Rib Injury – Tufts Medical Center Community Care

What is a rib injury?

A rib injury is a bruise, strain, break, separation, or irritation of one or more of the ribs in your chest. It can also be an injury to the tissue called cartilage that attaches the top 10 ribs to the breastbone.

What is the cause?

A fall or direct blow to the chest may bruise, strain, or break the ribs or injure the rib cartilage. Breaks usually happen in the outer curved part of the rib cage.

When a rib tears away from the cartilage, the injury is called a costochondral separation. It may result from a blow to the ribs, a fall, or landing hard on your feet. It might even be caused by forceful coughing or sneezing.

Irritation of a rib is called costochondritis. It may be caused by an infection or repeated coughing, or by overuse, like from rowing or heavy lifting. Sometimes the cause is not known.

What are the symptoms?

A rib injury causes pain and tenderness in the ribs. You may have pain when you breathe, move, laugh, or cough.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history. Your provider will examine your chest and listen to your lungs. Tests may include X-rays or other scans.

How is it treated?

Rib injuries can be painful and make it hard to cough or take a deep breath. Your healthcare provider may prescribe pain medicine.

You may need to do breathing exercises while you heal to prevent lung problems.

Rib injuries usually heal without surgery. Bruised ribs or a costochondral separation usually take 3 to 4 weeks to heal. Broken ribs take 6 to 8 weeks to heal.

How can I take care of myself?

To relieve pain and help the injury heal:

• Rest.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured ribs every 3 to 4 hours for up to 20 minutes at a time.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don’t take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
• If coughing is painful, holding a pillow against your chest may help.

Follow your healthcare provider’s instructions. Ask your provider:

• How and when you will hear your test results
• How long it will take to recover
• What activities you should avoid, including how much you can lift, and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent rib injury?

Ribs are often injured in accidents that are not easy to prevent.

In contact sports like football it’s important to wear the proper protective equipment.

Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2014-10-21
Last reviewed: 2013-07-19

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

Complex Chest Wall Injury | Rib Injury Clinic

The Chest wall is a complex structure consisting of a bony skeleton with multiple joints between the sternum (breastbone) and vertebrae (spine), and between the bony parts of the ribs and the costal cartilage part of the rib cage at the front of the chest between the ribs and sternum. In addition, there are multiple ligamentous, tendinous and muscle attachments. Many of this ‘junctional’ areas can be sources of injury or prone to inflammation and damage.

Annotated image of a CT 3D reconstruction showing the (a) anterior and (b) lateral chest wall structures.

Manubriosternal junction

Refers to where the manubrium sterni (top of sternum) and body of sternum joint together with the 2nd rib. It is a fibrocartilaginous joint and easily palpable as an often raised prominence as the manubrium joins the sternum at a slight angle (referred to as the sternal angle).

Symptoms

The maubriosternal junction can be injured through a direct blow or indirectly through acceleration-deceleration compressive-decompressive type of injury (for example during a front on collision in a seat belted passenger). This results in a dislocation and can lead to severe pain, tenderness and swelling (a step) in the area. If such an injury is suspected a chest CT scan is required to diagnosis and to assess for other chest injuries.

A more insidious problem is the development of localised inflammation in the area leading increasing pain, discomfort and occasionally the area can be hot or swollen. A high clinical suspicion is regarded and together with radiological investigations such as an MRI.

Manubriosternal junction or Sternal angle (highlighted with red circle)

Costosternal junction

Ribs can be classified on the basis of their costosternal attachments: true ribs if their costal cartilage attaches directly to the sternum, false ribs if their costal cartilage attaches to the cartilage of the next most superior rib (as part of the costal arch), and floating ribs if there is no costal cartilage connection. Ribs 1–7 are true ribs, ribs 8–10 are false ribs, and ribs 11 and 12 are floating ribs.

Costochrondral junction

Refers to the junction or joint between the ribs and the costal cartilage at the front of the chest typically away or lateral to sternum. Like the costosternal joint, the upper 8 costochondral junctions forms a type of joint (hyaline cartilaginous joints) which are more like the junction between the first rib and sternum (synchondrosis) so form a tough type of joint very little movement. The 9th and 10th rib costochondral junctions are fibrous.

Symptoms

The main types of pain seen are due to either injury from a blow or indirect trauma and inflammation.

Illustration of Costosternal and costochondral junctions

Acute trauma to costosternal / costochondral joint from an injury to the front of the chest such as a direct blow, or indirectly. It can be quite minor such as a twisting injury whilst lifting or even a violet cough or sneeze. It is typically associated with sudden and severe pain in the area next to the breastbone at the level of the injury or further away from the sternum with costal cartilage meets its rib connection. The pain is likely to be tender over the spot, and can be associated with swelling, even bruising and occasionally a sense of movement or even ‘popping’ caused by subluxation (partial disconnection of the junction) or dislocation (complete disconnection).

