It’s Dr. Parker again and in this post I’m going to talk about rib fractures. Rib fractures are a pretty common problem I see, and it’s not just the young dare-devil types! I often see folks in their 50s, 60s, 70s and 80s with multiple rib fractures. These are the result of a wide range of accidents – anything from falling off of a bench to getting bucked off of a horse. Of course, in Jackson in the winter time, skiers/snowboarders and snowmobilers are common recipients of a good ole’ fashioned butt kicking from mother nature.
Rib fractures can be mild to life threatening, depending on the severity of the injury and other associated injuries. I’m going to talk about common associated injuries in another post, so this one I’ll just stick to rib fractures.
Commonly, patients present with one or two non-displaced fractures (meaning the bones are still in the right place, they are just broken) and no other organ injury. This is the simplest form of rib fracture. The good news is, there is no surgery needed for something like this. The bad news is, there is no good way to splint the rib fractures. Some people may find some comfort in “taping the ribs or wearing a tight-fitting undergarment. If this works for you, great….if not….no big deal.
Our goal is to get you fairly comfortable using pain medication and avoid other complications commonly associated with rib fractures. The medication will not be able to take all of your pain away, but the main objective is to get you breathing and moving fairly easily. One of the main complications that can arise after rib fractures is pneumonia. When we have ribs fractured, we don’t want to take normal deep breaths. We often breathe much more shallow than normal. This lets the lung partially “collapse” in the bases and outer portion.
(Quick anatomy lesson….the lung is made of millions of microscopic sacs which take the oxygen in the air, and put it into the blood. If not kept inflated normally, these microscopic sacs can collapse. When they collapse, they are a good place for bacteria to attach to and start multiplying thus, causing pneumonia).
So to prevent pneumonia after rib fractures, I like to give patients a good amount of narcotic pain medication for the first 3 or so days. This is the time when the pain peaks and starts to subside. If we can keep you comfortable and breathing normally, we can lower your chance of pneumonia. In addition to breathing normally, we generally have patients use a “spirometer”. This is a little plastic machine that helps you determine exactly how much (in millilitres) you are breathing in when you take a deep breath. This just helps you monitor the deep breaths and actually put a number on them, instead of guessing.
The downside to taking narcotic pain medication is that it can make people very constipated. This is why I start a stool softener with everyone who has rib fractures and is taking narcotics. I generally give patients Senokot twice daily to prevent constipation. Some patients may need a little extra to keep them regular, and in this case, I start Milk of Magnesia twice daily as well. You should continue to take stool softeners as long as you are still taking narcotics.
The other main complication that is associated with rib fractures is “Deep Venous Thrombosis” or DVT. A DVT is basically a blood clot that usually start somewhere in the lower extremities. The dangerous part about a DVT is that it can break loose and then “embolize” or “travel through the blood stream” to the lungs. This is called a “Pulmonary Embolism”, or PE. PE’s can be very small and virtually have no symptoms, or they can be very large and result in death. So, we definitely want to prevent against a DVT and PE while you are in the hospital. There are a couple reasons people get DVTs after rib fractures. It’s not necessarily the ribs being broken which is the problem, but that the patient has sustained a significant trauma. Just like when you cut your finger accidentally, the body will try to “stop the bleeding” by producing blood clots. In a significant trauma, where ribs are broken and maybe even some other organs are bruised (skin, muscle, spleen liver), the body will try to “stop the bleeding” by forming clots. The body will be in a “hypercoagulable state” (coagulate = blood clotting). So, we develop a hyper-clotting state after major trauma, or even surgery. Depending on the trauma, the elevation of the clotting status will be variable, but combine that will laying in a hospital bed for a couple of days (the blood then doesn’t circulate as well….or as fast as if you were up walking or running around) and now we have a pretty good set up for blood clots…..or DVTs and subsequent PEs.
So prevention measures consist of two things. First, we get you walking as soon as possible, and we thin your blood just a little bit to prevent excessive clotting. The walking prevents DVTs by keeping good blood flow and circulation. The slower the blood flow, the easier it is for your body to make clots, so the walking prevents against that. Second, is the blood thinner. It’s a little stronger than aspirin, and not quite as strong as Coumadin (if you are familiar). Everyone who sustains a significant trauma (including rib fractures) will receive this blood thinner while in the hospital. When you go home, we typically stop the blood thinner because you are generally more active at home than in the hospital. Those are the main complications we are trying to avoid with rib fractures, so when I come in and ask how your deep breathing and walking is going, you’ll know why.
