Rib Fractures: Essentials of Management and Treatment Options

Rib Fractures: Essentials of Management and Treatment Options

Rib fractures are the most common chest injury accounting for 10 to 15 percent of all traumatic injuries in the U.S. Nearly 300,000 people are seen each year for rib fractures and 7 percent of this population will require hospitalization for medical, pain, and/ or surgical management.

Rib fractures can cause serious complications including: bleeding in the chest (hemothorax), collapse of the lung (pneumothorax), or result in a fluid accumulation in the chest (pleural effusion), just to name a few. As well, rib fractures may contribute to the development of a lung infection or pneumonia. These problems are important to diagnose following chest trauma and even more importantly, when present, they need to be followed closely in the early post-traumatic period.

Pain is the most common symptom that people experience with rib fractures. It will often take the upwards of 6 weeks, sometimes 6 months for the fractures to heal and for patients to become entirely pain free. This pain results mostly from the movement of the broken ends and subsequently, with each motion or deep breath, the unstable ends move and pain ensues.

Pain control is a top priority in the care of patients with rib fractures. Poor pain control renders the patients unable to effectively breathe deeply, placing them at risk for collapse of the air sacs in their lungs (atelectasis) and at higher risk for infection in their lung (pneumonia). Additionally, when people are in pain they eat less, they cannot effectively sleep, and they are unable to move freely, or participate in their normal activities including work.

Rib fractures are most often uncomplicated which means that the fractured rib(s) are broken in one place. These uncomplicated fractures are usually not displaced allowing for realignment during the healing process and little movement with breathing and moving. These fractures can usually be managed conservatively with simple pain control and time.

However, at times, the fractures are considered complicated either because multiple breaks are present on each fractured rib causing the broken segments to be unstable, or when the broken ends are severely displaced. These complicated fractured ribs are often more unstable during activity and breathing and will likely take longer to heal; some may never heal normally.

3D reconstruction of fractured ribs before surgery

3D reconstruction of fractured ribs before surgery

Historically, good pain control and at times the use of a stabilizing elastic binder (to wrap around the chest) have been the only treatment options for most rib fractures. These treatment options continue to be utilized and are effective for many patients with uncomplicated rib fractures.

For the more complicated rib fractures we may also consider early surgical intervention to stabilize the unstable and/or displaced fractures. This is accomplished by screwing a small, customized, titanium plate across the fractured segment(s) of the rib thus achieving surgical fixation (stabilization); these plates realign the ribs and speed up the healing process.

After rib plating surgery

Images from after rib plating surgery

After rib plating surgery

Swedish Thoracic Surgery offers a specific clinic that is designed to care for patients with newly fractured ribs, both complicated and uncomplicated. We have a multidisciplinary team of care providers including thoracic surgeons, an interventional pulmonologist, and nurse practitioners who are available to evaluate the injury and make a clinical treatment plan that is individually tailored to each patient’s needs. This clinical plan would include consideration of the patient’s age, their underlying health, the severity of the fractures and the specific needs in their life. Our team is equipped to work closely with patients and caregivers to prevent potential and unnecessary post-traumatic complications and guide them to a quicker recovery and earlier return to productive and normal activities of daily living.

Comments
Joelle Thirsk-Fathi, DNP, ARNP
Phyllis,

ALL great questions!!

Straight forward rib fractures in an otherwise healthy person should stabilize within 6 weeks. Meaning that the ribs should start forming that callus and stop moving around. In my experience, people notice that there's less popping and mobility around 4 weeks and their ability to do more things, including lifting more, occurs closer to the 6 week mark. The pain takes much longer to resolve and I wouldn't recommend going all out with activity at 6 weeks. Just slowly reintegrate activities of daily living, as tolerated.

It is not uncommon for people to report that popping activity with certain movements and that acute pain is associated with that movement of those ribs. Remember that most of the ribs have muscle that attaches to them and prevents them from wild motion despite that constant motion of the chest with every breath and just merely living. The pain should settle down as the ribs become less mobile.

With each passing week from your injury, you should notice small but progressive improvements. It's not uncommon for folks to start feeling better, do more, then realize they over did it and have some increased pain but this usually settles down and they get back on track with their improvements. So, don't be discouraged or worried if this happens along your recovery path.

For straight forward fractures like yours that is adequately managed with Advil, I would not suggest that you need to see a Thoracic Surgeon.

Best of luck to you and thanks so much for writing in.

Cheers,

Joelle
2/23/2015 10:01:03 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Bobby,

Without having the benefit of examining you and correlating your films with the physical exam and your report, it's difficult to say where the pain is arising from. Given that you're getting nerve blocks and on medication that would target these symptoms, I assume that you're under the care of someone who has reviewed all these items and putting the whole clinical picture together.

There are a number of pharmacologic approaches to nerve pain and if one is insufficient, you might want to try another.
You might also attempt o or a combination of complimentary methods of treatment for your symptoms including physical therapy, acupuncture, massage, reflexology etc. Strengthening and routine stretching are also critical elements to long-term management of symptoms following this type of injury. Some of these might be helpful for fibromyalgia too!

All the best to you in this journey of health and recovery.

Warm regards,

Joelle
2/23/2015 9:58:46 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Cathy,

YOU have been through A LOT with this significant trauma and multiple procedures not to mention your ongoing symptoms. I suspect your good health going into this event has served you well but can imagine your frustration with the shift in your routine and health.

I truly wish I could tell you that plating would be a guaranteed fix and take you to a pain free place in your life but I don't think anyone can tell you that. Given my clinical experiences with trauma patients both major and minor events, I have accrued some opinions and that one prevailing opinion is that the body ever forgets what's happened. There will always be residual reminders of what the body endured. I do believe that people can restore their health and physical well being through a number of modalities, especially if they are highly motivated.

In terms of your specific injury and the possibility of rib plating this far out of injury. There are potential risks and side effects of surgery such as infection, more pain, and in this particular case the tissues and scar tissue will need to be disrupted to get those bones in alignment. When making this decision I think the prevailing question is, have you reached a point that you just can't tolerate living the way you are now and the risk of surgery is worth it, even if it doesn't improve your condition? This is very personal question given your specific journey and where it's landed you.

I can't fully appreciate the structural condition of your chest wall and the type of pain your are having but often there is the pain from bones that are moving and then there's nerve pain that arises from the nerve root that tracks along each of the ribs. Certainly the plating could stabilize the ribs but the nerve roots could pose long term issues.

I would also suggest that whatever your decision is moving forward that you engage with a physiatrist/medical rehab doctor for further evaluation. The body puts itself back together in interesting ways and it's possible that specialists like these can help you re-establish your new norm and find ways to rebuild and balance your physical structure to compensate and become more pain free and mobile. Also remember that there are pain specialists who can target focal areas of pain with nerve blocks and other interventions to help you long-term.

Finally, don't give up hope and reaching higher levels of wellness; I've witnessed people come back from some significant events and it is possible!

I wish you all the best in this process Cathy and hope that there's something here that is helpful.

Warm regards,

Joelle
2/23/2015 9:57:08 AM
BBJ
Cathy,
I was in a mva in November 2014 and had 11 broken ribs. 4 of them were plated. I also had a collapsed lung, lacerated spleen, and damaged wall. I just wanted to say that even 3 months later, I am still healing and it still hurts to take a deep breath. Give it time.... Hopefully it will eventually get back to normal. :)
2/21/2015 12:49:19 PM
Bobby
Hi There, I was a mature fit woman of 53, and had an accident at work, last dec 2013 where a person knocked me to the hard frozen ground and fell across me breaking 4 ribs. i still feel a lot of painto this day on my left side where they were fractured. i am now under going nerveblocks and still on medication for pain. i had Fibromyalgia previously but it was dormant for some time and not really bothering. since april of 2014 my Fibromyalgia has hit the roof and i am taking 120 mg of cymbalta daily. I went for an exray today because when i laugh or lay in bed im still feeling pain and discomfort. i seen on my xray that one of my rib is not healed right and off th the side where it should have completely callasued over and healed..is this what is causing me all the pain right now, thank you dearly for your response.
2/19/2015 4:02:27 PM
Cathy
I was involved in a MVA in Aug.2014 with injuries of left side rib fractures 4, 8 thru 12 (9 and 10th ribs displaced which punctured lung) ruptured spleen, grade IV, and fractured T9 transverse process. I had two VATS. The first VATS removed ribs from lung and were sutured in place. I had 4 chest tubes because the 9th rib displaced again and was impaled in the lung for 4 weeks before being found. The second VATS was an attempt to plate the 9th rib which was unsuccessful and a resection was performed instead. Now, 6 months post MVA, I am having increased pain which my MD ordered a 3-D CT Scan. It showed that the 10th rib is displaced again by 1.5 inches and the 6th and 7th rib still nonunion/non healing. It was recommended to me to have all 3 ribs plated. Have other patients had this procedure completed? Is their pain resolved and can they return to normal activities? Prior to the MVA, I cycled 3100 mile that year, I want to get back to my bike and breathe deep without pain. Thanks for any feedback.
2/3/2015 5:58:44 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Collette,

I am very sorry to hear about your prolonged experience and current circumstances!