Chest CT scan following fall of an acute costochondral facture (red circle)

Costochondritis (Inflammation of the cartilage junctions of the sternum or ribs) and Tietze syndrome (sudden chest pain and localised swelling at junction of the sternum and ribs) are inflammatory causes of sternal and chest wall pain, see Costochondritis and other inflammatory problems.

Costal arch

Costal arch or margin refers to the lower edge of the chest formed by the bottom edge of the rib cage. It is formed by the 7th to the 10th rib costal cartilages to create the costal arch. Interchrondal junctions or articulations are joints between costal cartilage forming the costal arch and the lower ribs. The costal arch because it is made of cartilage is actually quite difficult to image.

CT reconstruction and rendering of the costal cartilage (in blue) showing the costal arch or margin

The costal arch varies in shape with narrow (left) and broad wide costal arches (right). Age, gender, obesity (particularly truncal abdominal obesity (pot belly) influence the shape

There appears to be some variation between how the costal cartilage of the lower ribs particularly the 9th and 10th ribs articulate with the costal arch. If the lower costal cartilages are not fully attached to the costal arch it may lead to a condition called slipped rib syndrome.

The shape of the lower chest created by the costal arches is quite variable with variation seen. Rib flare refers to a particular type of costal arch that is prominent particularly on the left and is often but not always associated with pectus chest wall deformities.

Bilateral rib flare showing a right sided costal arch with a dip (or deficit) (arrow in green) where the lower costal arch has not formed completely. In this case it was associated with slipped rib syndrome. NOTE: Incidental pectus Excavatum.

Bilateral rib flare in a young man with no symptoms or other issues

Symptoms

The main types of pain seen are due to either injury from a blow or indirect trauma and inflammation.

Acute trauma to costal arch from an injury to the front of the chest such as a direct blow, or indirectly. As with costosternal and costochondral injuries it can be quite minor such as a twisting injury whilst lifting or even a violet cough or sneeze. It is typically associated with sudden and severe pain in the area of the costal arch. The pain is likely to be tender over the spot, and can be associated with swelling, even bruising and occasionally a sense of movement or even ‘popping’ or even a ‘step’ caused by subluxation (partial disconnection of the junction) or dislocation (complete disconnection).

Old fracture of the costal arch leaving a ‘lump’ and chronic pain (red circle)

Left costal arch with excision of 9th rib tip (with costal arch illustrated in grey)

Slipped rib syndrome refers to pain of the lower costal arch caused by abnormal movement of the lower costal cartilage (typically the 8th, 9th or 10th rib tips). It’s likely to be associated an abnormal or ‘lose’ connection between articulations of the costal arch which then allows movement leading to irritation and pain. See Slipped Rib Syndrome.

Xiphersternal junction

At the bottom of the breastbone (sternum) is a further junction between the bony bottom of the sternum and the cartilaginous xiphisternum or xiphoid process. Xiphersternal junction is a type of joint with very little or no movement.

Symptoms

Pain caused by the xiphoid process is called xiphoidalgia. Xiphoid process pain occurs for varying reasons but is often related to minor trauma to the area, over exercise (such as abdominal crunches) or can become more prominent following excessive weight loss. Local inflammation can also occur. See Costochondritis and other inflammatory problems.

Chronic xiphersternal junction fracture (red circle) following direct blow leading to a lump and chronic pain on exertion

Treatment

Complex chest wall injuries can be treated either conservatively involving rest, restrictions of activities and painkillers, or through some form of intervention including targeted physical therapy, trigger point injections or a variety of surgical options. See Treatments.

Torn cartilage in the chest

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Torn cartilage is an extremely painful condition. In this article, we are to find out what can cause a cartilage tear in the chest or chest area, and see how you can go about managing its symptoms and recovering from it. The chest area contains some of the strongest muscles, cartilage, and soft tissue in the human body. They play an important role in providing strength to the human upper body. However, even they are not immune from injury.

When the cartilage in the chest ruptures, it can lead to debilitating pain, making it difficult or even impossible to carry out daily activities. This requires immediate medical attention and proper care in order to heal.

In the following sections, we will look at the typical causes of a cartilage tear in the chest, its symptoms, and the steps and procedures that need to be taken for a full recovery.

Causes

Torn cartilage in the chest is often the result of strenuous physical activity involving the upper body. This is an injury that is most commonly seen among people who go to gyms or play sports. Below are a few causes of this injury.
A tear in the pectoral or chest muscles can be caused several times by weightlifting despite muscle fatigue.
It can also occur when a cold or already worn muscle is shown.
If bench presses or similar exercises are performed incorrectly, this can lead to rupture of the cartilage of the chest.
Activities that require a significant amount of strength from the arm, chest, and adjacent area may cause this problem. A few examples of such activities include football tackle, chopping wood, pitching and batting, etc.
Symptoms

Pain
When there is torn cartilage, the first symptom is chest pain that seems to come from the shoulder or forearm and radiates towards the chest. This pain can be mistaken for arm pain caused by a heart attack. It is usually aggravated by moving the arms, coughing, laughing or sneezing.

