AT A GLANCE: Rib injuries can range from bruises and stress injuries to fractures with overlapping symptoms. Here are the key things you will learn about rib injuries from Gerald Megna, MD, a sports medicine physician with Advocate Health, in this article:
- Rib injuries can happen after falls, car accidents, sports collisions, or even severe coughing.
- Severe pain, trouble breathing, rapid breathing, feeling faint or a racing heart rate are reasons to seek care.
- Doctors may use a physical exam, X-ray, ultrasound, or other tests to check for rib fractures and complications.
- Broken ribs can lead to lung problems, including pneumothorax, hemothorax, or pneumonia if pain limits deep breathing.
- Recovery can take weeks with bruised ribs often healing in four to eight weeks and broken ribs taking up to 12 weeks or longer.
Have you ever bruised or broken a rib? Whether from a fall, sports collision or even severe coughing, rib injuries can be painful and slow to heal. But not every rib injury is the same. A bruised rib, stress injury and broken rib can all cause similar symptoms while carrying different risks and recovery timelines.
The AMA’s What Doctors Want Patients to Know™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.
For this installment, Gerald Megna, MD, a sports medicine physician at Harbin Clinic Family Medicine Rome, which is part of Atrium Health, took time to discuss what patients need to know about rib injuries, warning signs to watch for and when it’s time to seek medical attention.
Atrium Health is an affiliate of Advocate Health, which is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Rib injuries exist on a spectrum
“It’s kind of hard to describe because there’s a spectrum,” Dr. Megna said. “A bruise is something where you damage the cartilage or the actual bone, where a break is something that actually breaks the bone.”
“A cracked rib is usually a rib fracture,” he said, noting that “when you think of fracture or cracked, you think of actually visibly seeing a deformity in the bone.”
Patients can also develop stress injuries.
“You can get a stress injury to the bone, which is not necessarily a fracture, but it is damage to the bone,” Dr. Megna said. “There’s no real fracture line.”
Stress injuries are often caused by repetitive motion.
“We had a golfer hitting a thousand golf balls a day for months,” he recalled. “Eventually, that repetitive trauma caused a stress injury in the bone. It wasn’t actually a fracture, but if he kept going it could have developed into a fracture.”
Falls, sports and even coughing can cause rib injuries
“A lot of trauma causes rib injuries,” Dr. Megna said. “People fall off of ladders, fall on their side and get rib fractures that way.”
“Car accidents, falls, football injuries, hockey players getting hit—they can all cause rib fractures,” he explained.
Older adults with osteoporosis, patients with metastatic cancer that thins bones, and patients with COPD face additional risks.
Severe pain and breathing trouble are warning signs
“Pain is a strong indicator,” Dr. Megna said. “But everyone experiences pain differently.”
Patients should also pay attention to breathing symptoms.
“If they notice any difficulty breathing, especially with deep breaths or rapid breathing, any changes in their breathing, any changes in their pulse or heart rate,” he said, “those can all be signs of a worsening condition.”
In severe cases, rib injuries can affect nearby blood vessels or the lungs,” Dr. Megna said. Higher rib fractures may be especially concerning because “you have a lot of vessels that run through your neck,” he explained. “A rib one or two injury, if it goes backwards, can sometimes damage those vessels and cause other issues.”
Doctors use exams and imaging to diagnose rib injuries
“A good medical history and good physical exam” are important when evaluating a rib injury, Dr. Megna said.
Doctors will often listen to lung sounds, check vital signs and look for visible bruising or deformities.
“You can get what’s called flail chest, where you have multiple rib fractures in multiple locations,” he explained. “When you’re breathing, it moves the opposite way of what it should.”
Imaging is also commonly used to determine the severity of the rib injury.
“Usually, an X-ray is probably what you’re going to get to see if there’s a rib fracture,” Dr. Megna said. “If you're having some chest pain, an EKG may be ordered just to make sure there are no other signs going on.”
“You can sometimes ultrasound over the ribs and see little deformities,” he said, adding that doctors may also look for complications such as pneumothorax, which is a collapsed lung.
Physicians might perform an exam “to make sure there’s no pneumothorax or blood in the lung space,” Dr. Megna explained.
Broken ribs can lead to complications
Rib fractures can affect breathing and lung function. “You can get a bruised lung or lung contusion, which can lead to issues as well,” Dr. Megna said.
Patients with severe fractures can also develop pneumothorax or hemothorax. “A pneumothorax is almost like a collapsed lung,” he explained. “A hemothorax is where blood fills that space and doesn’t allow the lung to expand.”
Pain itself can create additional problems.
“People don’t want to take deep breaths because it hurts,” Dr. Megna said. “If they’re not taking deep breaths, they can develop pneumonia or other respiratory distress issues from not being able to open their lungs up.”
Recovery from a rib injury can take a long time
“It takes a long time” to heal from a bruised or broken rib, Dr. Megna said. “A lot longer than you would think.”
“Usually, bruised ribs can take anywhere from four to eight weeks to heal,” he explained. “Broken ribs can take up to 12 weeks, if not longer.”
Dr. Megna recommends using Tylenol or ibuprofen to control pain during the healing process.
“Sometimes you need something a little stronger, like a muscle relaxer,” he said.
Other pain-management options may include nerve blocks or local injections.
“There are other modalities where you can do thoracic nerve blocks or intercostal blocks to help numb the affected area,” Dr. Megna explained.
Dr. Megna also recommended using an incentive spirometer, a device that helps encourage deep breathing, “to keep your lungs open and prevent pneumonia during the healing process.”
Every movement can hurt with rib injuries
“You don’t think about how much you use your ribs,” Dr. Megna said. “Every time you cough, take deep breaths, laugh or make certain movements, it hurts.”
That constant movement is part of why recovery can be so frustrating.
“Every rib injury is different,” Dr. Megna said. “Unfortunately, it’s a hard pain to treat.”
Preventing rib injuries depends on the cause
“Prevention is hard, because we obviously don’t expect to get in a car accident,” Dr. Megna said, emphasizing that “some things just happen.”
For athletes, protective padding can help reduce risk. For example, he said, “if you see quarterbacks, they’ll wear a flak jacket that comes around and helps protect the ribs.”
Additionally, “making sure your screenings are up to date is important especially in the older populations with osteoporosis, and with their cancer screenings,” Dr. Megna said. “If you have a smoker, obviously trying to do some smoking cessation and counseling because all those things can put you at higher risk of these pathological fractures and thinning of the bones.”
Be cautious about “cracking” someone’s back
“Messing with your spine, unless you know exactly what you’re doing,” Dr. Megna said, “there are complications you can get from that too.”
“Rib fractures obviously can occur with that,” he added.
Know when to seek medical care for a rib injury
Patients should seek care right away if they develop breathing problems or experience severe pain after a rib injury.
“If they’re having any difficulty breathing, if their pain is uncontrolled or unbearable, if they start to have rapid breathing or feel faint or their heart is racing, those are reasons to get evaluated,” Dr. Megna said. Also, “if they notice an obvious injury or they’re just uncertain, get evaluated.”
“I’d rather you come in and it be nothing than you not come in and it be something,” he emphasized.
Urgent care centers and physicians can help determine whether imaging or additional treatment is needed for a rib injury.
When in doubt, get checked out
Ultimately, Dr. Megna said no two rib injuries are exactly alike. But because rib injuries can sometimes lead to serious complications, he emphasized the importance of not ignoring symptoms.
“When in doubt, get evaluated,” Dr. Megna said. “It’s better to be safe than miss something.”
