Broken ribs

A broken rib is a common injury that occurs when one of the bones in your rib cage breaks or cracks. The most common cause is chest trauma, such as from a fall, motor vehicle accident or impact during contact sports.

Many broken ribs are merely cracked. While still painful, cracked ribs aren't as potentially dangerous as ribs that have been broken into separate pieces. A jagged edge of broken bone can damage major blood vessels or internal organs, such as the lung.

In most cases, broken ribs usually heal on their own in one or two months. Adequate pain control is important so that you can continue to breathe deeply and avoid lung complications, such as pneumonia.

Symptoms

The pain associated with a broken rib usually occurs or worsens when you:

• Take a deep breath
• Press on the injured area
• Bend or twist your body

When to see a doctor

See your doctor if you have a very tender spot in your rib area that occurs after trauma or if you have difficulty breathing or pain with deep breathing.

Seek medical attention immediately if you feel pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes or pain that extends beyond your chest to your shoulder or arm. These symptoms can indicate a heart attack.

Causes

Broken ribs are most commonly caused by direct impacts — such as those from motor vehicle accidents, falls, child abuse or contact sports. Ribs also can be fractured by repetitive trauma from sports like golf and rowing or from severe and prolonged coughing.

Risk factors

The following factors can increase your risk of breaking a rib:

• Osteoporosis. Having this disease in which your bones lose their density makes you more susceptible to a bone fracture.
• Sports participation. Playing contact sports, such as hockey or football, increases your risk of trauma to your chest.
• Cancerous lesion in a rib. A cancerous lesion can weaken the bone, making it more susceptible to breaks.

Complications

A broken rib can injure blood vessels and internal organs. The risk increases with the number of broken ribs. Complications vary depending on which ribs break. Possible complications include:

• Torn or punctured aorta. A sharp end of a break in one of the first three ribs at the top of your rib cage could rupture your aorta or another major blood vessel.
• Punctured lung. The jagged end of a broken middle rib can puncture a lung and cause it to collapse.
• Lacerated spleen, liver or kidneys. The bottom two ribs rarely fracture because they have more flexibility than do the upper and middle ribs, which are anchored to the breastbone. But if you break a lower rib, the broken ends can cause serious damage to your spleen, liver or a kidney.

Prevention

The following measures may help you prevent a broken rib:

• Protect yourself from athletic injuries. Wear protective equipment when playing contact sports.
• Reduce the risk of household falls. Remove clutter from your floors and clean spills promptly, use a rubber mat in the shower, keep your home well-lit, and put skidproof backing on carpets and area rugs.
• Strengthen your bones. Getting enough calcium and vitamin D in your diet is important for maintaining strong bones. Aim for about 1,200 milligrams of calcium and 600 International Units of vitamin D daily from food and supplements.

Diagnosis

During the physical exam, your doctor will press gently on your ribs. He or she might also listen to your lungs and watch your rib cage move as you breathe.

Your doctor likely will order one or more of the following imaging tests:

• X-ray. Using low levels of radiation, X-rays make bones visible. But X-rays often have problems revealing fresh rib fractures, especially if the bone is merely cracked. X-rays are also useful in diagnosing a collapsed lung.
• CT scan. This often can uncover rib fractures that X-rays might miss. Injuries to soft tissues and blood vessels are also easier to see on CT scans. This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your body's internal structures.
• MRI. This can be used to look at the soft tissues and organs around the ribs to determine if there's damage. It can also help in the detection of more subtle rib fractures. An MRI uses a powerful magnet and radio waves to produce cross-sectional images.
• Bone scan. This technique is good for viewing stress fractures, where a bone is cracked after repetitive trauma — such as long bouts of coughing. During a bone scan, a small amount of radioactive material is injected into your bloodstream. It collects in the bones, particularly in places where a bone is healing, and is detected by a scanner.

Treatment

Most broken ribs heal on their own within six weeks. Restricting activities and icing the area regularly can help with healing and pain relief.

Medications

It's important to obtain adequate pain relief — if it hurts to breathe deeply, you may develop pneumonia. If oral medications don't help enough, your doctor might suggest injections of long-lasting anesthesia around the nerves that supply the ribs.

Therapy

Once your pain is under control, your doctor might prescribe breathing exercises to help you breathe more deeply because shallow breathing can put you at risk of developing pneumonia.

In the past, doctors would use compression wraps — elastic bandages that you can wrap around your chest — to help splint and immobilize the area. Compression wraps aren't recommended for broken ribs anymore because they can keep you from breathing deeply, which can increase the risk of pneumonia.

Preparing for an appointment

Because many broken ribs are caused by motor vehicle accidents, you may find out you have a broken rib in a hospital's emergency department. If you break a rib because of repetitive stress over time, you'll likely see your primary care provider.

Here's some information to help you get ready for your appointment

What you can do

Before you see your primary care provider, make a list of:

• Your symptoms, including any that may seem unrelated to the reason you made the appointment
• Key personal information, including recent accidents
• All medications, vitamins and supplements you take, including doses
• Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For broken ribs, some basic questions to ask your doctor include:

• How long will I be in pain?
• What treatments are available, and which do you recommend?
• How can I best manage this with my other health conditions?
• Do I need to restrict my activities?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask:

• When did your symptoms begin?
• Where is your pain?
• Are your symptoms continuous or occasional?
• How severe is your pain?
• Did anything happen to cause it?
• Does any action make the pain better or worse?

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