Edema
Immediately after a rupture, there will usually be mild to severe swelling starting at the affected area of ​​the chest and extending to the shoulders and arms. Swelling and swelling may remain for several weeks. The degree of swelling depends on how severe the injury is.

Movement and limitation of power
If the cartilage in the chest is torn, it can significantly reduce a person’s ability to lift weight, especially through the upper body. There is usually some kind of muscle weakness, especially when the person tries to take his/her arms out to the sides, making even simple daily activities a challenge. Shoulder movement will also be limited.

Treatment

Resting and not straining the affected area is the most important thing to do when trying to repair torn cartilage. The restricted movement of the oppressed parts will reduce pain and also allow the cartilage to heal faster.

Seeing a doctor as soon as possible and getting the right treatment is essential for a proper recovery. Medications such as non-steroidal anti-inflammatory injections or tablets may be prescribed, which will reduce pain and swelling, and allow you to carry out daily activities.

Using a rib belt will provide support to torn cartilage and restrict rib movement resulting in less pain when coughing, sneezing, moving and breathing which would otherwise exacerbate pain.

Applying heat or ice compression, too, may help reduce swelling caused by torn cartilage in the chest. Note, however, that they should not be applied for more than 20 minutes at a time.

Treatment may include strengthening procedures such as breathing exercises, which should be performed carefully and in consultation with a physician.

Using adhering to the doctor’s recommendations and instructions, as well as maintaining regular follow-up treatments is essential for a quick and complete recovery.

Disclaimer: This article is for informational purposes only, and should not be replaced on the advice of a physician.

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Tietze’s syndrome is a disease characterized by non-infectious inflammation of one or more costal cartilages. Most often, the pathology occurs in people aged 20-40 years, with the same frequency in men and women. The causes and clinical manifestations are diverse, so in patients with Tietze syndrome, symptoms and treatment can be drastically different. The main manifestation of the disease is chest pain, which also occurs in many pathologies of the internal organs and the musculoskeletal system. Due to the blurring of the clinical picture, it is difficult to make a differential diagnosis.

This article is advisory in nature. Treatment is prescribed by a specialist after consultation.

Causes

The first ten pairs of ribs are connected to the sternum through cartilage, forming the costosternal joints, which can be damaged due to overload of the shoulder girdle. Microtraumatization of the perichondrium, the shell of the cartilage, leads to the development of non-infectious inflammation in it. Over time, the cartilage deforms, grows, compresses the surrounding nerve endings, causing pain. According to histological studies, after two to three months from the onset of the development of Tietze’s syndrome, the cartilage tissue is actually transformed into bone.

Fig. 1 Costosternal joints

Tietze’s syndrome is a rare pathology. The reasons for its development can be any diseases that disrupt the metabolism in the connective tissue and reduce immunity, as well as mechanical damage.

Risk factors for the development of Tietze’s syndrome:

• The same monotonous physical activity on the arms and chest

• Chest injuries

• O chest surgery

• Metabolic defects in the connective tissue

• Costal chondritis – inflammation of the costal cartilages

• COPD), bronchial asthma, etc.

Symptoms

The clinical picture of the disease is similar to pneumonia, exacerbation of COPD, bronchial asthma, coronary heart disease, myocardial infarction, intercostal neuralgia and osteochondrosis.

Possible symptoms of cartilaginous rib joint syndrome:

• 1

  Sharp shooting pain in the anterior chest wall. It can hurt on one side, rarely on both. Sometimes it radiates to the neck, back or arms

• 2

  Over time, the pain becomes undulating, aggravated by movement, deep breathing and pressure on the attachment points of the ribs to the sternum

• 3

  900 04 Possible spasm of the sternocleidomastoid muscles located on the anterior-lateral surfaces of the neck, right or left pectoralis major muscle – depending on which side of the chest the ribs are affected

• 4

  Limited range of motion in the neck, right or left shoulder joint, limitation of the depth of inhalation and exhalation ber with sternum. Education gradually hardens, becoming “bone”. When pressing on it, the pain intensifies, “shoots through”

• 6

  Increase in body temperature up to 38-39 degrees, general weakness, sweating

• 7

  Possible shortness of breath, loss of appetite, insomnia and tachycardia

Symptoms may develop acutely or gradually. Most often, Tietze’s disease of the chest affects the II-IV ribs.

