Chest Pain and Costochondritis Associated with Vitamin D Deficiency: A Report of Two Cases

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• v.2012; 2012
• PMC3384935

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Case Rep Med. 2012; 2012: 375730.

Published online 2012 Jun 12. doi: 10.1155/2012/375730

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Vitamin D is integral for bone health, and severe deficiency can cause rickets in children and osteomalacia in adults. Although osteomalacia can cause severe generalized bone pain, there are only a few case reports of chest pain associated with vitamin D deficiency. We describe 2 patients with chest pain that were initially worked up for cardiac etiologies but were eventually diagnosed with costochondritis and vitamin D deficiency. Vitamin D deficiency is known to cause hypertrophic costochondral junctions in children (“rachitic rosaries”) and sternal pain with adults diagnosed with osteomalacia. We propose that vitamin D deficiency may be related to the chest pain associated with costochondritis. In patients diagnosed with costochondritis, physicians should consider testing and treating for vitamin D deficiency.

Chest pain is a leading cause of ambulatory visits and accounts for over 6 million emergency room visits in the United States [1]. After serious cardiopulmonary conditions are considered, musculoskeletal causes of chest pain, including costochondritis, are commonly attributed to the final diagnosis [2, 3]. Costochondritis is not clearly understood, but may be related to inflammation of the costochondral junctions associated with illness, coughing, or trauma [3]. Although there are a few reports of osteomalacia and vitamin D deficiency associated with chest pain [4–6], we are not aware of any literature reports of costochondritis associated with vitamin D deficiency. This paper describes two cases of patients with chest pain, eventually diagnosed with costochondritis and vitamin D deficiency.

In this paper, both patients had extensive workups done with concern for cardiac disorders but were eventually diagnosed with costochondritis and vitamin D deficiency. We hypothesize that these patients’ costochondritis may have been related to vitamin D deficiency. Vitamin D is integral for bone health, and serum 25-OH vitamin D (25-OHD) is predictive for body stores of vitamin D [7–9]. While there is controversy over what defines deficient or optimal serum levels of 25-OHD, levels less than 50 nmol/L (20 ng/mL) lead to increase in bone turnover markers and increase in parathyroid hormone (PTH) [10]. Another study found that defective bone mineralization was evident in patients with serum 25-OHD less than 75 nmol/L (30 ng/mL) but none above that threshold [11]. The recent Institute of Medicine report found evidence that a serum 25-OHD level above 50 nmol/L (20 ng/mL) is generally sufficient for bone health for 97.5% of the population. Hence, a 25-OHD level less than 50 nmol/L (20 ng/mL) is generally considered consistent with vitamin D deficiency [7, 8]. Severe vitamin D deficiency, defined as a 25-OHD less than 25 nmol/L (10 ng/mL), can cause rickets in children and osteomalacia in adults [12]. Rickets classically causes “bow legs” or “knock-knees” due to disordered growth along weight-bearing bone. “Rachitic rosaries” describes hypertrophied costochondral junctions in relation to defective mineralization [13, 14]. Osteomalacia, the adult version of rickets, can cause diffuse bone pain. Tenderness to the anterior tibia, sternum, and costochondral joints can indicate osteomalacia and vitamin D deficiency [14, 15]. Although bone biopsy is the gold standard for osteomalacia, it is not generally practiced. Bone pain and vitamin D levels less than 25 nmol/L (10 ng/mL) are often sufficient for the clinical diagnosis of osteomalacia.

Although both patients did not have had levels less than 25 nmol/L (10 ng/mL) to suggest osteomalacia, we theorize that milder forms of vitamin D deficiency can cause a spectrum of pain along the sternum and costochondral junctions similar to patients with rickets and osteomalacia. Costochondritis continues to be a poorly defined entity but may represent a milder, earlier form of osteomalacia associated with higher serum 25-OHD levels. Importantly, osteomalacia and vitamin D deficiency may not be considered when a patient presents with complaints consistent with costochondritis, as testing for vitamin D deficiency in these patients has not been reported, nor is it routine.