It's truly difficult to fully appreciate the setting here and what the long-term prognosis is for you from this perspective on a blog; so sorry. In the surgical world I would say it's too soon to make firm decisions about changing your career and encourage you to give your body more time to repair itself and certainly avoid heavy lifting in the short term. Don't give up hope. I've witnessed people endure major operations who really do make strong recoveries, with the benefit of time. Additionally, it can be helpful to gain another professional opinion from a Thoracic Surgeon who specializes in Thoracic Outlet Syndrome. It's not too early to do this and may help you understand what's next for you.

All the best to you Collette!

Warm regards,

Joelle
1/27/2015 12:13:01 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Janet,

My sincere apologies, I misplaced your message in my filing system and just now discovering this! SO sorry for my tardiness!!

We have seen folks like you who have had an old injury that continues to hassle them. The ability to repair the underlying defect depends on many things including the location of the injury. In our experience, it's difficult, even in the early period after injury to fix things under the scapula or close to the spine. The site of your injury may have healed just fine but it's very plausible that the local scar tissue that was integral in the healing/stabilizing of your injury is causing mechanical disruption now. Given the location of your injury, I think it is likely not an option to fix it now. I have a clinical background in the primary care setting. I have taken care of many patients with a variety of injuries and I DO want to tell you that I have seen people respond to many alternative modalities of treatment with complaints such as yours. I always believe there's value in starting with a good medical rehabilitation evaluation by a specialist in this area and consideration of physical therapy just to be sure there's nothing else going on here that is going unchecked. This can be followed by seeking out folks that work with myofascial, deep tissue work in the form of massage acupuncture. Many physical therapists do this type of work including deep tissue work with ultrasound. Clearly this is interrupting your life enough that ten years later you're researching it and reaching out to me. This tells me that your recovery is not satisfactory. I would encourage you to continue to look for constructive help and rehabilitation until your quality of life is acceptable as it relates to this injury and at the very least, you are able to manage your symptoms.

Wishing you all the best in this journey of health.

Warm regards,

Joelle
1/26/2015 11:44:27 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Pat,

Your report is not uncommon. Depending on the location and severity of your injury, it can take a long time before the rib cage is ready to sustain the kind of force from laying and twisting in a dependent position such as lying in bed. When I have these discussions with people, I usually start by determining if the problem is getting better, worse, or it's unchanged. Putting it this way and with some thought, most people will report that the condition is very slowly improving. If you are not improving and certainly, if you are sliding back in your recovery then you should see your medical provider for re-evaluation. If you are making small, incremental, improvements then hang in there; things will get better.

On another note, the type of pain you are experiencing at night can be sheer mechanical pain from laying on those bones that are still healing. It can be muscles spasms in the chest wall at the site of the injury in which case, an evening heating pad before bed or muscles relaxants may be helpful. You could also be experiencing some nerve pain that is lingering; this too can be treated but a medical professional will need to tease out the exact mechanism of pain you're having at night so they can target treatment.

Don't give up on this.

All the best to you in your journey of recovery.

Joelle
1/26/2015 11:42:04 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear John,

I am sorry to hear about this and perplexed about your persistent pain in this clinical setting. If your pain was truly from positioning from a routine hip replacement, I would expect you to be fully recovered within a month following the procedure. Without reviewing your operative report, examining you and taking a full history, I can't fully appreciate what this looks like. I would recommend you see a medical rehabilitation/physiatry doctor for full evaluation and determination of what your underlying pain is so you can make a plan to get better. I would aim for finding answers and a rehab plan that returns you to 100% of your baseline before that surgery.

Warm regards,

Joelle
1/26/2015 11:40:54 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Leah,

The body is sophisticated enough to heal itself but it definitely needs tincture of time the proper setting. Even in the most optimal healing conditions, it takes a an absolute minimum of six weeks for the bones to start bridging in the repair process and provide some stability but the healing and stability is not anywhere near where it needs to be to endure another fall without injuring them again. Given the risk and intensity of hockey, I wouldn't recommend someone play this sport for at least 12 weeks following injury. There are many other things you CAN do to maintain fitness and cardio and I would encourage this.

I would recommend referring to some of my prior comments to learn more about how the healing occurs; it may be helpful in understanding how your body puts itself back together and safe approaches to reintegration of activity.

Wishing you a full recovery,

Joelle
1/26/2015 11:39:49 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Gert,

Thank you very much for your mail AND for advising your location; it's really fun to understand the reach that this blog has!

You bring up several great questions that haven't been addressed on this blog.

The mechanism of injury and the extent of trauma to the chest wall widely varies person to person. Two people could have the exact same mechanism of injury but could look very different on imaging. Without viewing your films I can't fully understand what's happened mechanically/physiologically to your chest wall as a result of the injury but suffice to say that your report is consistent with early rib fracture injury. As I've noted previously, the chest wall is always in motion and given the improbability of splinting the ribs unless you have them surgically plated, it's likely that they won't heal in perfect alignment. This said, the body does amazing things and it is capable of putting itself back together given the proper setting.

If you're an otherwise healthy person including well nourished, I would expect broken ribs to be stable by 8 weeks from injury but remember, the callus is formed by young cells that haven't turned into solidified and stable bone yet; that takes more time. You have some time on your side and I don't think it's out of the question to attend your ski trip but I would recommend that you plan to revise the extreme of skiing. Obviously skiing applies loading forces to the thorax (upper body) and significant rotation (twisting) and then there's the possibility of blunt trauma if you were to fall on your chest wall. Only you know what your skill level is and what you may encounter in terms of technical skiing and the challenge of staying out of immediate danger depending on where you'll be skiing. Approach your skiing carefully.

In regards to your current symptoms and hesitancy to freely move, I highly recommend that, short of heavy lifting on the side of injury, that you increase your range of motion of your chest wall and avoid favoring the side of injury. This will provide optimal recovery and maintenance of conditioning of all the muscles in your upper body. When you protect or guard one side you neglect vital muscles and promote deconditioning and weakness on the side of injury while you burden the non-injured side with the bulk of work. Subsequently there's an imbalance that develops that can last a lifetime with other negative physiologic sequela. Bottom line, avoid lifting greater than about 5 kilos on the side of surgery for the first six weeks but don't stop moving and do try to maintain as much of a normal range of motion of your thorax as possible. Most people report that it's difficult to lay on the side of injury at night and make revisions to their sleeping/laying patterns but slowly do get back to normalcy at night around 6 months following injury.

Be as active as possible right now just avoid significant force to the chest wall. Reintegrating activities, including sports should be done as tolerated. I usually advise to wait a minimum of four weeks following injury but listen to your body. If you have significant pain and it just doesn't feel right then avoid it and retry in a revised fashion in another week.

I hope this is helpful information to you. Wishing you all the best in your recovery. Just for the record, I really enjoy visiting your country!