Diagnosis

The symptoms of Tietze’s syndrome are similar to those of other diseases of systems and organs. In addition, some patients do not have local signs of inflammation, further complicating the diagnosis. An important role is assigned to a thorough clarification of complaints, anamnesis, visual examination and palpation. To clarify the diagnosis, an instrumental examination is often prescribed.

Additional diagnostic options:

• Chest x-ray to exclude lung disease and cancer
• Chest spiral computed tomography (SCT) for better visualization of pathological changes
• MRI chest for soft tissue assessment
• ECG
• Echocardiography, or ultrasound of the heart to rule out cardiac pathology

Which doctor to contact

In case of chest pain, they often turn to cardiologists and neurologists, and in case of induration in the area of ​​the anterior chest wall – to an oncologist. However, Tietze’s syndrome is dealt with by surgeons and orthopedic traumatologists.

The doctor conducts a survey and examination of the patient, prescribes additional examinations to clarify the diagnosis. How to treat costal chondritis, the specialist decides, taking into account the cause and severity of the condition.

Make an appointment with a neurologist

Appointment lasts 60 minutes, includes diagnostics, analysis of your MRI and preparation of a treatment plan, takes place both in person and online.

Treatment

At the Temed Clinic, patients with Tietze’s syndrome are treated in a complex manner by several narrow specialists: a neurologist, an orthopedic traumatologist, a massage therapist, a physiotherapist. Treatment of the disease is conservative. Surgical intervention – removal of the affected part of the rib – is resorted to extremely rarely, with an advanced stage of the disease. The emphasis in the treatment of costal chondritis is on taking medications, physiotherapy.

Medical treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) and, in some cases, glucocorticosteroids to relieve inflammation, localized swelling, and pain.

Tietze’s syndrome often occurs in a chronic form, requiring constant pain relief. But due to long-term use of medications, there are side effects. Therefore, drugs are prescribed only during the period of exacerbation in order to relieve inflammation. The basis of treatment is physiotherapy.

Temed Clinic focuses on modern and effective techniques:

• Acupuncture . The doctor introduces special thin needles into biologically active points, stimulating the nerve fibers leading to the pathological focus. Pain intensity decreases and tissue recovery accelerates

• Pharmacopuncture . Subcutaneous injections of drugs into the pathological focus relieve inflammation, swelling, stimulate tissue healing and eliminate pain. The procedure quickly relieves the patient’s condition. The choice of drugs and their combination depends on the severity of symptoms

• Taping . By fixing the elastic bands along the course of the muscles in a certain direction, the doctor redistributes the load on the joints of the shoulder girdle and chest. Kinesio taping for post-traumatic costal chondritis accelerates recovery, makes you feel better and allows you to reduce the dosage of drugs taken

• Magnetotherapy . The modern BTL Super Inductive System technology relieves chest pain, increases the mobility of the costosternal joints and triggers regeneration processes

• Laser therapy . MLS 6, a robotic multi-wavelength system, emits various tunable waves. With its help, the doctor achieves analgesic, anti-inflammatory and anti-edematous effects. The laser acts pointwise, the procedure is as safe as possible

• exercise therapy . Therapeutic exercise for Tietze’s syndrome includes individually selected exercises aimed at improving the mobility of the chest, developing the rib-sternal joints. Exercise therapy is often combined with taping: tapes increase the effectiveness of gymnastics

• Massage . The specialist kneads the muscles of the chest, which improves the nutrition of soft tissues. The procedure is carried out only after the exacerbation is removed

The treatment lasts from two to three weeks to several months until the symptoms are completely resolved. To improve and consolidate the result of therapy, patients perform exercises for Tietze’s syndrome at home for at least 2 weeks. Costosternal joints can crackle, during their development recovery occurs, nutrition and mobility of the chest as a whole improves.

In case of slow dynamics or its absence during therapy, it is recommended to consult an oncologist and repeat an in-depth examination of the patient with a mandatory puncture biopsy of the chest mass.

Prophylaxis

No specific prophylaxis. Overloading of the shoulder girdle, chest injuries and diseases of the respiratory system should be avoided. To prevent exacerbations, it is enough to follow the simple recommendations of a traumatologist, regularly perform gymnastics, eat a balanced diet and lead an active lifestyle.

Consequences

With timely diagnosis and treatment, the prognosis is favorable. Without therapy, the disease becomes chronic: exacerbations alternate with remissions. The pain may disappear spontaneously after 2-4 weeks, and reappear after a couple of months.

Abstracts

• 1

  Tietze’s syndrome is a rare disease characterized by non-infectious inflammation of one or more upper costal cartilages where the ribs meet the sternum

• 2

  The main symptom of Tietze’s syndrome is chest pain and an elastic mass on the anterior chest wall

• 3

• 4

  Treatment of Tietze’s syndrome is based on medicines, physiotherapy and therapeutic exercises

List of sources:

1. Shesternya P.