A review of the literature revealed no reported cases of costochondritis associated with vitamin D deficiency, and only a few case reports of chest pain associated with vitamin D deficiency. One case described chronic chest and leg pain of 2 years duration in a 34-year-old female [4]. After two years of conservative treatment with anti-inflammatory medications, she was eventually diagnosed with osteomalacia associated with aluminum-containing antacid use. Aluminum containing antacids may cause osteomalacia by binding to phosphate, causing a negative phosphate balance and eventual disordered bone growth. However, there was no serum 25-OH vitamin D (25-OHD) level measured to support the diagnosis of osteomalacia. She improved with vitamin D supplementation and decreased antacid use. Another case reported a 37-year-old Indian living in Germany who was subsequently diagnosed with vitamin D deficiency and osteomalacia. Chest pain was the only presenting symptom. His 25-OHD level was undetectable. He was started on high-dose vitamin D and then maintenance vitamin D with resolution of his chest pain [5]. Lastly, a 21-year-old Turkish female living in Germany presented with left-sided chest pain with unremarkable electrocardiogram, troponin and d-dimer [6]. Her 25-OHD level was 9 nmol/L (4 ng/mL), and she was diagnosed with osteomalacia causing her chest pain. Treatment with vitamin D, calcium, and calcitonin resolved her symptoms in two months. These case reports are suggestive of osteomalacia and severe vitamin D deficiency as the cause of chest pains. It is possible that the spectrum of bone pain, including costochondritis, may be correlated to the degree of vitamin D deficiency.

In our paper, both patients were at significant risk for vitamin D deficiency despite living in an area with abundant sunshine. Vitamin D can only be obtained through ultraviolet light exposure, vitamin-D-rich foods, and supplementation. Both patients reported little to no milk intake, no other vitamin supplementation, and little sun exposure, putting them at high risk for deficiency. The IOM recently increased the recommended daily allowance (RDA) of vitamin D for adults from 400 IU to a minimum of 600 IU in order to maintain 25-OHD levels above 50 nmol/L (20 ng/mL) for 97. 5% of the population [7]. However, other expert recommendations have suggested much higher levels of vitamin D, ranging from 400 to 2000 IU daily to maintain adequate serum 25-OHD; depending on risk factors present [8, 9]. Sun exposure can provide the most efficient means of maintaining vitamin D stores; however, dark-skinned individuals absorb less ultraviolet radiation from sunlight and thus convert less 7-dehydrocholesterol into vitamin D. People living at higher latitudes are at increased risk for deficiency, but studies show that even in areas with adequate sunshine, vitamin D deficiency can be highly prevalent [16, 17].

Our paper has clear limitations. With prevalence of vitamin D deficiency reported to be up to 36% in young adults [12], costochondritis may be merely an unrelated association. However, with treatment of deficiency and normalization of their serum vitamin D, both patients’ costochondritis improved, further supporting vitamin D deficiency as a potential cause of their costochondritis. The improvement of symptoms may also be attributed to self-limited costochondritis rather than the vitamin D supplementation. However, it is notable that once adequate treatment was initiated, no further cases of chest pains have been reported—including the patient who had 3 years of chronic chest pain. This further strengthens our hypothesis that vitamin D deficiency may be a cause of costochondritis. We recommend further prospective studies, specifically in primary care, to help elucidate the association of vitamin D deficiency and costochondritis.

In patients with costochondritis, or bony sternal pain, physicians should consider vitamin D deficiency and osteomalacia and elicit any risk factors for deficiency. Patients with costochondritis who are at risk for vitamin D deficiency should be tested with a serum 25-OHD level and treated if found to be vitamin D deficient. Studies looking further at the association of costochondritis and vitamin D deficiency are warranted.

The authors declare no conflict of interests.

The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

This paper was presented as an oral case presentation at the Uniformed Services Academy of Family Physicians Annual Conference, New Orleans, LA, February 2010.

