A rib fracture is a fairly common musculoskeletal injury and is usually the result of blunt force trauma (slips and falls, car accidents, or hard tackles in football), overexertion (swinging a golf club) or a barrage of violent coughs. There are several degrees of severity of rib fractures, ranging from minor injuries or minor fractures, to serious rib fractures with serrations at the ends of several pieces of the rib. In such cases, complications from rib fractures can range from mild discomfort to life-threatening conditions, such as a pneumothorax (punctured lung). It can be helpful to learn how to assess potential fractures at home so you can determine if you need to see a doctor. However, the final diagnosis can only be made by a professional. Therefore, if you have any doubts about an injury involving the ribs, don't risk it and seek medical attention.
Part 1 of 2: Assessing Rib Fractures at Home
Step 1. Understand basic human anatomy
You have 12 sets of ribs to protect your internal organs and allow for attachment of various muscles so you can move and breathe. The ribs are attached to the 12 thoracic vertebrae and are most converging and connect to the breastbone (sternum) in front. Some of the "floating" ribs at the bottom protect the kidneys and are not connected to the sternum. The top rib is at the base of your neck (below your collarbone), while the bottom rib is a few centimeters above your pelvis. The ribs are usually easily visible under the skin, especially in thin people.
- The ribs in the middle are most commonly fractured (4 of 9 ribs). Usually, the rib fractures at the point of impact or at the greatest arch, which is the weakest and most vulnerable part.
- Rib fractures are rare in children because their ribs are more flexible (the majority are cartilage than adults) and tend to be difficult to fracture.
- A risk factor for rib fractures is osteoporosis, a condition that often occurs in people over the age of 50 and is characterized by bone loss due to mineral deficiencies.
Step 2. Look for a swollen deformity of the chest
After removing the shirt, find and feel the area of the torso where the pain is coming from. In smooth rib fractures, no deformity is seen. However, there should be a point that is sensitive to pain and may swell (especially if trauma has occurred in the area). In more serious rib fractures, (several bones are broken or separated from their walls), a flail chest may appear. Flail chest is the term used when the broken chest wall moves against the movement of the chest during breathing. Therefore, the injured area will be sucked in when the patient's chest expands when inhaling, and pushed when the chest contracts when exhaling. More serious rib fractures tend to be very painful and increase swelling (inflammation) and bruising quickly from damaged blood vessels.
- The flail chest is sometimes easy to see when the patient is lying on his back and is shirtless. This condition is easy to find when you see the patient breathing and hear his lungs
- Healthy ribs are usually quite flexible when applied to pressure. However, a broken rib will feel unstable and lowered by the pressure so it is very painful.
Step 3. See if the pain increases with deep breaths
Another common rib fracture symptom is increased sensitivity to pain when taking deep breaths. The ribs move with each breath so taking a deep breath will cause pain. In serious rib fractures, even shallow breathing can be painful and difficult. Therefore, patients with severe rib fractures tend to breathe quickly and shallowly which can lead to hyperventilation and then cyanosis (bluish discoloration of the skin due to lack of oxygen).
Step 4. Check for reduced movement
Another symptom of a rib fracture is a reduced range of motion in the torso, especially sideways rotation. Patients with stab fractures are unable or reluctant to twist, bend, or flex their upper body laterally. Again, mild stress (fine fracture) is less restrictive of the patient's movement than more serious injuries.
- A broken rib at the junction of the cartilage attached to the breastbone can be very painful, especially when rotating the upper body.
- The combination of restriction of movement, impaired breathing, and sensitivity to pain can limit a person's ability to exercise and move, even in minor fractures. The patient should not exercise until the injury has healed.
Part 2 of 2: Obtaining a Medical Assessment
Step 1. See your doctor
If you or your partner has experienced any form of trauma that causes ongoing pain in the torso, visit your doctor immediately to receive a thorough physical examination and find the best strategy. Even if the pain is mild, you should still visit a health professional.
Step 2. Know when to receive emergency care
You should receive medical care if you have a life-threatening complication, such as a pneumothorax. Symptoms and signs of a punctured lung include difficulty breathing, sharp pain in the chest (plus pain from a fracture), cyanosis, and extreme restlessness accompanied by a sensation of inability to breathe.
- Pneumothorax occurs when air is trapped between the chest wall and lung tissue. This can be caused by a rib fracture that tears the lung tissue
- Other organs that can be punctured or torn by a rib fracture include the kidneys, spleen, liver, and heart (rarely).
- If you experience the above symptoms, go to the nearest emergency room immediately or call emergency services.
Step 3. Get an X-ray scan
X-rays, along with a physical examination, can visualize the bones and are effective in diagnosing the presence and severity of most rib fractures. However, stress or smooth fractures (sometimes referred to as rib "cracks") are difficult to detect on X-rays because of their small size. Therefore, several series of X-rays may be needed after the swelling subsides (about a week or so).
- An X-ray of the chest is also useful in diagnosing lung function failure because fluid and air can be visualized on X-ray films.
- X-rays can also detect bone bruising, which can be mistaken for a fracture.
- If the doctor is sure of the location of the patient's fracture, a more centralized X-ray scan may be performed to enlarge the scanned image.
Step 4. Get a CT scan
A subtle rib fracture is not a serious injury and can usually be treated with painkillers or anti-inflammatory drugs until the fracture heals on its own. CT scans can often find fractures of the ribs that regular radiographs (X-rays) miss and injuries to organs and blood vessels that are easier to see.
- CT technology uses various X-rays from several angles and is combined via computer technology to display a cross-section of your body.
- CT scans are much more expensive than regular X-ray scans so make sure your health insurance covers the cost.
Step 5. Get a bone scan
A bone scan is performed by injecting a small amount of radioactive material (radiotracer) into a vein, which then spreads through the blood into the bones and organs. Because the effect wears off, the radiotracer emits only a small amount of radiation, which can be captured by a special camera that scans the patient's body slowly. This tool is useful for viewing even the slightest fine and stress fractures (even new fractures that are still inflamed) because the fracture appears lighter on a bone scan.
- Bone scans are effective in showing minor stress fractures, but because these injuries are not very severe, the risk of potential side effects associated with the bone scan procedure may not be worth taking.
- The main side effect is related to an allergic reaction to a radioactive material (radiotracer) that is injected into the bone.
- In the past, doctors used to use compression bandages to keep broken bones from moving. However, this method is no longer recommended now because it reduces the patient's ability to breathe deeply, which increases the risk of pneumonia.
- Treatment for most bone fractures includes rest, cold therapy, and short-term use of pain medication or anti-inflammatory drugs. Rib fractures cannot be cast in a cast like other fractures.
- Sleeping on your back is usually the most comfortable position for fracture patients.
- It is also recommended to do deep breathing exercises several times a day to reduce the risk of pneumonia.
- Increasing the strength of the chest wall by applying pressure over the injured rib can relieve acute pain from coughing, straining, etc.