Warm regards,

Joelle
1/26/2015 11:37:18 AM
Collette Dunn
I had a bilateral 1st rib resection in July/August last year for arterial Thoracic Outlet Syndrome. Unfortunately I had a rare complication whereby within a week of the second resection both my 2nd ribs completely fractured, one displaced. Six months down the track one is healing, the other however is still displaced and has a poor prognosis of reunion. My question is this. I work in an area that requires alot of manual upper body movement (pushing heavy loads and working in autopsy theatre). I have been given another six months to let the fracture try and heal. Given that I have 1st ribs resected, and 2nd ribs fractured do you think it is likely that I should look for another career. Given that no one understands why I fractured the first time there are concerns for future fractures, and concerns that the third ribs may be compromised. Any advise would be greatly appreciated
1/22/2015 11:38:48 AM
Gert Jan Timmers
Dear Joelle,
First let me thank you for your personal and informative comments on this forum. Perhaps I may I ask you question as well.
Three weeks ago I fractured at least one rib at the left lateral side of my chest during a stupid fall with my ATB. It was not seen on routine X ray, but later an ultrasound clearly showed the crack, with slight dislocation of the fractured ends. Pain is manageable now, even without much painkillers. I still suffer from some "clicks" now and than, with certain movements.
I did understand your remarks about "callus" formation in about six weeks and slow calcification during the months thereafter. My problem is that I am moving with care to the extreme, not so much because of pain but because I am concerned movement may shift the fractured ends and may eventually lead to non-union.
Is it wrong to move as normal as possible, as long as it causes not too much discomfort?? Or should I take as much rest as possible. When do you think it is possible to go back to sports? I am quite anxious to go skiing in march, about 8 weeks after the injury. Is in general the callus than strong enough to take some force in case of falling? I read that American football players went back to match-play in about the same period of about 1 - 2 months.
Thank you so much for your advice.
Kind regards,
Gert Jan Timmers, The Netherlands
1/19/2015 2:04:47 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Debbie,

You bring up a good question and an interesting problem. In the traditional setting of a fracture (broken) bone, we are able to splint bones in casts so that they can be realigned with the best chances of healing as "properly" or as close to their usual position as possible. However, when ribs are broken, it's impossible to provide a splint or cast so these bones can heal in perfect position. Make things more challenging, it's impossible to immobilize the chest wall to provide alignment in the healing process because we require the chest wall to move in order to breath; the ribs are moving at least 16 times a minute.

Given these considerations and the various mechanisms of injury when people break their ribs, it's not surprising that the old injury will haunt folks every now and then. I always tell people, that your body remembers injury and will remind you in certain settings.

So, you have the bones that needed to heal but you also have the nerves that run along each of the ribs that can also get irritated with disruption and this disruption can certainly come in the form of a bad chest cold and vigorous coughing. There's bone pain and nerve pain. These types of pain are very different and are approached differently in treatment. I would expect these symptoms to improve when he's no longer coughing but if they don't he should be evaluated by his health care provider. It's not entirely out of the realm of possibility that a person can sustain rib fractures from vigorous coughing. He could have disrupted the nerve root and if it's nerve pain he could benefit from medicine that targets nerve pain.

Another consideration, since his injury, he may be protecting that chest wall and developed some weakness/deconditioned muscles on that side. Now he's coughing and using these chest wall muscles and there's all kinds of disruption in the chest wall. It's like not using your bicep muscle for a year and then deciding you're going to life do some repetitions with a 20 lb weight; the bicep muscle won't be happy. My point is that he might benefit from an evaluation by a physical therapist and get some reconditioning to return him to a previous state of health and strength that may prevent such decline in the pain arena when he coughs or uses his muscles again.

Wish you and your family the best.

Warm regards,

Joelle
1/19/2015 12:23:59 PM
Leah
I was told I fractured one of my ribs from hockey about 9 weeks ago. My limitations were up to me, although he recommended 2-3 weeks I went back after 1 and a half because I wanted to get back in the game so badly. With lots of ibuprofen, my injury had seemed to heal mostly but then a week ago I fell wrong and now it feels like I am back where I started, but much more popping and locking and it isn't as bad with breathing as it is with movement. Was my doctor right to let me go back so early?...I don't want more reinjuries like this. I have a reasonably high pain tolerance from what I have figured from other injuries, and I don't want to sit out but I don't want this to lead to other complications-is that a risk? Basically my main question after all this is what should I expect for the future and should I go back to a doctor or is this normal?
1/13/2015 7:02:34 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Sandy,

I would recommend you consider further evaluation by a Thoracic Surgeon with a CT scan + 3-D reconstruction before you see the surgeon. There needs to be a thorough evaluation of exactly what is structurally happening with the chest wall before understanding what the underlying nature of your pain is and what your options are moving forward.

All the luck to you!

Warm regards,

Joelle
1/12/2015 10:50:30 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Joan,

Thank you for your kind remarks; it’s a privilege to care for people and this forum is just another way to extend our ability to care for folks. Isn’t modern technology cool?!

Your injury and story are interesting and similar to another person who wrote to me. Basically an old injury coming back to haunt you. These are my thoughts. You had an extensive and complex injury to your chest wall. Short of plating all those ribs, we wouldn’t expect them to heal in total alignment, especially if some of them were fractured in more than one place.

When you have such an injury, you likely developed a new posture in order to accommodate the healing chest wall. You are structurally different on the side of injury AND on the non-injured side, as a result of this whole ordeal. Likely you have imbalance in your chest wall/cage and all the muscles that comprise these structures. Some of those muscles you rely more heavily on and I suspect you have developed significant weakness in many other muscles that are closer to the site of injury. The only way to move through this and get to the other side is to recondition these muscles and this will take some time. I would very seriously recommend that you get an evaluation with a good Rehabilitation Medicine doctor. They are commonly noted as Physiatrists too. They have special training in the evaluation, diagnosis, and care of folks like yourself who have incurred an injury. Physical therapy will be key and this will be a long relationship to get your muscles reconditioned and strong again. You may also want to consider augmenting your rehab with deep tissue massage and acupuncture. However, start with the Rehab Medicine doctor and physical therapy.

You haven’t used these muscles for a very long time, you should also consider using heat/ice/and muscle rubs after a hard day or a rehab day.

I wish you all the best in this journey. I have to believe that it’s possible that you can recover most of what you lost but it will take time and vigilance.

I hope this is helpful to you.

Warm regards,

Joelle
1/12/2015 10:49:55 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Herve,

I am SO sorry to hear about your suffering; this is very life altering!

I work on a Thoracic Surgery service, we insert and remove chest tubes all the time. I reviewed this with one of our Thoracic Surgeons and our advice is that you consider contacting either a thoracic surgeon or a neurosurgeon for further evaluation and consideration of ablation or removal of that nerve.

I can tell you that in our experience, pain medications like fentanyl are NOT so effective for pain that arises from a nerve. Medicines that are specific to the nerves are more effective. There are oral tablets and capsules and also topical transdermal patches that can target nerve pain. You should consider this conversation as well with your medical doctor or caring provider. If you are not already under the care of a pain clinic, you may want to consider this.

Wishing you all the best in this endeavor.

Warm regards,

Joelle
1/12/2015 10:48:45 AM
Debbie
Hello, my husband fell about a year ago and broke 2 ribs..The doctor said they healed improperly...He recently had a cold with a bad cough, and now his side with the broke ribs is causing him a lot of pain...My guestion is can this be caused by the fx ribs and if so what can he do about the pain? Thanks for your time..
1/11/2015 6:06:45 AM
John crockenberg
After having full hip relacement surgery at age 57at mayo clinic I was told by staff that my ribs may have been bruised as a result of being isolated in a device during the procedure. Recovery has been 5 months and left side middle back still has imflammation pain. Is this normal?
1/11/2015 6:01:49 AM
Pat Hall
Hi im a 55 yr old lady who in july 2014 aquired 2 lower back # ribs when hit by a surfboard. i was told recovery would be between 5 and 6 weeks, overall i am ok but my only problem is when i lie down, i wake in the night unable to move without pain, i find myself holding on to headboard to help me turn over. when upright and moving about there is a constant tenderness in that area. is this normal or should i seek further adivce? Pat
1/8/2015 9:35:13 PM
Joan M.
Hi.

First, let me say how impressed I am by the sincerity and individualism you have answered comments to your blog. Bravo.

Here is my question:
4.5 years ago I fell from a ladder onto a bannister breaking 7 ribs in 10 places. There was no damage to my lungs and a mild concussion. I was given pain meds and sent home where according to one account, my ribs shifted and were healing on top of each other. I was re admitted 10 days after returning home when tht was discovered in an exray. One doctor felt I should have them plated. The surgeon who would do that chose not to recommend it.

Regardless of all that, the overall treatment was pain relief and.imsat in a chair. I am the mother of a young man who has multiple disabilities and often requires physical interaction.

