Introduction

A broken rib, or fractured rib, is a common injury that occurs when one of the bones in your rib cage breaks or cracks. The most common cause of broken ribs is trauma to the chest, such as from a fall, motor vehicle accident or impact during contact sports.

Signs and symptoms of a broken rib include pain, especially when taking a deep breath or pressing on the injured area.

In most cases, treatment of broken ribs is directed at controlling the pain until the fracture heals. Broken ribs usually heal in about one to two months.

Signs and symptoms

Signs and symptoms of a broken rib may include:

• Pain when you take a deep breath
• Pain that gets worse when you press on the injured area, or when you bend or twist your body

Causes

Broken ribs are a common injury, usually caused by trauma to the chest as during a fall, motor vehicle accident or impact during contact sports.

If you have a condition that weakens your bones — such as osteoporosis, a disease that causes you to lose bone density — it’s possible to break a rib with a milder strain, such as a strong coughing spell.

Risk factors

The following factors can increase your risk of breaking a rib:

• Osteoporosis. Having osteoporosis, a disease in which your bones lose their density, makes you more susceptible to a bone fracture.
• Age. Because older adults are more prone to osteoporosis and have less elastic ribs, they are at an increased risk of rib fracture.
• Sports participation. Participating in contact sports, such as hockey or football, increases your risk of trauma to your chest, which can result in a rib fracture.
• Cancerous lesion in a rib. A cancerous lesion can weaken the bone, making it more susceptible to breaks.

When to seek medical advice

See your doctor if you have pain in your rib area that occurs after trauma or is present with deep breaths or hinders your breathing.

If you experience pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes, pain that extends beyond your chest to your shoulder or arm, and increasing episodes of chest pain, get medical attention immediately. These signs and symptoms may indicate a heart attack.

Screening and diagnosis

Your doctor may be able to diagnose a broken rib based on a medical history and physical examination. During the exam, your doctor will ask about your signs and symptoms and may press gently on your chest.

To confirm the diagnosis, you likely will undergo imaging tests, usually a chest X-ray or, on occasion, a computerized tomography (CT) scan.

Complications

When ribs break, the sharp edges can occasionally puncture your lung or surrounding tissue. This can cause blood (hemothorax) or air (pneumothorax) to accumulate in the space between your lungs and the walls of your chest. These conditions require immediate medical attention.

Treatment

Self-care measures, including rest and the use of ice for pain and swelling, are the best treatments for a broken rib.

Over-the-counter pain medications, including acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others), can help relieve discomfort as you wait for the fracture to heal. If the pain is severe, injections around the nerves that supply the ribs (nerve blocks) can be used.

Doctors rarely use compression wraps — elastic bandages that you can wrap around your chest — anymore to help “splint” and immobilize the area. Doctors typically don’t recommend compression wraps for broken ribs because compression wraps can keep you from taking deep breaths, which can increase the risk of lung infections (pneumonia).

Broken ribs usually heal completely in about one to two months.

Prevention

The following measures may help you prevent a broken rib:

• Protect yourself from athletic injuries. Wear protective equipment when playing contact sports.
• Take steps to decrease your risk of household falls. Remove clutter from your floors and clean spills promptly, use a rubber mat in the shower, keep your home well lit, and put skid-proof backing on carpets and area rugs.
• Decrease your chance of getting osteoporosis. Getting enough calcium in your diet is important for maintaining strong bones. Aim for about 1,200 milligrams of calcium daily from food and supplements.

Self-care

Self-care measures — including rest, over-the-counter pain medications and use of ice — are the best treatment for a broken rib. Avoid activities that aggravate the injury or cause more pain, such as:

• Vigorous coughing
• Pressing or putting pressure on your chest
• Bending or twisting your body, such as in sports like golf or bowling
• Contact sports, such as football or basketball

When you overdo it physically, you may experience sudden pain and swelling around a joint or a muscle. The injury you have may be a sprain or a strain. Here’s the distinction:

• Sprain. A sprain is a stretching or tearing of ligaments. Ligaments are tough bands of fibrous tissue that connect one bone to another. Common locations for sprains are your ankles and knees.
• Strain. A strain is a stretching or tearing of muscle or tendon. People commonly call strains “pulled” muscles. Hamstring and back injuries are among the most common strains.

Treatment for sprains and strains depends on the severity. Many times, you can take care of a sprain or strain on your own.

Signs and symptoms

Sprains and strains vary in severity. Signs and symptoms depend on the severity of the injury.

Sprains
Sprains can cause rapid swelling. Generally, the greater the pain and swelling, the more severe the injury.

• Mild. Your ligament stretches excessively or tears slightly. The area is somewhat painful, especially with movement. It’s tender. There’s not a lot of swelling. You can put weight on the joint.
• Moderate. The fibers in your ligament tear, but they don’t rupture completely. The joint is tender, painful and difficult to move. The area is swollen and may be discolored from bleeding in the area. You may feel unsteady when you try to bear weight on your joint.
• Severe. One or more ligaments tear completely. The area is painful. You can’t move your joint normally or put weight on it. If the sprain occurs in the ankle or knee, when you try to walk, your leg feels as if it will give way. The joint becomes very swollen and also can be discolored. The injury may be difficult to distinguish from a fracture or dislocation, which requires medical care.

Strains
As with sprains, signs and symptoms of strains will vary depending on the severity of the injury. Common signs and symptoms include:

• Pain
• Stiffness
• Swelling
• Bruising

If you have a severe strain, the muscle or tendon is torn apart or ruptured. You may have significant bleeding, swelling and bruising around the muscle, and your muscle may not function at all.