1. Pitts SR, Niska RW, Xu J, Burt CW. National hospital ambulatory medical care survey: 2006 emergency department summary. National Health Statistics Reports. 2008;(7):2–39. [PubMed] [Google Scholar]

2. Ebell MH. Evaluation of chest pain in primary care patients. American Family Physician. 2011;83(5):603–605. [PubMed] [Google Scholar]

3. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American Family Physician. 2009;80(6):617–620. [PubMed] [Google Scholar]

4. Kaufman AM, Abraham JA, Kattapuram SV, Hornicek FJ. Chronic multifocal chest and leg pain in a 34-year-old woman. Clinical Orthopaedics and Related Research. 2009;467(4):1112–1117. [PMC free article] [PubMed] [Google Scholar]

5. Schiltknecht M, Furrer J. Chest pain in a 37-year-old Sikh. Praxis. 2002;91(4):99–102. [PubMed] [Google Scholar]

6. Mosimann T, Meier C. Left-sided chest pain. Praxis. 2003;92(8):353–355. [PubMed] [Google Scholar]

7. Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. The Journal of Clinical Endocrinology & Metabolism. 2011;96(1):53–58. [PMC free article] [PubMed] [Google Scholar]

8. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of Vitamin D deficiency: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911–1930. [PubMed] [Google Scholar]

9. Hanley DA, Cranney A, Jones G, Whitling SJ, Leslie WD, Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada Vitamin D in adult health and disease: a review and guideline statement from osteoporosis Canada (summary) Canadian Medical Association Journal. 2010;182:1315–1319. [PMC free article] [PubMed] [Google Scholar]

10. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. The Lancet. 1998;351(9105):805–806. [PubMed] [Google Scholar]

11. Priemel M, von Domarus C, Klatte TO, et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. Journal of Bone and Mineral Research. 2010;25(2):305–312. [PubMed] [Google Scholar]

12. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clinic Proceedings. 2006;81(3):353–373. [PubMed] [Google Scholar]

13. Greer FR, Finberg L. Rickets. eMedicine. http://emedicine.medscape.com/article/985510-overview.

14. Holick MF. Resurrection of vitamin D deficiency and rickets. Journal of Clinical Investigation. 2006;116(8):2062–2072. [PMC free article] [PubMed] [Google Scholar]

15. Holick MF. Medical progress: vitamin D deficiency. The New England Journal of Medicine. 2007;357(3):266–281. [PubMed] [Google Scholar]

16. Jacobs ET, Alberts DS, Foote JA, et al. Vitamin D insufficiency in southern Arizona. American Journal of Clinical Nutrition. 2008;87(3):608–613. [PMC free article] [PubMed] [Google Scholar]

17. Binkley N, Novotny R, Krueger D, et al. Low vitamin D status despite abundant sun exposure. Journal of Clinical Endocrinology and Metabolism. 2007;92(6):2130–2135. [PubMed] [Google Scholar]

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7 Causes Of Waking Up With Chest Pain

February 25, 2022

Chest pain happens to everyone from time to time, especially when it’s caused by indigestion or stress. However, chest pain may indicate you have a more serious problem if it’s waking you up in the middle of the night or if it happens every morning.

Here are seven reasons you may be waking up with heart pain, and how to know when it’s time to see a doctor for treatment.

7 Reasons You Are Waking Up With Chest Pain

Chest pain that you feel upon waking can be caused by any one of several reasons. Try to avoid self-diagnosing your chest pain at any time, as this symptom could indicate you need medical attention right away.

1. Heartburn

Heartburn can be described as a burning sensation in your chest right behind your breastbone. It usually occurs at night after eating a meal and becomes worse when you lie down. It occurs when stomach acid flows from your stomach back toward your throat.

Heartburn is a symptom of acid reflux and gastroesophageal reflux disease (GERD). Acid reflux can happen after you eat spicy foods or citrus fruits and after you drink alcohol. GERD is much more serious and requires medical treatment. If you do not treat GERD, it can damage your esophagus and increase the risk of esophageal cancer.

2. Heart Attack

Pressure, pain, or tightness in the chest is the most common sign of a heart attack. Heart attack can also cause heartburn, shortness of breath, nausea, and sweating. A heart attack occurs when an artery to your heart becomes blocked. A blocked artery is usually caused by plaque buildup.

Common causes of heart attacks include high blood pressure, high cholesterol, obesity, and lack of exercise. It may also be caused by stress, diabetes, and illegal drug use. Heart failure and death can occur during or shortly after a heart attack.

3. Myocarditis

Myocarditis is inflammation of the heart muscle. This heart condition can cause rapid or abnormal heartbeats, which are called arrhythmias. In addition to chest pain after waking up, myocarditis can cause fatigue and shortness of breath. It may also cause swelling of the legs, ankles, and feet.

