The human body has twelve pairs of ribs; ten pairs attach to the spine and wrap around to attach to the sternum in the front of the chest, and the two lower pairs only attach to the spine in the back. The ribs serve to protect the internal organs, lungs, heart, liver, kidneys, spleen, from injury. The bones have a lot of nerve endings so when damage occurs, pain is significant.
A patient with an isolated rib fracture or a minor costochondral separation usually has a history of falling on the side of the chest, being struck by a blunt object, coughing violently or leaning over a rigid edge. The initial chest pain may subside, but over the next few hours or days pain increases with movement, interfering with sleep and activity and becoming severe with coughing or deep inspiration. The patient is often worried about having a broken rib, and may have a sensation of bony crepitus or abnormal rib movement. Breath sounds bilaterally should be normal unless there is substantial splinting or a pneumothorax or hemothorax is present. There is point tenderness over the site of the injury and occasionally bony crepitance can be felt.
The general principle for treating broken bones is to put them back into the right place anatomically, and allow time for healing. In the case of a broken arm, this would mean a cast, or surgery followed by a cast, and 4-12 weeks to heal depending on location and severity. The ribs cannot be immobilized without causing severe lung problems (pneumonia, collapsed lung) so they are usually left alone to heal in time, meaning lots of pain and disability while that takes place. Since the ribs move whenever we breathe, this is a difficult process!
A blow to an unprotected rib cage can bruise the ribs. The treatment for bruised ribs is to rest them and apply ice until the pain is gone. You can continue activities if you use a pad to protect the ribs. This pad, made of strong plastic with an absorbent material underneath, looks like a flak jacket; it hangs on the shoulders and wraps around the rib cage. Several varieties are available in sporting goods stores.
A severe blow can cause a rib separation, in which the rib tears loose from the cartilage in the front.
You will feel severe pain, usually toward the front of the rib cage, and it will hurt to breathe. When you bend over or rotate your body, you may feel a “pop.” It will be particularly painful to go from a lying to a sitting position, so you may have trouble getting out of bed in the morning. If someone puts one hand on your back and the other on your breastbone and squeezes, you will feel tremendous pain.
The treatment is to use a rib belt. This is a strap of elastic, about eight inches wide, that goes around the rib cage. It stretches tight and closes in front. This compresses the rib cage so that it can’t expand too far. The belt holds the rib end in place until it heals and lessens the pain of everyday movements.
No matter how much you may want to, you can’t participate in sports when you have separated ribs. The resulting pain will be too much to allow you to continue.
The ultimate injury from a blow to the rib cage is a broken rib. The pain may occur anywhere in the rib cage depending on where the rib is broken. It may be that more than one rib is broken.
You will feel the same pain as with bruised or separated ribs, only more severe. You should be concerned about sharp ends of broken ribs and should have an x-ray. Any excessive strain or movement, or another blow, can cause a sharp end to puncture a lung, sending you to the hospital for emergency treatment.
Again, the treatment is to rest (for about six weeks) and to wear a rib belt until the pain is gone. An x-ray must show that the ribs have healed before you can return to activity.
Pulled Rib Muscle
The muscle between each pair of ribs, the intercostal muscle, which is the muscle used in respiration, may pull or tear due to overstress. This can happen to a tennis or football player who makes a sudden, violent lateral motion or suddenly rotates the rib cage.
As a result, you will feel tenderness between the ribs, not on them. Again, rest the ribs and ice them until the pain disappears, and use a rib belt until you can move about freely.