Lastly, patients always want to know “when they can get back to normal activity”. Well, unfortunately the only thing that is going to heal those ribs is time. In general, bones take about 6-8 weeks to heal well. You, of course, will be feeling much better in about 1-2 weeks, but you should gradually increase your activity during those 6-8 weeks. It’s fairly normal to have a few good days followed by a really bad day (as far as pain is concerned). As long as you are improving week to week, you are on the right track.
I hope this has given you a little insight to the natural course of rib fractures and what to expect while you are in the hospital.
-Dr. Buck
P.S. Please leave comments or questions for me below. Thanks!
Hi Dr. Buck, I cracked my scapula & first 8 ribs when i fell almost flat on my back on the left side. Its been 8 months and the lower part just under the shoulder blade that took the hit is still numb to the touch. Will this ever go away? Is it from circulation or nerves?
thanks much
Hi John,
If it’s just the skin that is numb, it may or may not improve with time. This is from skin nerve damage. I actually have this myself on my back after 5 years a little spot is still there.
Happy Holidays!
Dr. Buck
HHello I fractured my 11 th rib on the left side of my chest on 11-14-13er doc said to rest for two weeks and not lift anything over 20 lbs. If it is fractured though and it takes 6 – 8 weeks to heal but he told me to only rest for two weeks. does this mean i can continue back to my normal routine. horse riding in two weeks or should i wait six weeks for the bone to completely heal? Should i go to an orthopeodic doc. i was diagnosed with the fracture in the er after i fell off a trainer horse. a horse that im riding that is in training .
Hi Doc, I had a fall two weeks ago and X-rays came back saying I had bent ribs 4, 5, & 6. How dose a rib bend without breaking? It is extremely painfull and painkillers do nothing. Should I seek further tests or treatment? Thanks Jo.
Hi Dr Buck, i found it very interesting reading all the posts, as I could relate to some of them. I am based in South Africa and was involved in a serious car accidet 18 months ago. Fracturing 10 ribs on my right and 2 ribs on left also fracturing my sternum in two places. Unfortunately my full injuries was only diagnosed a few months after the accident by a Trauma cardiotologist which resulted in the ribs overlapping and nerves being exposed (if that sounds right) and the sternum also not properly healed. The end result – continous discomfort and pain in by upper breast/shoulders and side to back of my body. The Cardiotologist did indicate that he could operate and re-attach the ribs but is not advisable due to the seriousness of the operation. Any advice from your side?
Hello Dr. Buck,
First, thanks and kudos for providing this info–this is one of best resources for rib injuries I’ve found. And believe me, I have been googling a lot since I hurt myself last week.
Now to my question. Last week I fell while rollerskiing. My elbow jammed into the side of my ribcage and now I have severe pain at several points on my lower right abdomen–pretty much right where elbow concentrated force of impact onto my ribs.
I am guessing I bruised or fractured ribs because I have all the classic symptoms–pain sitting up, rolling over in bed, coughing and when I press on injured ribs. Area is also very tight, perhaps due to muscle spasm. No problems breathing, thankfully.
Now my question–is there any reason to avoid gentle exercise while rib heals? I would like to start some gentle running ASAP because it keeps me sane and I don’t want to lose fitness. It’s now been about one week since injury.
I will avoid anything that strains upper body or uses abdominals (lifting weights, pullups, ski poling) or risks another fall.
If I can do some moderate exercise (with help of some ibuprofen) I will be much happier in next 3-6 weeks while this injury heals. Is that a good idea?
As background, I am in my mid 40s and have remained active most of my life (now probably about 6-10 hours of running, XC skiing and gym exercises per week).
Thanks!
Nordic (injured) Skier
Hi Dr. Buck,
My wife and i were in a bad Motorcyle accident june 2011. she fractured her C6 and C7 vertebra and had them fused with a caging. that seems to have healed OK. She also broke about 7 rib on her right side. they have healed but a little funny. the most recent CT scan shows 3 of her ribs(near the caging) have “bridged” or fused together with bone in her intercostal spaces. we have been trying to figure out her source of pain for 2 yrs now and no doctor can seem to help get her out of pain. we think it might be the ribs now but we can’t find a neuro/ortho surgeon willing to look at the entire picture. Do you think her ribs “bridging” could be the main source of pain that wont go away? crushing a nerve or something?
I can e-mail pics of the recent 3d CT scan if your up for a challenge 🙂 thanks in advance for any assistance or direction. we’re becoming hopeless!
