Broken or bruised ribs are common injuries that occur as a result of trauma to the chest wall. These injuries may result from direct blows (such as during contact sports, accidents, or falls), severe coughing, or repetitive strain. Although painful, they often heal with supportive care, but broken ribs can sometimes lead to complications such as damage to internal organs, making recognition and proper management important.
Causes
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Direct trauma: Car accidents, falls, assaults, or contact sports can directly fracture or bruise ribs.
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Severe coughing: Prolonged, forceful coughing can sometimes fracture or bruise ribs, particularly in individuals with weaker bones (e.g., osteoporosis).
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Repetitive strain: Athletes who repeatedly twist their torso may sustain rib injuries over time.
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Osteoporosis: Weakening of bones increases the risk of rib fractures even from minor trauma.
Symptoms
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Sharp pain in the chest wall, particularly when breathing deeply, coughing, or laughing.
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Tenderness over the injured area.
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Bruising or swelling at the site of injury.
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Pain when pressing on the affected rib.
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Shallow breathing due to pain on deep inhalation.
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In more serious cases: difficulty breathing, dizziness, or symptoms of internal injury.
Diagnosis
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Clinical examination: Tenderness and pain on rib palpation usually indicate the injury.
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X-ray: Can show broken ribs but may miss smaller fractures.
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CT scan: More sensitive in detecting rib fractures and complications.
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Ultrasound: Sometimes used to identify rib fractures or associated injuries like pneumothorax (air leakage into the chest cavity).
Complications
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Pneumothorax: Air escapes into the chest cavity, causing lung collapse.
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Hemothorax: Accumulation of blood around the lung.
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Flail chest: Multiple rib fractures leading to instability of the chest wall and difficulty breathing.
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Infection: Bruised or broken ribs accompanied by lung infection may lead to pneumonia.
Treatment
Most rib bruises and fractures heal on their own within 4 to 6 weeks. Treatment focuses on pain relief, breathing support, and preventing complications.
1. Pain Relief
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Paracetamol (acetaminophen): Commonly used for mild to moderate pain. Adult dose: 500 mg to 1 g every 4–6 hours as needed, not exceeding 4 g in 24 hours.
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Ibuprofen: A nonsteroidal anti-inflammatory drug (NSAID) useful for pain and inflammation. Adult dose: 200–400 mg every 6–8 hours as needed, maximum 1,200 mg daily over-the-counter, or up to 2,400 mg under medical supervision.
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Diclofenac: Another NSAID option, dose: 50 mg orally two or three times daily.
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Opioids (e.g., codeine, tramadol): Sometimes prescribed for severe pain when NSAIDs and paracetamol are insufficient. Example: Codeine 15–60 mg every 4–6 hours, maximum 240 mg/day. These should be used short-term to avoid dependency.
2. Breathing Support
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Encourage deep breathing and coughing to prevent lung collapse and infection. Patients may be given a spirometer device to maintain lung expansion.
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Avoid tight bandages or chest wrapping, as this can restrict breathing and increase pneumonia risk.
3. Activity Modification
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Rest and avoid heavy lifting, twisting, or strenuous exercise.
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Gradual return to normal activity as pain improves.
4. Treatment of Complications
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Pneumothorax/Hemothorax: May require chest tube insertion to remove air or blood.
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Flail chest: Hospitalization with possible mechanical ventilation and surgical rib fixation.
5. Adjunctive Therapies
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Ice packs: Reduce swelling and pain in the first 48 hours.
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Heat therapy: After initial swelling subsides, heat may relieve muscle stiffness.
Prevention
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Use protective gear during sports and work activities.
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Strengthen bones through adequate calcium and vitamin D intake.
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Avoid smoking, as it weakens bone health and lung function.
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Manage chronic cough conditions to reduce rib strain.
Prognosis
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Bruised ribs: Usually heal in 2–4 weeks.
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Broken ribs: Typically heal in 4–6 weeks, though older adults or those with osteoporosis may take longer.
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With proper care and absence of complications, full recovery is expected.
When to Seek Urgent Medical Help
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Severe chest pain not relieved by medication.
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Difficulty breathing or shortness of breath.
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Coughing up blood.
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Dizziness or fainting.
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Signs of infection (fever, productive cough, worsening pain).
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