My pain continues, though not everyday. Recently I started walking again as my health requires some movement (I used to bike 200 miles a week, so this has been hard), even walking is causing flare pain now. I returned home today in tears after just 40 minutes.

Can PT help? Should I be seeking a thoracic surgery consult? I seek wise coaching on where to look for help.

Thank you. I enjoyed your article very much.
1/4/2015 9:04:51 PM
Sandy
I broke 3 ribs on February 23,2014. I had a ct scan July15,2014. It showed they were still broke and dislocated. It is now the first week of January 2015 and still cannot do many things. Like shovel lift things sleep and it hurts badly if I do something like that. The pain is always there and it is making me crazy. Help me please!!!
1/4/2015 4:16:55 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Alicia,

Thank you very much for your comment.

I’m sorry for your injury. Although I can’t give you formal medical advice in this online forum, I can give you some general information about rib fractures that maybe helpful.

Rib fractures take a solid six weeks to stabilize therefore we recommend avoiding any lifting over 5 lbs and significant activity with the upper body until that time or later and only as tolerated. Until this time, your chest wall and ribs are mobile and will be irritated and usually much later than 6 weeks. Monitor your activity and proceed only as you tolerate. If it hurts, back off.

Chest xrays can be helpful to see if there was an injury and if there are signs of healing but they don’t always pick up the broken bones. It can be more helpful to obtain a CT scan with 3D reconstruction to best view exactly what happened to your chest wall.

There can be significant irritation of the nerve roots that run along each rib. The pain you're experiencing, especially at night, can be associated with the actual chest trauma and ribs moving but also the nerve pain. Discuss this with your doctor to determine how to proceed.

Remember that a healthy diet will also help the body heal.

Wishing you all the best in your recovery.

Joelle
12/22/2014 9:18:00 AM
Herve Girouard
After my 5th spontaneous pneumothorax two doctors inserted two chest tubes (one each). One has no problems, but the other damaged the nerve under the rib. For over two years now I've had severe pain at the insertion site. I've tried steroid and electronic blocks without relief. I've been living on a Fentanyl patch (75mcg). Is there something that can be done to the nerve to remove the source of the pain? My last pain doc wants to try to uses his specially compounded ointment. I want to (surgically?) remove the cause of the pain. Any suggestions will be greatly appreciated.
12/21/2014 7:29:09 PM
alicia
4 weeks ago i injured my ribs due to a bad fall. The pain went away the first day so i started to walk, exercises clean vacuum and forgot about the pain. week latter pain came back worst i take Motrin for pain it seems to help a little. it goes like this for 3 days then i feel fine again.......so I stopped the Motrin hate to take medication ( another of my problems) finally after waking up one morning pain was really bad went to see DR he just just check me asked me a bunch of questions i had no visible bruises breathing was normal he order X-rays still waiting for results. I had another 3 days of feeling pretty good with the difference i cant stop the medication for 10 days..... its 2:00am the pain wake me up....it hurts when i take a deep breath but i had this before then went away.......the worse time is at night.
mentally is getting to me and i dont like this feeling am very active, from tennis to the elliptico 5 days a week... bothers me not to be able to exercise... sometimes I walk holding my ribs or I go crazy.....sometimes its ok other times I had to stop the walk too.
im 65 years old in good health....I though. any advice? thanks
12/21/2014 12:06:22 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Arshad,

I’m sorry to hear about your injury and prolonged suffering. You could be experiencing muscular and/or neurologic symptoms related to this injury. Additional clinical considerations would be to visit physical therapy for further evaluation and treatment. A visit with a pain specialist might be worthwhile for consideration of a nerve block if their evaluation is consistent with residual nerve pain.

All the best to you in your endeavor to find resolution in your symptoms.

Joelle
12/8/2014 9:20:28 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Adiyan,

I understand your concern for complications from what we would call a non-union of your ribs following fracture or a break. Believe it or not, our bodies have some protective mechanisms and are built to last. Most of the ribs are anchored by other structures including muscles and even if they don’t heal back together following a break in them, they will continue to function for you and likely with no adverse repercussions. However, without actual imaging of your thorax (chest wall) we can only speculate on exactly what occurred when you sustained the injury and what you are feeling on inspection of your chest wall. If you are experiencing prolonged discomfort and feel that you haven’t made a full recovery you might want to visit your doctor for consideration of a chest xray to better understand the location of injury and how you have healed. If the xray doesn’t provide answers you can then progress to a cat scan with a 3D reconstruction to fully visualize the thoracic cage including all the ribs and clearly understand how everything healed.

I hope this is helpful to you.

Wishing you a successful recovery.

Joelle
12/8/2014 9:19:49 AM
Adiyan Hara
About six weeks ago I was pulling a branch out of a pile of wood and it suddenly released and hit the right side of my chest. There was considerable pain which I assumed was either a bruised, cracked or broken rib. A friend had been diagnosed with a cracked rib at another time and there was not a lot they could do but let it heal, so I did not bother to go to a doctor. Gradually the pain has decreased but a month or so after the accident I was feeling the rib to see if I could tell any difference from the other ribs. It seems to dive inward then there is a break and the other side of the break is level with my chest so that the two ends appear to not meet. Obviously if this is the case, the bone will not heal, and I am beginning to wonder what the chances are of having serious complications in the future. It has been about six weeks now and I can breath easily and only feel pain when I lie on my side or sometime pull upward on a heavy object. Thanks so much
11/3/2014 7:20:42 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Kirsten,

Given your injury history and ongoing symptoms, I would recommend you follow up with a Thoracic Surgeon. Thoracic Surgeons specialize in the organs, structures and mechanics of the chest, also known as the “thorax”. A 3-D reconstruction of a chest CT scan will very clearly display the injuries you’ve had and how they are healing. Wishing you all the best in your journey to health!

Warm regards,

Joelle
10/28/2014 5:26:15 PM
Kirsten
Hello,
I was a passenger in a car that was hit head on by a drunk driver back in February. I was diagnosed with four mildly displaced fractures of ribs 3-6 on my right side from the seat belt. Back in July, I went to a walk-in clinic when pain that had always been present in my lower left rib area suddenly got much worse with activity. Also I had previously felt the bones in this area pop, and no injury had been diagnosed in this area despite my complaint of pain. The doctor at the walk-in told me that I probably had a costochondral separation initially with remaining costochondritis. The pain has improved, but is still present. What type of specialist do you normally recommend patients with this type of injury see if pain persists? I have called an Orthopaedic specialist but they don't treat ribs.
Thank you!
10/26/2014 9:08:44 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Toni,

Let me just begin by telling you that given my 30+ years of experience working in health care, life, and life as a parent; I believe there's not greater pain than losing children. I'm extending you my heartfelt condolences. I am terribly sorry for your loss!

Technology and care for injuries like you suffered have advanced since your accident. Until you get more imaging, it's difficult to understand how your bones healed and how the layers of muscle are compensating. A cat scan without contrast plus 3D reconstruction of your chest is the imaging that would look at the bones of your thorax (chest). It would very clearly display where your injuries were and how the anatomy healed. That is the place to start. If you are in the Seattle or greater Seattle area or even Washington State, you are welcome to come see us. If you are at a distance, you would want to locate a thoracic surgeon to order this study and interpret the films with you.

I think you may have already looked at my blog but in case you haven't the following link demonstrates a "3-D reconstruction" via the CT scan. You can see how clearly it allows you to see the bones. Given the location of your injury, as described, they'll want to remove the scapula on the reconstruction so you can see the ribs as they travel under the scapula (where you're having the pain).

http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management-treatment

Depending on the location of injury, anatomy, and if they correlate with symptoms, it may be possible for a thoracic surgeon to fix the issue.

I wish you all the best in your endeavors. Do let me know if we can help you further. Thank you for visiting my blog!

Warm regards,

Joelle
10/10/2014 11:41:22 AM
Toni Woods
Twenty seven years ago the car I was driving was hit by a drunk driver. Among other injuries, I received crushed ribs resulting in a flail chest. I was on a ventilator, etc. Over the years a pain has developed on the right side of my back, about 6 inches below my shoulder blade. It developes upon any exertion--even standing or walking for an hour or so. For years I ignored the pain because I was grieving over the loss of my 12 and 23 year old sons in the accident. However, it has gotten to the point where I can no longer ignore it. It is stopping me from participating in many normal activities. The pain sees to lessen if I apply pressure to the spot with my hand. Can a doctor help me? What kind of doctor should I see? I once saw a physical therapist who told me she couldn't believe I was able to walk with the extent of muscle damage.