Causes

Sprains and strains occur commonly, and most result in minor injuries.

• Sprains. A sprain occurs when you overextend or tear a ligament while severely stressing a joint. Ligaments are tough bands of fibrous tissue that connect one bone to another. They help to stabilize joints, preventing excessive movement. You may sprain your knee or ankle when walking or exercising on an uneven surface. A sprain also may occur when you land awkwardly, either at the end of a jump or while pivoting during an athletic activity.
• Strains. A muscle becomes strained or pulled — or may even tear — when it stretches unusually far or abruptly. This type of injury — an acute strain — often occurs when muscles suddenly and powerfully contract. A muscle strain may occur when you slip on ice, run, jump, throw, lift a heavy object or lift in an awkward position. A chronic strain results from prolonged, repetitive movement of a muscle.

Risk factors

Factors contributing to sprains and strains include:

• Poor conditioning. Lack of conditioning can leave your muscles weak and more likely to sustain injury.
• Poor technique. The way you land from a jump — for example, when skiing or practicing martial arts — may affect your risk of injury to a ligament in your knee called the anterior cruciate ligament (ACL). Past research has shown that landing with an inward rotation at the knee (“knock-kneed” position) can predispose you to an ACL sprain.
• Fatigue. Tired muscles are less likely to provide good support for your joints. When you’re tired, you’re also more likely to succumb to forces that could stress a joint or overextend a muscle.
• Improper warm-up. Properly warming up before vigorous physical activity loosens your muscles and increases joint range of motion, making the muscles less tight and less prone to trauma and tears.

When to seek medical advice

For a sprain, seek emergency medical care in the following situations:

• Popping sound. You may hear a popping sound when your joint is injured; you may have considerable swelling about the joint and be unable to use it. On the way to the doctor, apply an ice pack.
• Inability to bear weight. You’re unable to bear weight on an injured joint because of a feeling of instability or pain.
• Severe sprain. Inadequate or delayed treatment may cause long-term joint or tissue damage.

For a strain, seek medical help immediately if the area quickly becomes swollen and is intensely painful or if you suspect a ruptured muscle or broken bone. Also call your doctor if the pain, swelling and stiffness of less severe strains don’t improve in two to three days.

Screening and diagnosis

With both sprains and strains, the discomfort in the area is the key to diagnosis. Examination may reveal swelling, bleeding in the joint or muscle, and tenderness. Your doctor may order an X-ray to rule out a fracture or other bone injury as the source of the problem. Magnetic resonance imaging (MRI) also may be used to help diagnose the extent of the injury.

Treatment

Treatment for a sprain or strain depends on the joint involved and the severity of the injury.

Mild to moderate injuries
For mild sprains and strains, your doctor likely will recommend basic self-care measures and an over-the-counter pain reliever such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others). In cases of a mild or moderate sprain or strain, apply ice to the area as soon as possible to minimize swelling.

More severe injuries
In cases of severe sprain or strain, your doctor may immobilize the area with a brace or splint. In some cases, such as in the case of a torn ligament or ruptured muscle, surgery may be considered.

Prevention

Conditioning is important
Regular stretching and strengthening exercises for your sport, fitness or work activity, as part of an overall physical conditioning program, can help to minimize your risk of sprains and strains. Try to be in shape to play your sport; don’t play your sport to get in shape. If you have a physically demanding occupation, regular conditioning can help prevent injuries.

Your own ‘muscle brace’ is best
If you’re prone to sprains, taping, bracing or wrapping knees, ankles, wrists or elbows can help while you’re recovering from injury and when you’re first getting back into your regular activities. It’s best for many people to regard taping, bracing and wrapping as short-term protective measures.

You can protect your joints in the long term by working to strengthen and condition the muscles around the joint that has been injured. The best brace you can give yourself is your own “muscle brace.” Ask your doctor about appropriate conditioning and stability exercises. Also, use footwear that offers support and protection.

Self-care

For immediate self-care of a sprain or strain, try the P.R.I.C.E. approach — protection, rest, ice, compression, elevation. In most cases beyond a minor strain or sprain, you’ll want your doctor and physical therapist to help you with this process:

• Protection. Immobilize the area to protect it from further injury. Use an elastic wrap, splint or sling to immobilize the area. If your injury is severe, your doctor or therapist may place a cast or brace around the affected area to protect it and instruct you on how to use a cane or crutches to help you get around, if necessary.
• Rest. Avoid activities that cause pain, swelling or discomfort. But don’t avoid all physical activity. Instead, give yourself relative rest. For example, with an ankle sprain you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest peg. That way you still exercise three limbs and keep up your cardiovascular conditioning.
• Ice. Even if you’re seeking medical help, ice the area immediately. Use an ice pack or slush bath of ice and water for 15 to 20 minutes each time and repeat every two to three hours while you’re awake for the first few days following the injury. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the area turns white, stop treatment immediately. This could indicate frostbite. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.
• Compression. To help stop swelling, compress the area with an elastic bandage until the swelling stops. Don’t wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area.
• Elevation. To reduce swelling, elevate the injured area above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Continue with P.R.I.C.E. treatment for as long as it helps you recover. Over-the-counter pain medications such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) also can be helpful. If you want to apply heat to the injured area, wait until most of the swelling has subsided.

After the first two days, gently begin to use the injured area. You should see a gradual, progressive improvement in the joint’s ability to support your weight or your ability to move without pain.

Mild and moderate sprains usually heal in three to six weeks. If pain, swelling or instability persists, see your doctor. A physical therapist can help you to maximize stability and strength of the injured joint or limb.