What is a rib fracture and a rib stress fracture?
A rib fracture is the term for a break or fracture in one or more of the bones of the rib cage. A rib stress fracture is similar to a rib fracture only the break along the rib is incomplete and more like a crack than a break. Occasionally a break in the thick cartilage that connects the ribs to the breastbone may also be called a fractured rib even though there is no damage to the rib itself. The rib cage consisting of 24 ribs forms a core portion of the human skeleton providing protection for your internal organs, supporting your shoulder blade and upper arm movements and facilitating breathing. Your ribs are interconnected by intercostal muscles when you breathe in these muscles contract drawing each rib up and creating more room within the rib cage for your lungs to expand. As you breathe out the lungs decrease and the muscles start to relax returning the ribs to their resting state.
Why and when do rib fractures and rib stress fractures happen?
The most common cause of a rib fracture is a direct trauma to the chest, often from a bike or car accident or a fall. Stress fractures have been known to be caused by minor injuries like mild knocks to the side and even coughing hard although this typically only happens when there is an underlying bone weakening condition like osteoporosis and therefore is more commonly seen in the elderly. Full rib fractures can also occur without direct trauma, this is normally only seen in athletes who repetitively push their bodies to the limit often seen in rowing and throwing sports. The most commonly fractured ribs are the 7th and 10th ribs, the first rib normally escapes injury as it sits behind and is protected by the collar bone. However the first two ribs can be fractured during head and neck injuries. This is considered a medical emergency as the fractured bone can cause serious injury to the nerves and blood vessels.
A fracture to one of the lower ribs carries the potential complication of injuring the diaphragm and when more than three ribs are broken and each rib is broken in several places it creates what is known as flail chest. Flail chest is when the detached portions of rib bone move independently to the rest of the chest. This means that a portion of your chest doesn’t move with the rest of your rib cage, decreasing the space in your chest for your lungs to expand, making breathing laboursome and painful.
What does a rib fracture and a rib stress fracture feel like?
A rib fracture from trauma causes a very intense immediate sharp pain around the fracture site this pain can radiate around into the chest, mid back or up into the neck or abdomen. The fracture is often accompanied by swelling and bruising and aggravated by most movements including arm movements. Occasionally a grating sound will heard with breathing or movement. The fracture will mean that even shallow breathing is painful with deep breathing causing excruciating pain; the pain will increase with the number of fractures. Pressure over your breastbone will reproduce pain over the fracture site. Feel short of breath. A flail chest leaves patients feeling anxious, restless, dizzy and very tired most will also experience headaches.
The intense pain after a break will last for several hours to days which will be aggravated by movement and examination. When the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a rib fracture and a rib stress fracture be diagnosed?
Patients will be taken to A&E and a full examination of your chest and lungs will be done to rule out any additional injuries or complications. Your doctor will order a chest X-ray to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally if the extent of the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Rib fractures don't always show up on X-rays, your doctor may continue to treat you with a working diagnosis of a fractured rib, even if an X-ray doesn't show any broken bones. Doctors may also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the muscles, ligaments or cartilage and not indeed from a fracture. The occurrence of a chest fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for rib fractures and rib stress fractures?
There is no specific treatment for rib fractures only supportive measures to help with the pain control. Flail chest on the other hand is a medical emergency and a potentially life-threatening injury; the patient will often require breathing assistance. Healing times for rib fractures vary depending on the position and severity of the fracture and also on the complications from any additional injuries. Most cases of rib fractures do not need surgery however it is occasionally necessary to surgically stabilise multiple fractures or some severe complete breaks. Patients will initially have to rest and avoid aggravating activities whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. A rib fracture and stress fracture can take anything from 6 -10 weeks to heal if not longer for more severe multiple breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen and mobilise the upper body to aid the healing process. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. Rehabilitation exercises as well as massage and some manipulative therapies will aid in recovering the mobility in your chest and mid back. It is recommended that you only use these therapies once your rib has completely healed.