Thank you
10/5/2014 10:31:57 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Luke,

I’m sorry to hear about your significant accident and injuries! Given the current forum online and because you are not under my medical care, I cannot provide direct medical advice. I’m not sure of the extent of your injuries but likely you are under the care of medical professionals who will be able to guide you through your recovery. I would suspect it will take a minimum of six months to return to your usual activities and a pain-free state. Physical therapy and rehabilitation will be very important in a full recovery from such an injury.

All the best to you in your recovery.

Warm regards,

Joelle
9/18/2014 12:57:51 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Brian,

When a bone is broken, including ribs, the body understands that there’s been a break. There are young cells that congregate to the area of damage to fix the break. These cells grow in numbers and build what is called a “callus”. This callus is initially soft and serves as a splint for the broken bone in stabilizing the bone but it also helps the bone repair itself and gather all the necessary tissue/minerals necessary to heal and strengthen it. You can see this “callus” on xray as early as four weeks following injury. It looks like a nob on a tree when you see it on film. This soft callus turns into a hard callus by 3-4 months and is usually present many years following a bone fracture. This is the hint that a fracture has occurred when someone views your xray film. A radiologist may be able to advise if the fracture is acute (occurred in the recent past) or if it occurred greater than 3 months ago but likely not much more detailed prediction past that.

Best of luck to you.

Warm regards,

Joelle
9/18/2014 12:54:29 PM
Brian
How old does a rib fracture have to be before it starts to heal and a dr can determine the age of the injury?
9/15/2014 5:46:11 PM
Dana Lewis | Swedish Blog Administrator
Hi Jeffrey, our providers are not able to provide medical advice online. If you have a specific question about your medical condition, please talk to your health care provider.
9/9/2014 10:30:19 AM
Jeffery Eiting
im not too hip on the computer stuff. so does that meen after he reads it he will give me his opinion on what i should acctually do?
9/9/2014 2:43:34 AM
Jeffery Eiting
Aloha, four days ago i went for milk and eggs early in the morning for the kids. I took my scooter to save gas, being early morning the sun just broke over haleakala and was directly in my eyes. didnt see the car in front of me brake in timme and hit her rear end causing me to crack my rib cage into the back of her car and fly over onto pavement. went to maui medical, took x rays and was shown on x ray that my 6th rib was cracked 7th was broke in half and 8th was cracked. ive been icing and doing moderate moving around exept for going freediving yesterday at about 30 to 40 feet of water. since then im having pains in my chest like i think its my lung on the left side. ( same side as the break ) should i be worried and go doctor imediatly, or wait and see if it subsides. signed KOLOHE MAUI BOY!!!
9/9/2014 2:39:00 AM
luke
i was in a car accident and punctured both lungs and 15 fractured ribs and fractured collar,how long before i feel better?i was in hospital for 15 days,i am at home now but in lots of pain.....
9/7/2014 9:57:14 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Rob,

Thank you for your comment. I appreciate your concerns and your interest in your health. Given that I don’t have specific information and films from your injury and this medium of interaction; I can’t give you medical advice but I can make some generalized comments about your concerns. It is possible to disrupt healing ribs within the first six months of healing, by direct or even indirect trauma, including bouncing on a horse. 3 months is too early to do a high impact activity, 6 months is a much more appropriate and reliable time to approach riding again. We recommend reintroduction of activities slowly and with caution until you’re certain that your body is tolerating it. We have had many people with injuries from being thrown from a horse with a successful return to their riding. I wish for you a successful and full recovery!

Best regards,

Joelle
8/7/2014 3:45:45 PM
Rob Lundgren
On June 20 I was thrown off my horse and hit the ground very hard n my left side the local hospital sent me north much larger hosp. The found I had broken 4 ribs but had a total of 11 fractures trauma surgeon told me about plating had the surgery went back 3 wheeks later for checkup doctor was very happy with my progress he did have to drain some fluid out on my back my breaks were on my back side I asked him if it was okay to start riding horses again he looked at me and said your kidding no riding or risky behavior for six months he told me if I was to fall I could die now I am wondering if I should ever ride again if my ribs with plating will be stronger or weaker as they heal should I give up my pation I have done most of my life
8/5/2014 11:40:15 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Erik,

Thank you for your message.

It’s unclear to me if you had some imaging that diagnosed your rib fracture at the time of injury. There’s a complexity of structures including cartilage and bone that organize your chest wall; any of these structures can be disrupted and heal differently than their original orientation. A cat scan with 3-D reconstruction of the chest wall will very clearly demonstrate the orientation of your chest wall structures. In considering this study, you have to consider what difference it will make in the long-term outcome. If you decide to pursue this, it would be advisable to meet with a thoracic surgeon. They specialize in the thorax (chest and chest wall); they are also well equipped to clinically evaluate you as well as order and counsel you about the findings on a 3-D reconstruction. Given that you are 3 years out of your injury, this is really your only option to best understand exactly what is going on with the structures of your chest wall.

Wishing you the best.

Warm regards,

Joelle
7/21/2014 11:48:00 AM
Erik Baxter
Hi About 3 years ago I had an injury, a blow to the front of my chest, which caused a fracture. Not long after I began to get wheezy, and despite many tests for asthma, this has been discounted. This developed into really bad breathing problems - breathlessness, bad breathing control, and chest pains when breathing. At first it appeared that the problem was breathing dysfunction but after having physio for that I am still getting problems - it feels like my chest will not expand properly, to its full extent, especially around the middle, which is where I got the injury. Is it possible my ribs did not heal properly and I have been having trouble ever since? If so, what should I ask my doctors to do? Thanks very much for any help you can give.
7/15/2014 5:56:51 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Ingrid,

Although this is not a forum in which I can provide medical advice and given I don't have the benefit of evaluating you in person; I can tell you that likely the interval of time has allowed healing and stability of your injury rib/chest wall and should not pose a risk in your upcoming surgery.

It's also not uncommon for some symptoms to take time to clear after a chest wall injury, even this far out from injury. However, if they persist and certainly if they worsen, you should seek further evaluation with your primary care provider.

All the best to you in your recovery.

Warm regards,

Joelle
7/14/2014 8:46:46 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Mehra,

I am sorry for your wife’s recent injury. Rib fractures can be very disruptive to comfort and routine for many weeks. Given this electronic forum and that I have not evaluated your wife I would recommend that she visit with her primary care provider for further evaluation, treatment, and monitoring.

Thank you for your message.

Warm regards,

Joelle
7/14/2014 8:43:30 AM
mehra
My wife had a fall she has 3 brokrn ribs on her left side, ribs number 9, 10, 11 please advise what should to do
7/12/2014 8:19:59 AM
Ingrid
I think I fractured a rib in January 2014, never had it evaluated. Seems 95% healed. Feel pressure in that spot while sneezing, and a little tightness in general. Can exercise without pain. Scheduled for cosmetic surgery today. Am I putting myself at risk for post op complications by not having this evaluated fully prior to my surgery? Thanks.
7/11/2014 7:57:11 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear David,

You are likely about month out of your injury by now. If you in fact fractured your ribs, your pain should be improving now. If your chest wall seems unstable and the pain is not improving slow but progressively by now, it is time to consider further imaging and diagnosis of what has happened. When bones are fractured, including ribs, there are immature cells that congregate to the area of injury and build new bone to fix the break. It takes a solid six weeks for this repair to create enough stability in the break that you can be more active without significant pain. That six week mark tends to be the turn around point. There can be sharp stabbing pain with rib fractures that is associated with moving bones, nerve pain and muscle spasm and this can last intermittently for the upwards of 6 months following injury. It should start getting better by now though.

I hope this is helpful information for you.

Best of luck in your recovery.

Warm regards,

Joelle
6/23/2014 9:49:42 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Wang,

Thank you very much for reading our blog on rib fractures! Remember that it takes a minimum of 6 weeks for the bones to fuse back together and you can experience pain for the upwards of 6 months following an injury like this. Patience truly is a virtue in the healing process. Wishing you all the best in your recovery.

Warm regards,

Joelle
6/19/2014 12:24:24 PM
Wang
Hi,

I was in a motorcycle accident last week. Broke my collar bone and 4 ribs. Dr. said my ribs are stable and prescribed norgesic and voltaren every 8 hours and omeprazole bd. I'm still in a bit of pain.

