breathing seek help.
In the process of healing, it is important to walk around and move your shoulders occasionally to prevent mucus from building up in your lungs.
Getting out of bed can be challenging due to pain, you can get assistance if you find it a struggle, or your bed can be adjusted with handles to hold on.
▶️How to deal with constipation when you have fractured your ribs.
Having constipation after a broken rib is very common and I have seen patients complain of pain slowing down their natural contractions of intestinal muscles leading to constipation.
How can you prevent constipation or minimise its duration?
⚫Try to adjust your diet and drink a lot of fluids during your healing process.
⚫Consider increasing your activity by walking to allow bowl movement.
⚫Do not delay if you feel you want to use the toilet
⚫ Speak to a pharmacist if all these are not helping, you may be given some laxative medicines to help you poop.
▶️Recovery tips and timeline of broken ribs while healing at home.
Broken or bruised ribs heal in the same way and usually get better by themselves within 3 to 6 weeks.
Here are things you should avoid as you wait for your full recovery.
❌Try not to wrap a bandage tightly around your chest to stop your lungs from expanding properly
❌Avoid lying down or try to stay still for a long time.
❌Do not strain yourself by lifting heavy objects
❌Do not play any sports or do any exercise that makes your pain worse
❌Avoid smoking or stop smoking to help with your recovery.
▶️Here are the average timelines retrieved medical studies
| Stage | TimeLine from day of the broke |
| You have less pain | A few weeks |
| Ribs well consolidated | About 6 weeks |
| Swelling & bruising around the ribs | Several weeks |
| Resume walking | Immediately or support of a walking stick |
| You can drive | In a few weeks or immediately for your pain is mild |
| Return to sports | For 4 months, keep off for at least 4 to 6 weeks |
| Return to work | A few months |
| Fully recovered | 3 to 4 months or more if you had surgery |
These timeline will depend on individual basis, how many rib fractures are broken, treatment and your general health.
▶️What happens if you leave a cracked rib untreated?
When untreated, rib fractures will lead to serious short-term consequences such as:
Rib fractures can lead to solid organ injuries such as the liver and splenic.
🟠Severe pain when breathing.
🟠 Pneumonia and, rarely, death.
Long-term consequences include:
🟠 Chest wall deformity.
🟠 Chronic pain
🟠 Decreased lung function.
I have come to the end of this article hoping I have answered some of the commonly asked questions about rib fractures.
Wishing you a quick recovery!🙋
📚Source:
Kuo K, Kim AM. Rib Fracture. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541020/
Graeber GM, Nazim M. The anatomy of the ribs and the sternum and their relationship to chest wall structure and function. Thorac Surg Clin. 2007 Nov;17(4):473-89, vi. doi: 10.1016/j.thorsurg.2006.12.010. PMID: 18271162.
Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000 Jun;48(6):1040-6; discussion 1046-7. doi: 10.1097/00005373-200006000-00007. PMID: 10866248.
Hwang EG, Lee Y. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 2014 Aug 31;10(4):241-4. doi: 10.12965/jer.140137. PMID: 25210700; PMCID: PMC4157932.
Martin TJ, Eltorai AS, Dunn R, Varone A, Joyce MF, Kheirbek T, Adams C Jr, Daniels AH, Eltorai AEM. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury. 2019 Jun;50(6):1159-1165. doi: 10.1016/j.injury.2019.04.020. Epub 2019 Apr 22. PMID: 31047683.
Knipe H, Neto A, Bell D, et al. Rib fractures. Reference article, Radiopaedia.org (Accessed on 21 Oct 2024) https://doi.org/10.53347/rID-30713