Thanks,
Jamie Wright
Hi Jamie,
It’s possible the nerves were injured or are being impinged on with the new growth of bone. I would do a trial of a “rib-block”. This is basically an injection of local anesthetics in between the ribs where the nerve is. If the pain goes away, you know that’s the problem. The block only lasts for a few hours, so a definitive treatment will then have to done subsequently.
Hope this helps
-Dr. Buck
Thank you for the quick response. She has done an intercostal nerve block on her ribs and also CT guided nerve root blocks in the past. the root block lasted 1-3 days at most and the intercostal block only a few hours of relief.
Based on the temporary relief and the newest scans showing the fused/bridged ribs near the spine, how would we fix this long term?
What type of doctor would we need to go to to look at the entire picture of ribs and spine? I assume a surgery would be needed to romve the excess bone? We can’t find a doctor/neuro/ortho/surgeon who will even look at her case let alone give any answers.
Again your help is extremely appreciated!
Thanks,
Jamie Wright
Hi Jamie,
This is definitely a difficult problem…you’re right, not many doctors will want to treat this and I’ll tell you why. Basically this is not a common problem…and it’s very difficult to tell what EXACTLY is causing the pain. Sure, we know that there is some strange bone growth there, and that there is pain from the intercostal nerves. The problem is that there is no pinpointed piece of bone that is causing the pain, or pinpointed nerve spot that we know the pain is coming from. So, can someone take that bone out and see what happens? Yes. But since there is no guarantee the surgery will make her better, then the liability for the surgeon is very high. The bottom line is if there is a complication from the surgery….and the surgery does not have a strong indication, that surgeon is extremely exposed to a lawsuit. There are very few surgeons who will tell you and your wife in a straightforward manner “I will do this surgery, but there is a high chance we will not fix your problem”. Simply because it is easy to get burned in this situation. That being said, I think a Trauma or Thoracic Surgeon would be your best bet in this situation. Most General Surgeons do not operate much on ribs. Since this was trauma related you may get a Trauma Surgeon to understand the problem….but Thoracic Surgeons also may have some insight to this problem. If you tell me what city you are in/near, maybe I can give you some recommendations. Send an email to: drbuck@jhsurgery.com with your city of preference.
Hope this helps!
-Dr. Buck
Hi Dr. Buck,
Sorry for the delay as i was out of the country. I have just sent you an e-mail with Some information such as our location, some images, some past information, and current/past doctors we are trying to see.
thanks for the help,
Hi Dr. First off, I’m impressed that you’ve been keeping up with the comments considering the date of your original post.
I broke my 3rd through 7th rib on my right and punctured my right lung 2 days ago in a boating accident. only issue is I’m in Thailand! therefore I’m finding it a bit difficult to make myself understood / understand any answers I’m given.
as I understand it, 2 ribs are cleanly fractured, not displaced, and two are overlapping- will this restrict any movement? I’m quite an active person and am looking forward to getting back to physical fitness…how long will it take?
Hi Sam,
Thanks for the compliment…and sorry I’m getting back to you so late! It is a pretty rare occasion that the ribs need to be operated on for displacement. If you are young and healthy and active (which it sounds like you are), your ribs will heal OK. They may not be perfectly aligned, but that should not restrict you at all. It will take several months to get back to normal….but you will get there. Healing from broken ribs can be more like a marathon than a sprint. Give them time….and you will be back to your normal active self….but really..they will need some time.
-Dr. Buck
Hi,
I am a cheerleader and recently while doing a backflip I fell straight out of the air onto my knees very hard. As I landed on my knees, my torso was leaned to the left slightly & the impact left me with pain in my lowest left rib. I can’t twist my torso to the left or bend my back backwards without intense pain. My coach tells me I strained a muscle but I’m not sure how an impact could do that. I’m thinking its my rib because I only get pain when I press on it, not anywhere else even the rib directly above it. Could I have broken my rib in this fall and what do I do? Thanks!
I fractured probably 2 ribs ( nine and 10) 14 months ago… Was not diagnosed until 2 months ago. So had all the wrong therapy since it was thought it was just muscle spasms… In the meantime, I fractured the eighth Rib trying to exercise… Had three mall unions and so had surgery on all three ribs with two plates put in. what is the timeframe for these ribs now to heal? It still hurts all the time and I feel occasional popping… If I walk does it impair the healing…
Thx
Sally
Hi Sally,
It should take about 6 week for the ribs to be about 60% of the strength they were before. Total healing time is about 8 weeks. Walking should not impair the healing.