Anyway I just wanted to say thank you as reading all the posts and replies has made me more informed and is somewhat comforting.

Thank you
6/17/2014 10:46:34 AM
David H.
About 2 1/2 weeks ago, I was doing bench press (205 lbs.) and the bar rolled of my palms and fell on my chest. Despite a fair amount of pain initially, the x-rays showed no broken ribs and I felt like things had been progressing well. Within the last two days, I have experienced a sudden increase in pain particularly on my left side under my arm and under my pectoral muscle.

What symptoms generally necessitate a CT scan? I don't want to spend a lot of money trying to find the correct diagnosis if nothing is going to change in terms of care or treatment. I can't help but wonder with a blunt force such as that, would a CT scan show other possible complications that may require a different route of treatment than normal rib injuries?
6/7/2014 2:21:10 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Randy,

Thank you for your mail.

Although we can not provide direct medical advice in this forum I can provide a few thoughts.

Nerve pain following a significant chest wall injury, such as yours, commonly disrupts nerves along the ribs. We frequently see patients like yourself in our clinic. Sometimes you can have a "non-union" of one or more of your ribs where they have not healed back together properly. There are surgical procedures that can be helpful in fixing these. We have had many patients who require long-term nerve pain medicines for that "neuropathic pain". Some folks even see pain specialists for nerve blocks to get relief.

Certainly you could consider clinical follow-up with your primary care provider with serious consideration for referral to a thoracic surgeon, including CT scan with 3D reconstruction to get an accurate picture of exactly how your ribs have healed and proceed from there.

If you're in the Seattle area you may want to see Dr. Eric Vallieres or Dr. Alex Farivar.

All the best for a complete recovery.

Warm regards,

Joelle
3/11/2014 11:10:04 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Robert,

Thank you for your comment. I regret that we can not provide medical advice in this forum. However, it would be advised that if your symptoms persist that you seek medical care ASAP.

Best of health to you,

Joelle
3/11/2014 11:09:28 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Phyllis,

Thank you for your mail. It takes many months to fully heal rib fractures. When there's been an injury to the chest wall there can be a lot of soft tissue disruption too. Unless your massage therapist was very aggressive with manual therapy, I suspect this is soft tissue responding to the massage with some local inflammation. Unfortunately, we can not provide direct medical advice in this forum, but I would recommend you see your general practitioner if this does not improve following the massage.

Good luck in your recovery.

Warm regards,

Joelle
3/11/2014 11:08:47 AM
Phyllis Jansen
I was in a motor roll over 3 months ago. I had a broken C1, fractured C2, T3, fractured 5th rib in my back and one on my left front side.
I had x-rays taken 2 weeks, all the bones are healed and I was feeling fairly good.

On the advice of my physio therapist I went for a massage last week. After the first massage I felt very good, but since the second one I am having severe pain in my back right side up under the shoulder blade.

Could she have injured any of my previous injuries? I have another app't with her in 3 days and I am wondering if I should go.

Thanks.
3/8/2014 12:58:06 PM
robert
2 weeks ago a took a blow to my left shoulder. since then,i have pain in both armpits, both breasts top and bottom, left shoulder blade, and when breathing. i am a male 6 ft. 170 lbs, please advise.
2/24/2014 10:47:23 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Brenda,

It is not too late to operate. However, your CT was a considerable amount of time ago and during this time considerable healing could have occurred. Our approach would include repeating the CT now to be sure the operation is necessary.

Wishing you all the best in this process.

Warm regards,

Joelle
2/24/2014 10:33:34 AM
randy pogorelc
15months ago I fractured more than 10ribs.I,m having pain (shock)spikes threw out my body,Also I have body spasms,, will these stop? Are these Nerves trying to heal?I can,t sleep,when i do i wake up sweaty in chest area,I have a constant (3-7)pain in chest area,also numbness in chest area.and from this my mind is starting to go crazy. why won,t my chest heal? Please help
2/18/2014 4:32:44 AM
Brenda Moore
I fell off of a ladder on Dec 19th, I have nine broken ribs on my left back side ribs 1 and 2 ribs have healed rib 3-6 are displaced fractured I had a CT reconstruction done Jan 29th and went to a Thoracic Surgeon on the same day I am schedules for surgery Feb 21st it will be 9 weeks since my fall and 3 weeks since the CT scan
After learning about the rib plating surgery my concerns are that it is to late to have this surgery most cases have surgery 1-4 weeks after the initial breaks, are there any successful surgeries being preformed at 8- 9 weeks?
2/16/2014 4:11:09 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear John,

Thank you very much for your inquiry.

We have seen the screws work their way out. Our clinical approach is to leave it alone if they are not causing any discomfort. We would recommend that you follow-up with your surgeon who placed the system for further evaluation and discussion and long-term follow-up in case it becomes a problem for you.

Warm regards,

Joelle
2/12/2014 9:05:00 AM
John Lek
Hi, in July 2013 I fell from mountain bike and was admitted to Hospital A. Diagnose with a few broken ribs on my left chest and after a few day was discharged to go home with pain management.

Few weeks later I had a haemothorax, then was rush to Hospital A again for emergency procedure to release the blood. Later to find more broken ribs on the same rib bone.

Then was transferred to Hospital B due to Hospital A does not have expertise in thorax. In Hospital B, I was installed with MatrixRIB, plate and splint.

3 months after the operation, an x-ray shows that a screw attached to the splint is sticking out from the rib. It is on the back of 5th rib between the scapula.

Would like to know if I should remove it?
2/7/2014 8:49:35 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Gabby,

Your complaints are interesting so far out from your injury. It's not uncommon for patients to be told they don't have fractures by plain xray film but in fact, they do. Usually the ribs will heal back together. We do see people who had non-union or poor alignment of the broken bones in the healing process and this chronic poor alignment of the bones can trigger nerve pain. Nerves run along each rib and nerve pain can be sharp, stabbing, piercing, or even electrifying. The only way to fully appreciate if ribs have been broken is to have a CT scan with a 3-D reconstruction of the rib cage; this study would reveal if bones were injured and how they have healed back together.

Before engaging in consideration of further imaging it's important to ask whether or not it would change the outcome and if there anything you can do for this. Usually people feel that they can tolerate the fleeting and intermittent nerve pain but if it's disrupting quality of life and functionality then it's important to consider a trial treatment for nerve pain and possibly the imaging. Consider following up with your local primary care provider or a thoracic surgeon for further discussion about your condition and your options.

Best regards,

Joelle
2/4/2014 11:48:21 AM
Gabby
Hey how are you doing? I just had a quick question. I was in a bad car accident going on 5 years ago. I was told I didn't have any broken bones. I was put in a coma for maybe up to a couple of weeks. Every once in a blue moon I still get this sharp pain in my side right under my breast. The pain is so bad it hurts to breath. It lasts a few minutes. Should I be worried??
2/3/2014 4:18:29 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Kate,

Thank you for writing on our blog!

I recommend that you seek immediate medical care with your primary care provider or a local urgent care. They should be able to make a definitive diagnosis and treat.

Warm regards,

Joelle
1/27/2014 11:23:08 AM
kate purcell
I am 50 years old and have asthma which makes me cough a lot. I think I may have fractured a rib coughing. It is at the top of my right rib cage. It has been getting worse and worse for 5 days, and my lungs are suffering. Is this normal? Thanks
1/25/2014 9:04:11 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Hector,

Thank you for your message and for visiting our blog!

Although we cannot provide direct medical advice in this forum, I do believe, given our experience in this area, that unless you experienced some recent trauma or forceful blow to the chest wall, your injury from 10 years ago is likely stable. Your pain and twinges are more likely related to muscles that you haven’t used in a while. Certainly if it gets worse and disabling seek medical care sooner.

Best of luck to you!

Warm regards, Joelle
1/17/2014 11:33:33 AM
Hector
My name is hector and at the age of 17 I was jumped and one or maybe even two of my ribs were kicked in. I see a debt under my armpit. Well I kinda ignores the fact it happened for several years. I never experienced any pain so I ignored it. I have know started a new job carrying heat trays on my left hand and ribs we're injured on my left side. I'm know getting symptoms of small pain here and there . I'm kinda worried. I'm know 27 years of age. This was 10 years ago. Any advice. I don't have insurance and I'm considering on waiting a few months till I get insured. Any advice?
1/16/2014 3:59:00 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Catherine,

Thank you for your mail.