Myocarditis can be caused by a wide range of factors, including viruses, bacteria, and medications. Over time, this heart condition can lead to heart failure, heart attack, stroke, and sudden death.

4. Pancreatitis

Pancreatitis is inflammation of the pancreas. When your pancreas is inflamed, it can cause pain in the abdomen that radiates up to your chest. Other symptoms of pancreatitis include fever, nausea, and abdominal pain that gets worse after you eat.

Pancreatitis is often caused by obesity, smoking, heavy alcohol use, and diabetes. It can also be caused by other medical conditions, including gallstones, infection, and cystic fibrosis. When left untreated, pancreatitis can lead to breathing problems, kidney failure, and pancreatic cancer.

5. Gallstones

Gallstones are small hardened stones that form in the gallbladder. These stones usually form due to eating too much cholesterol and fats and not enough fiber. Gallstones can cause abdominal pain that radiates up to your chest. This pain can become more severe if your gallbladder is also inflamed.

Gallstones can eventually lead to gallbladder cancer and the surgical removal of your gallbladder. Exercising regularly and eating a healthy, high-fiber diet can often reduce your risk of developing gallstones.

6. Pulmonary Embolism

A pulmonary embolism (PE) is when a blood clot forms in an artery in the lungs to block blood flow. A PE can cause chest pain and tightness, making it feel like you’re having a heart attack. Other symptoms of PE include cough and shortness of breath.

You may get a PE if you have a history of blood clots or have cancer or heart disease. People with severe COVID-19 are also at high risk for PE. When not diagnosed or treated right away, PE can often lead to death.

7. Pulmonary Hypertension

Hypertension means high blood pressure. Pulmonary hypertension is when you have high blood pressure in the arteries that carry blood to your lungs. This medical condition can cause a rapid heart rate and tightness or pressure in the chest. It may also cause dizziness and shortness of breath.

Pulmonary hypertension may be caused by obesity, a history of blood clots, and the use of drugs and medications. Antidepressants, weight-loss drugs, and illegal drugs like cocaine can all increase your risk of getting this respiratory condition.

Other Causes Of Chest Pain After Waking Up

Chest pain after waking up may be caused by other factors and health conditions.

Possible heart-related causes of chest pain are angina and pericarditis. Angina occurs when blood flow to the heart is reduced due to a blocked artery. Pericarditis is inflammation in the sac around your heart.

A collapsed lung or lung cancer is a possible respiratory-related cause of chest pain after waking up. A panic attack can also cause chest pain upon waking, which is a major symptom of a type of anxiety disorder. An injury to a muscle or rib can cause chest pain when waking if you twist or move your upper body while sleeping.

At-Home Treatments For Waking Up With Chest Tightness

Heartburn and indigestion are usually common and mild health problems that can be treated on your own at home. Baking soda, apple cider vinegar, and yogurt are all anecdotal home remedies that can relieve heartburn. Speak with your doctor before trying these remedies to make sure they don’t interfere with special diets or medications.

Muscle pain or injury to the chest may be treated with a cold pack, which can reduce the need for pain relievers and medications. Your doctor may recommend other natural and at-home treatments for chest tightness based on the suspected cause of the problem.

When You Should See a Doctor

Any type of chest pain that feels unusual or that is accompanied by other symptoms should be treated as a medical emergency. Chest pain is the primary symptom of a heart attack. Don’t hesitate to seek help right away, as it’s better to be safe than sorry when it comes to your health and livelihood.

If you think you may have gallstones, pancreatitis, or another medical condition causing chest pain, make an appointment to see your doctor. Your healthcare provider can review your medical history and talk to you about your symptoms. Your doctor may also run tests to determine the true cause of your chest pain.

Healthcare Associates of Texas is home to a large team of board-certified medical professionals who can work with you to diagnose and treat chest pain that wakes you up. Visit our website to find the nearest location and request an appointment.

Posted in: Cardiovascular Health, Pain Management

Discomfort in the chest in Kazan, prices at the Quality of Life clinic

Discomfort in the chest is treated by a cardiologist.

In any case, pain is a signal that tells a person that it is necessary to worry about the diagnosis. A specialist with the help of advanced equipment will find out the true cause of pain, which may be hidden not only in the cardiovascular system.

