The function of our ribcage is to support the upper part of the body and protect the internal organs like the lungs and the heart. The ribcage also assists in breathing. One of the several causes of chest wall pain is costocondritis caused by rib cage injuries.1 Rib injuries are bruised ribs, sprained rib muscles, fracture of the rib bone and fractured cartilage mostly caused by direct impact.2 Chest wall or rib cage injury is extremely painful condition. Traumatic injury of the cartilage results in severe pain and breathing difficulties. In this article, we will discuss about the causes, symptoms, and treatments for a Rib Cartilage Injury.
How Do We Define Pain Due To Rib Cartilage Injury Or Rib Cartilage Fracture?
Rib cage or chest wall is formed by 24 ribs, costal cartilages, sternum and vertebral column. Twelve Ribs lies on each side of chest wall and forms half a loop, which covers front, side and back of the rib cage. First seven pairs of ribs are connected directly to the breastbone (sternum) by a cartilage called Costal Cartilage. These pairs of ribs are also called as True Ribs. Next five pairs of the ribs are known as false ribs. The five false ribs (6th to 10th ribs) are linked to a common cartilage. The link between 6th to 10th ribs with common cartilage is known as Osteo-Chondral joint. The common cartilage is attached to sternum or breastbone. The last two pairs are not connected to the breastbone at all and they are called as Floating Ribs. The joints of ribcage in our body are held together by ligaments and muscles. The bucket handle movement of ribcage during inhalation and exhalation is achieved by muscles contractions. Ribcage expands during inhalation and contracts during exhalation. Any sort of injury to these cartilages result in severe Rib cage or Chest Wall Pain during inhalation and exhalation with movements of rib and cartilage attached to ribs.
Causes Of Rib Cartilage Injury Or Rib Cartilage Fracture
Rib cartilages lies on either side of breastbone (sternum).
- Sports Injury- Rib cartilage Injury can also occur due to undue and repeated pressure on the ribcage, especially in individuals involved in sports requiring swinging of the arms with extreme force. A sudden jerking movement of the chest can also cause a Rib cartilage Injury.
- Work Injury- Direct impact of heavy equipment over chest wall can cause fracture or dislocation of the cartilage of rib cage.
- Automobile Accident- Rib Cartilage Injury can also occur as a result of high-speed motor vehicle accidents, especially when airbags fail to deploy resulting in the chest hitting directly the steering wheel.
- Domestic Fall- Rib cartilage injuries are often observed following direct trauma or fall on anterior (front) rib cage.
- Assault or bodily injury- Cartilage injuries such as fracture or dislocation results following assaults and direct blows to the chest by solid object.
- Forceful Coughing- There is also a medical condition in which the ribs separate from its attachment, which may result due to severe forceful coughing.
Risk Factors For Rib Cartilage Injury or Rib Cartilage Fracture
- Age- Older patients suffering with degenerative diseases are prone for cartilage injury after fall or rapid jerking upper body or chest movements.
- Athletes- People who are involved in sports like tennis or volleyball are at risk for Rib Cartilage Injury. Also, people involved in weightlifting are more prone to get Rib Cartilage Injury, especially when they do a Clean-And-Jerk movement.
- Not Wearing Seat Belt- Passenger or driver is at risk when not wearing seat belt while driving.
- Chronic Smoking- Individual with history of chronic smoking suffers with smokers cough. Persistent forceful smokers cough may cause rib cartilage injury in elderly patients with history of degenerative disease.
Symptoms Of Rib Cartilage Injury or Rib Cartilage Fracture
Some Of The Symptoms Of A Rib Cartilage Injury or Rib Cartilage Fracture Are:
- Excruciating pain where the injury occurred.
- Severe pain with movement, taking a deep breath, or with coughing and sneezing
- Crepitus with palpation at the injured area
- Muscle spasms in the area of the ribcage
- Ribcage deformity
- Breathing problems
Diagnosis Of Rib Cartilage Injury or Rib Cartilage Fracture
- X-Ray Chest- Any sort of rib injury has the potential to cause a rib fracture; hence it is essential to get a chest x-ray as soon as an injury occurs. The x-rays can rule out a fracture of the ribs. X-Ray may not show hairline or displaced cartilage fracture.
- CT Scan and MRI Examination- Selective CT Scan or MRI study of tender and painful cartilage does show the hairline and un-displaced fracture of the cartilage and dislocation of Costochondral joint.4
- Bone Scan- Apart from chest x-ray, bone scan and other imaging studies are also done to confirm the diagnosis of a Rib Cartilage Injury.3
Treatment For Rib Cartilage Injury or Rib Cartilage Fracture
Conservative Treatment For Rib Cartilage Injury or Rib Cartilage Fracture-
- Ice local application
Medications For Rib Cartilage Injury or Rib Cartilage Fracture-
- In case of a Rib Cartilage Injury, pain management with medication therapy is the treatment of choice in case of a minor injury.
- Medications like ibuprofen or NSAIDs are generally used by physicians for treatment of Rib Cartilage Injury to help with the pain and inflammation.
Physical Therapy (PT) To Treat Rib Cartilage Injury or Rib Cartilage Fracture-
- Physical therapy is not tolerated during the initial phase of the pain.
- Physical therapy is advised after 6 to 8 weeks of initial injury.
- Physical therapy helps to strengthen intercostal muscles.
Interventional Pain Therapy For Rib Cartilage Injury or Rib Cartilage Fracture-
- Intercostal nerve block with local anesthetic and corticosteroids are tried to treat pain and inflammation.
- Initial 3 injections are tried. If pain relief is adequate and lasts for 4 to 6 weeks then follow up injections are tried every 6 weeks.
What Is The Recovery Time For A Rib Cartilage Injury Or Rib Cartilage Fracture?
The usual time taken for complete recovery from a Rib Cartilage Injury is approximately three to four months because the cartilages take quite a bit of time to heal since the blood supply to them is hindered. Refraining from strenuous activities and taking adequate rest can speed up the healing time.
- Evaluation and treatment of musculoskeletal chest pain. Ayloo A1, Cvengros T, Marella S. Prim Care. 2013 Dec;40(4):863-87,
- Study of rib fracture mechanisms based on the rib strain profiles in side and forward oblique impact. Leport T1, Baudrit P, Potier P, Trosseille X, Lecuyer E, Vallancien G. Stapp Car Crash J. 2011 Nov;55:199-250.
- Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma. Kara M1, Dikmen E, Erdal HH, Simsir I, Kara SA. Eur J Cardiothorac Surg. 2003 Oct;24(4):608-13.
- Costal cartilage fractures as revealed on CT and sonography. Malghem J1, Vande Berg B, Lecouvet F, Maldague B. AJR Am J Roentgenol. 2001 Feb;176(2):429-32.