In order to answer your questions you’ll likely need a CT scan to accurately evaluate your anatomy following your injury. Our recommendation would be to follow up with a thoracic surgeon in your area to have this imaging and follow-up visit to discuss options. If you are in our area, you are welcome to make an appointment.

Warm regards,

Joelle
1/13/2014 9:31:49 AM
catherine
hi
I was in an accident last year in September, I fell on my left shoulder and now I've got a bent collarbone, broke a rib just above my breast and bottom part of my rib cage on the left looks a bit bigger than the right.
I don't feel any pain at all. is it a floating rib? and what should I do to bring it to it's original position?
1/12/2014 5:15:26 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Holly,

Thank you for responding to our blog.

I’m sorry for your injury. Given our experience in our rib fracture clinic, I can comment on your two concerns. Pain at the site of rib fractures is not uncommon even as late as 6 months following the injury. Typically the pain is not disabling or interfering with most activities for people but it’s present. It’s also not uncommon for this pain to be neuropathic pain. Each rib has nerves that run along it and when the rib is disrupted the nerve is inflamed and irritable. This condition can last at least six months following injury and if it’s interfering with activities you may want to visit with a medical professional to consider treatment with medication or even a nerve block. In regards to your chest wall deformity. When ribs are fractured they are either displaced or non-displaced. This means that either the bones are broken but in alignment or the fracture is more complex and the two broken ends are shifted out of place of one another. It is possible that you had displaced bones at the time of injury and they healed in this displaced way, causing the deformity in your chest wall. It may be helpful for you to follow up with a medical professional near you to best identify exactly what has occurred. Certainly if you are in the Seattle area we would be happy to see you too!

Wishing you all the best in 2014.

Sincerely,

Joelle
1/7/2014 10:07:19 AM
Holly
I broke two ribs about 6 months ago. I fell chest first onto a deck railing while trying to prune a tree branch. I still have a fair amount of pain but my big concern is that my left rib cage, is now deformed looking. Its hard to explain but it looks like my rib cage is much larger on the left side then my right side. Have you ever heard of something like this? The ribs I broke were 7 and 8 but the area that looks much larger is at the bottom of my rib cage. I had my ribs re-xrayed about 10 weeks after I broke them and they said they were healing normally and everything look good.
1/4/2014 9:33:02 PM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Gary,

Thank you for your comment.

Although I can’t provide direct medical advice in this forum I can tell you a typical and expected course of recovery for patients with uncomplicated rib fractures.

When there’s a fracture in any bone there is a repair process that occurs. Your body’s cells understand that there’s been a break and recruit cells to the area to repair the bone. This repair takes a minimum of four weeks to fuse the bone(s) enough to provide stability in the ribs/chest wall. The challenge with rib fractures, unlike other bone fractures, is that you can’t splint them with a cast. The chest wall is always moving and this makes the healing process and time element to heal more difficult. Typically we advise patients to be on light duty, no heavy lifting over 10 pounds, for 4-6 weeks in order to optimize the healing process. It is very possible to disrupt those cells that are working hard to fuse the bones if lifting occurs. Meanwhile, the focus of treatment for patients is good pain control so that people are walking, coughing, and deep breathing in order to prevent pneumonia and resume functionality in their lives. The pain is the most severe in the first 2-4 weeks then as the chest wall stabilizes the pain improves. At our center we also offer rib plating for high functioning patients who need to return to their lives sooner and interested in expediting their recovery. You can learn more about this at this link. http://www.everydayhealth.com/pain-management/broken-ribs-a-new-fix-for-one-of-the-most-painful-fractures.aspx Perhaps someone in your area offers this option or at least a consultation to discuss if it’s right for you.

Wishing you all the best in your recovery.

Warm regards,

Joelle
12/10/2013 1:53:54 PM
gary
I had a x-ray after bursting a fire door open with my shoulder I have 2 fractured ribs, this was 5 days ago, the local GP at hospital[ princess royal] gave me 10 days off work, I want to return now after 5 days but I have a chesty cough which as you can imagine is very painful as the ribs that are fractured are under my left arm and every time I cough my ribs kill, would I be better totally resting my body or doing light duties [if such a thing] at work ,is this coughing stopping my ribs from healing quick?, thank you from Gary Jones ,Telford.
12/10/2013 5:05:19 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Chiela,

I’m sorry for your injury. Rib fractures can take a very long time to heal. Although I can’t provide direct medical advice on this blog I can tell you that in general it would not be within the realm of healing to have such a significant relapse in your recovery including symptoms that suggest re-injury. I am unsure of your geographic location but I would recommend you follow up with your local practitioner or you’re welcome to call and make an appointment in our clinic at 206-215-6800.

Wishing you the best of recovery.

Warm regards,

Joelle
11/14/2013 9:25:19 AM
Chiela
Hi

I fell six months ago and bruised/cracked my upper ribs mainly in the area beneath my breast. I was on painkillers for a few weeks and was improving all the time, although I still found it difficult to lie on that side. Two weeks ago the pain suddenly came back again quite severely. It does't hurt to breathe but there is a constant ache in the area below my armpit and below my breast. Is it possible that I have somehow damaaged the ribs or torn muscles again? Or does the pain from cracked/bruised ribs continue for such a long time after the event?
11/13/2013 6:58:50 AM
Joelle Thirsk-Fathi, DNP, ARNP
Dear Stefanie,

Thank you very much for your inquiry. First I would like to extend our concern for your husband; this is a traumatic event for all involved, you included. This is not a straight forward answer because each clinical case is specific to each patient. There are interventions that can be done to stabilize the sternum and ribs which can promote recovery for patients but whether or not this is realistic for the patient depends on many factors. You are very welcome to have the direct health care providers who are responsible for your husband’s care to call us and review the clinical case with one of our specialists. It is not uncommon for patients to airlifted from AK to our center if there is a clinical reason. Feel free to have them call me at 206-386-6800 and I can connect them ASAP to one of our docs.