Symptoms when to see a doctor

The following pathologies require the most prompt medical response:

• mitral valve prolapse and atrial fibrillation, which give pain behind the chest;

• dissection of the aorta, with sharp pain, as if in the middle of the chest they were trying to tear it;

• acute burning in the chest at rest, caused by thromboembolism and accompanied by a cough with orange sputum.

If a specialist does not intervene in these processes in time, the pathology will worsen.

However, the causes of pain in the chest can be other diseases of the cardiovascular system, as well as the digestive system, respiratory organs. Disorders in the functioning of the musculoskeletal system or experienced stressful situations can also provoke deviations. The feeling of discomfort in the chest is of different types. It is often accompanied by a severe cough. In this case, we can say about the presence of a respiratory disease.

Burning pains in the chest may also be detected, which indicates problems with the heart. If the pain radiates to the arm (neck), there is a risk of a heart attack or ischemia. Severe pain radiating to the arm is associated with aortic dissection in the chest. When it comes to problems with the gastrointestinal tract, the symptoms are heartburn, discomfort in the abdomen, high acidity in the stomach.

Reasons:

• Diseases of the musculoskeletal system or ODA (osteochondrosis of the spine, dorsalgia, hernia).

• Heart diseases (myocarditis, ischemic heart disease, cardiomyopathy, defects).

• Diseases of the broncho-pulmonary system.

• Herpes Zoster.

• Diseases of the gastrointestinal tract.

• Diseases of the urinary tract (may irradiate).

• Autonomic dysfunction of the nervous system or VVD.

• Osteoporosis.

Diagnostic measures

Elucidation of the etiology (causal relationships of pain and disease) is the first step towards the patient’s recovery. For this, the doctor prescribes primary examinations of the musculoskeletal system and internal organs. The main tools in visualizing the picture of pathology are informative medical methods.

1. ECG is a study that excludes or confirms the pathological process of the chest. The diagnostician will immediately see the presence of myocardial ischemia by changing complexes, raising the ST interval. Arrhythmia is diagnosed by a Holter examination.

2. Ultrasound is a method used when a patient feels pain in the chest on the left. On this examination, the doctor examines the ejection fraction, the functionality of the heart muscle, examines the damage to the valvular mechanisms and reveals signs of heart destruction. In parallel, a specialist may prescribe an ultrasound of the abdominal cavity to study diseases of the spleen, pancreas, gallbladder, which lead to thoracalgia.

3. An x-ray helps the doctor to clarify the situation with the volume of the lungs. Women should get a mammogram. In parallel, an X-ray of the gastrointestinal tract is prescribed to exclude a diaphragmatic hernia or ulcer.

4. Endoscopy will tell about dysfunctions of the esophagus along the mucous membrane and the contractility of the cardiac sphincter. Severe lung injury necessitates bronchoscopy.

How to treat?

With minor physical exertion, doctors recommend taking a vacation for a few days and keeping calm emotionally. Patients with breast pain do not need to wear tight bras during this period. Experts do not advise overeating, especially fatty foods. It is better to exclude salinity, smoked meats and consult a doctor for an examination. This behavior will be a significant help to the doctor in determining the exact diagnosis.

Treatment with conservative therapy

The tactics of a specialist in the selection of a method of treatment depends on the cause of thoracalgia (chest pain). If the cause lies in the pathological condition of the internal organs, doctors prescribe an etiotropic form of treatment. It can be supplemented with analgesics for unbearable pain. To reduce pain, patients use warm compresses, electrophoresis and anti-inflammatory drugs. However, to eliminate the cause of pain, medicine has developed the following type of medicines.

1. Non-steroids with anti-inflammatory effect have the proper effect in rheumatism and relieve symptoms. Means are used for bronchitis, pneumonia. Their advantage is the support of stable remission.

2. The specialist of the clinic prescribes medicines for angina for pain in the pericardial space. Their goal is to reduce the risk of myocardial infarction and normalize the heart rhythm. Calcium channel blockers work well.

3. Antibiotic therapy is effective in detecting pleurisy and bronchitis.

4. The doctor advises antacids to reduce the acidity of gastric juice after examining the esophagus.

5. Hormones are effective for severe pain in the mammary glands, which are given to the sternum.

Surgical intervention

Chest pain associated with rib/spinal fractures requires surgical attention. Radical operations are prescribed for oncological causes of pain. A competent approach of a doctor of the highest category, a specialist with extensive experience helps to quickly and correctly determine the decision on the treatment of the patient. You can make an appointment for a consultation if you have chest pain. Here you may need the advice and help of a neurologist, cardiologist, gastroenterologist. Our clinic provides ample opportunities for diagnosis. Contact us, together we will find the right solution!