Dr. Buck
I broke 8 ribs(3-10 on the Left) last Friday. 4 of them are displaced. getting into and out of bed is horrid. are there any comfort measures? I usually dangle on the side of the bed and then lean to my right and my husband slowly lowers me to the bed to get in which hurts but is not as bad as getting up. to get up I inch over to the edge and bend at the waist with my legs hanging off the bed and my husband lifts me. which is ok till I am almost upright then intensely painful for about 15 seconds.
Hi Rachel,
Sorry to hear. Yes, these are very painful to heal the first week. Hopefully you got some narcotic pain medication and muscle relaxants. If you feel the pain is still too much, I think you should see your doctor again to adjust the dose or type of medication.
-Dr. Buck
Hi Dr. Buck,
Thank you for all of this information and continuing to answer everyone’s questions. When I was 16 I had a really bad case of bronchitis which I think caused a rib fracture or a dislocated rib… I’m not sure exactly what but I went to my chiropractor and he laid me down and used his knee on my back to pop it back and it felt a lot better after that because I could breathe deeper and the pain wasn’t as bad. Over time, the pain eventually went away. Flash forward and I’m now 22 and for the last couple years whenever I go running (usually around 4 miles a few times a week) by the time I get to mile 2 I feel immense, uncomfortable pain in the same place that my rib was dislocated or fractured when I was 16. The pain primarily comes when I’m running or walking for long distances really quickly when my lungs are working hard. I don’t know if it never quite healed properly since my injury at 16 or what and as of this month the pain has been slightly noticeable even when I’m walking. Is there anything at this point that I should do? Would there even be any treatment for something like this? My main concern is that its the exact same pain and rib location from when I was 16. I’m worried it didn’t heal properly or that I’ll just have to deal with this pain forever which makes running unbearable after a couple miles.
Thank you so much I really appreciate your time and care,
Emily
Dr Buck, Great information. I just re-injured my lower ribcage. Originally damaged it sparring last week of May. Have a fight already set last week of August. Professional Boxing. Do you think that will be enough time to heal and is there any exercise or treatment that can speed up the recovery. Hate to let promoters down and I really need this fight. Thanks for your time.
Hi John,
I think you are probably cutting it close. If you re-broke it this week, and you get it injured again in late august, my guess is that it may break again easily. 6 weeks are usually needed for the bones to heal well….so I think they will be partially healed, but just weak. Not much you can do to speed up the process.
-Dr. Buck
Dr.Buck, Thanks for the quick response. I had an x-ray today. Tenth rib on left side is broke with slight displacement. Will this slight displacement affect the ribs strength in the future once it’s healed?
Thanks again, John
Dead Dr.
I had a boating accident 2 mths ago. I recently found out after complaining of chest pain that I have 12 fractured ribs and a cracked stern in 2 places. To add to my problems I developed a blood clot in my lung which was diagnosed prior to all these fractures. I know it takes time and am on Comadin for the PE. My question, I am having alot of popping on the rt side, top of my ribs. ( I fractured 2-8 on the rt., and 2-6 on the left) is this normal?? Or do I need another x-ray?
Hi Carroll,
Some rib popping is normal after fractures in some people. However, at 2 months after your accident, it seems to be too much time. I think I would like to see an x-ray to make sure it’s healing correctly.
-Dr. Buck
Hello Dr,
Im in the Army and fractured my 9th rib in the rear doing combatives a little over a year ago. Its still quite painful to run and in some cases even to walk at a brisk pace. I sometimes have the feeling of it ” popping” similar to popping your fingers. But it is most of the time very painful when my rib “pops” Ive talked to friends of mine that have said that my ribs will never be the same. But Id like your opinion. Jonathan
Hi Jonathan,
I think it would be best to see your physician or a general surgeon. Sometimes ribs do not heal at all and that would be a reason to have an intervention so you don’t experience this forever. Other times it can be the muscle is still weak around the joint and the joint itself is popping. In which case physical therapy might be your answer. Either way I recommend seeing your doctor.
-Dr. Buck
Hi Dr,
I am a Jiujitus practicioner, last week I rolled with my friend, and when I do hip escape, something popped in my left rib, I think in the lower, in the 1st day, it was hurt, and hardly get up to my bed, and manage to lay down, but when I walking its not hurting, in my 6th day, i felt the hurt sensation was subsided, when I getting lay down, the pain is subsided, and manageable, but still a little pain, I am just wondering, Is this broken, or cracked or what ever? because it still swollen, and not same in my right rib, what can I going to do to back in the normal? Thanks, not yet x rayed.