Warm regards,

Joelle
11/5/2013 4:37:04 PM
Stefanie Anderzen
Hi, my spouse was just in a car accident on Friday, Nov 1,2013. He punctured both lungs, has 16 broken ribs, & a fractured sternum. He is in our local hospital in Palmer,AK, being treated by a trauma surgeon. I know it will be a long, painful recovery for him but am wondering if there might be more options & better treatments available at Swedish? I am not unhappy with the care so far, but am wondering what options you have for us? Thank you
11/4/2013 8:48:13 PM
Olivia
I fractured 2 ribs about 10 years ago, I had no idea at the time how it happened, and had xrays where the doctor said the fractures healed themselves. I saw a chiropractor a few times, but it didn't do much for the discomfort.
All these years later, more often than not I feel discomfort on the left side of my back.
I would describe it as like the feeling of an arm or leg you've had in one position for a while/leant on and need to stretch.
I feel I need to stretch that side a lot, but to no relief. I feel better standing, will this ever go away?????
10/8/2013 8:51:44 PM
Joelle Thirsk-Fathi, DNP, ARNP
Thank you for your response to our blog. We are very sorry for your recent events. Although we can not provide medical diagnoses and advice without seeing you we can comment on the following. Rib fractures heal in varying amounts of time following injury and this is dependent on many factors including your overall health and ability to heal. Tincture of time heals most fractures, even the most complicated fractures, but the time it takes to heal varies person to person depending on the location of the injury and in your case a possible upset to that initial injury. Finally, in our clinic we rely nearly 100% on CT imaging with 3D reconstruction of those images to make firm diagnoses of rib fractures. It is the most accurate means for evaluating the bones to your chest wall. Wishing you the best in your recovery.
8/20/2013 9:26:54 AM
Jennifer L Emerson
On June 26th, 2013. I was in an automobile accident which caused an inferiorly displaced fracture of distal aspect of the RT 7th rib. I was advised to do no heavy lifting for 6 weeks and since I am a CT technologist on night shift in a hospital, I simply had to be put on medical leave. At about 5 weeks I went back to my physician for a recheck and to see if he would release me to go back to work the following week which would be 6 weeks post injury. He had no problem with that since my pain had greatly lessened, but he did not want to do it without another xray. Which I did. Here's where it gets complicated. In the days(yesterday) waiting for the report to come back, a gentleman ran a redlight a tboned me in the new car. I'm stubborn so I didn't go to the ER, but I called my doctor this morning and he wanted me to go back in and get examined in an ER. I went to the same facility where the last xrays had been done. MORE xrays and the ER physician told me that he can see the fracture on this xray, but not as well on the ones from last week due to a difference in quality, so it was difficult for him to compare. He also said that he's seeing some but not as much callous formation as he would expect at now almost 6 weeks out...and also no way to know for certain if this second wreck reinjured it. Obviously, I don't have a radiologist's report yet and neither does my MD. Its simply hard to tell if this pain is just normal pain that comes from a car wreck or the rib itself. It does seem to be hurting again in that area. Could I be dealing with a non union fracture if what the ER physician said is true about the small amount of callous formation? And do I truly just need a non contrast CT to better evaluate this? I did look at the images too and I don't see a lot of callous formation either....but of course, I'm not a doctor. Any thoughts or advice would be much appreciated.
8/5/2013 7:05:27 PM
Eric Vallières, MD
There are many causes for chronic pains after rib fractures. The most common etiology is some degree of nerve damage to the nerve that travels under each rib. This is usually treated by pain medications and at time physiotherapy may help. Less frequently, the chronic pains may be secondary to a lack of healing of the fracture (non-union). The best way to evaluate for this possibility is to get a CT chest with a special software reconstruction of the images to create a 3D shaded surface display of the rib cage. This is much more sensitive than plain rib views in assessing for such a process. If non-union is documented a surgical procedure where the non-healed fracture is repaired (plate and screws) is a possibility and could offer much relief.
7/19/2013 4:40:40 PM
Jeannine
I was visiting Vancouver BC. 5 years ago and had an injury and went to the ER there. The ER doctor at the hospital I went to initially said there was nothing showing up on my x-ray. I was in such severe discomfort and could not take a breath without excruciating pain in my right upper stomach. The process of doing the x-ray in itself sent me screaming in pure agony. I am not a dramatic person but the simple act of lying on a table was too much. When doctor came back and said he found nothing on my x-ray... I asked him top please try to find out what was wrong with me. He left the exam room and looked at the x-ray again. He came back and said, "good to listen to the patient", it turns out that I had fractured rib(s). He said that there was nothing that could be done and that they didn't recommend wrapping ribs any more... He sent me home with pain meds that made me sick to my stomach, so I only took OTC acetaminophen. It took 3-4 months before I could move properly. I wish now that I had gotten a second opinion when I got back to the US.

I am now researching rib fractures because I still get an aching pain in that place in my rib-cage. It hurts after I eat even a light meal. I am concerned about the continued discomfort and wonder if it is common to still have pain 5 years later?

Thank you for any of your thoughts.
7/4/2013 2:13:23 PM
Donna Krumm
Dr. Vallieres, thank you so much for taking the time to respond to my questions. I have printed your response and contact information to pass along to his doctor and the treating physician. Initially we believed that some of his pre-existing health problems, arthritis and knees of which one after replacement had a staff infection. He has had surgery on his neck and shoulder blade. So he was already dealing with considerable pain and was taking Vicodin along with a nerve pill. They are now administering Morphine. While he is awake he becomes easily agitated when he feels any pain and frustrated that he cannot communicate other than to squeeze the hand and shake his head. The trauma physician has indicated that patients with worse injuries than his have been up and around in a few weeks. Needless to say both his family and the doctors are frustrated that we don't have any answers. My thoughts were that his ribs may just be too much for him to bear despite any medication. Hopefully, I can have his doctor contact you soon. Would be nice to have another opinion.
Thanks again.
6/12/2013 10:36:56 PM
Eric Vallières, MD
Sorry to read about your brother’s ordeal. It may very well be that he would benefit from having his ribs plated , though other unrelated issues may here be at play. Though it is logistically impossible to see him in consultation, we would be happy to review his films if you were able to send us copies on DVD or CD. Ideally we would want to review a CT of the chest with 3-D shaded surface display of his rib cage, with and without the scapulae.
6/10/2013 4:47:25 PM
Donna Krumm
My 70 year old brother in law fell a month ago and broke 5 ribs which we are told are displaced. Had a collapsed lung and fractured pelvic bone. After a month in the hospital he has continued to have complications trying to treat the lung and controlling the pain. The doctors at memorial in Modesto CA are baffled by his lack of improvement. He has required the use of a ventilator to assist with breathing as he has not been able to maintain adequate oxygen levels when breathing on his own. They just now did a tracheostomy to hopefully make him more comfortable but the pain levels continue to be unbareable. What are the signs that the ribs need to be repaired to insure that he can recover. I've been told that they have to get him breathing on his own before they could attempt surgery if it were feasible. How would we go about a consultation? Thanks for any help you may be able to offer.
6/9/2013 10:23:18 AM
Joelle Thirsk-Fathi, ARNP
Thank you for your response to our blog. When you have a fractured rib or ribs you can experience pain and disability for the upwards of 6 weeks, depending on how severely the fracture is displaced. It can be helpful to see your doctor for pain management during this time. If your ribs are more severely injured or displaced you may need to see a specialist. As a patient you have a right to transfer your medical records and radiographic films to another medical facility; this is common practice for patients. Usually you can sign a consent by the physician you intend to go see and they will request the records for you. Certainly if you are in the Seattle area we would be happy to see you in our Acute Rib Fracture Clinic. Wishing you a quick recovery!
5/21/2013 10:44:36 AM
Ella Ledet
I fell from a ladder and went to the emergency roon at our local hospital. They did a ex ray and I was told by the nurse it was one fractured rib. The hospital was very busy that night. Should I follow up with a Dr. ? Can I request the hospital to send my ex ray to my doctor?
5/21/2013 7:34:46 AM
Joelle Thirsk-Fathi, ARNP
Dear Hazel,

Thank you for your inquiry. Given the intensity and duration of pain that are associated with rib fractures we have established a rib fracture clinic here just to take care of people like you. Good pain control is of utmost importance in the setting of rib fractures in order to optimize recovery and prevent conditions such as pneumonia.
Unfortunately rib fractures hurt whether you are up moving around or even lying in bed. This is because the ribs are part of the chest wall that moves with any kind of action including just with breathing. Although you broke your ribs it is not necessary for you to be in agony.

Some of our patients feel benefit with an elastic abdominal binder around the chest wall that provides some comfort and support. Some people only sleep with this because night time is often the toughest part of the day for people. Others like to wear it in the car to avoid unnecessary jarring of the chest wall while riding and others wear it during the day with activity; it can be personalized to your needs but important that it is not too tight so you can still take a deep breath.

At our clinic it is not unusual for patients to be on a long-acting narcotic pain reliever. Long-acting medications provide a slow release of medication and help bring the overall pain score and experience to a lower level of intensity with less breakthrough pain. Long-acting medications usually last 8-12 hours, then you can use the shorter acting medication, such as the Codapane Forte, as needed. The goal is to make you more comfortable so you can resume your baseline activities with minimal interference by the pain. We want people comfortable enough to walk, talk, cough deep breath, eat, and sleep.

In addition to the narcotic pain relievers it is important to consider integrating heat or ice application and acetaminophen and/or ibuprofen into the regimen for pain relief. There is often a component of nerve pain involved with rib fractures because the nerves run along the ribs and a break in the rib disrupts the nerves. There are nerve medications and a topical anesthetic patch (Lidoderm Patch) that can also help with the pain experience and cut the intensity while you heal.

During this time it is important to be under the care of a health care provider that is comfortable treating you for this type of injury and to be followed closely until you have achieved full recovery from your injury. Tincture of time and patience is essential in the treatment plan of rib fractures. In my experience in treating patients with rib fractures, the first four weeks are the hardest, then the intensity of the pain eases and we can start backing down on the pain medication but not much sooner than that. Stability of the chest wall and those fractured ribs takes closer to six weeks and by six weeks you will start seeing your traumatic rib fractures and pain in the rear view mirror.
3/26/2013 4:00:26 PM
Hazel Ford
Iam 85 years old and have just had a fall onto mychest now have 3 broken ribs in agony taking 3 codapane forte every 6 hours no much relief any help availbe
3/21/2013 6:42:41 AM
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