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Injuries of the chest and methods of their treatment – Article

Breast injuries are open and closed. Open injuries occur mainly with injuries from cold and firearms. Such victims are mainly treated by thoracic surgeons. Traumatologists often deal with a closed chest injury, the causes of which are bruising, concussion or compression of the chest. With local bruises of the chest of small force: (a blow with a fist, a blow on a protruding object when walking, running, falling), isolated fractures of the ribs (from one to three) occur most often without damage to the internal organs. With bruises of great force (car injury, fall from a great height, compression of great force), multiple and combined fractures of the ribs occur.
According to the nature of the injuries, the following groups of victims are distinguished:

• with multiple fractures without damage to other parts of the skeleton
• with multiple fractures of the ribs, combined with injuries of the chest organs and multiple fractures of other parts of the skeleton
• with minor injuries of the chest wall (one to three ribs) associated with injuries to other parts of the body

Injury mechanism

With the direct action of a protruding object with great force, a fracture first occurs due to overextension of the rib in this place, then fractures of neighboring sections of the rib form due to excessive bending. When a traumatic element acts simultaneously on a large section of the chest wall along the longitudinal line of the body, multiple fractures of many ribs occur. The number of fractures on each rib depends on the shape and area of ​​the contacting surface of the traumatic object. With a small area of ​​contact, a fragment of one or more ribs can “knock out”, pressing into the chest, while a large displacement of fragments occurs with rupture of muscles, blood vessels and pleura. If the impact area is large, then a mobile section of the chest wall is formed, called the “costal valve”. Such fractures occur more often with automobile and railway injuries, with falls from a height, with a sharp compression of the chest with great force. In the latter case, multiple fractures of the type of “broken chest” may occur

Rib fractures

Rib fractures without damage to internal organs. The following symptoms are characteristic:

• sharp pain at the fracture site, aggravated by coughing and deep breathing
• shallow rapid breathing and forced position of the victim, trying to provide rest to the injured area
• symptom of “broken breath” – when trying to inhale, there is a sharp pain

Treatment of rib fractures

Damage to the skeleton of the chest is always accompanied by a violation of the function of vital organs – the lungs and the heart. With mild chest injuries, functional disorders usually do not cause an immediate threat to life, but make patients suffer from severe pain due to displacement of rib fragments. Treatment is usually limited to a single novocaine blockade of fracture sites. The main principles of treatment of rib fractures are reposition and immobilization of fragments. Fractures of the ribs along only one line do not require special measures for reposition, since the ends of the fragments usually remain in contact with each other, and the fusion of the ribs, even with a slight displacement, does not prevent the full restoration of the function of the chest. N.I. Pirogov back in 1877-1879For years, he successfully used a plaster corset for fractures of the ribs, strengthening both the upper and lower ribs with it. A more well-known method of restricting the mobility of the chest is the application of strips of adhesive tape. After 2 weeks, the fragments of the ribs cease to move due to the development of fibrous callus, the pain stops, the patients become active, willingly begin to engage in exercise therapy and no longer need bandages that limit the chest. Full recovery of function is usually seen after 5-6 weeks.

Diaphragm and aorta injuries due to rib fractures

Diaphragm injuries are difficult to diagnose, especially in severe multiple injuries. X-ray examination is mandatory. The following symptoms are typical:

• pressing the lung up with restriction of its mobility
• Contralateral mediastinal displacement, which can lead to heart failure

Damage to the aorta in victims is extremely rare, as they mostly die at the scene. Modern advances in thoracic surgery allow us to hope for the possibility of saving such victims with timely diagnosis and surgery. Early symptoms:

• short-term loss of consciousness
• arterial hypotension
• dysphagia
• hoarse voice
• systolic murmur on aorta
• expansion of the shadow of the upper part of the mediastinum on the radiograph

Treatment of severe chest injuries

Both a thoracic surgeon and a neurosurgeon, urologist and traumatologist take part in the treatment of such injuries.