Broken ribs or bruised ribs

definition

Broken rib

A broken rib is a severing of the bony ribs. In the course of external violence, one or more ribs can break (series of ribs fractures).

Bruised ribs

The term rib bruise describes a bruise (technical term: Contusion) in the area of ​​the bony chest. A rib bruise usually occurs as a result of blunt trauma.

General information

Injuries to the ribs are typically very painful, regardless of whether it is a broken rib or a bruised rib. It is difficult to distinguish between a broken rib and a bruised rib based on the symptoms caused by the impairment of the chest. Both injuries cause pronounced pain even at rest. These complaints usually increase significantly in intensity while breathing.

In addition, the course of the accident can only provide limited information on whether a rib is broken or bruised.
In both cases, the injury is caused by external force on the chest.

As a rule, it can be assumed that the development of a broken rib is associated with significantly stronger violence. Nevertheless, even small forces can lead to fractures of the ribs in individual cases.

In general, it can also be assumed that blunt acts of violence on the chest lead to a broken rib more quickly in older people than in younger people and children. The main reason for this is the elasticity of the chest, which decreases with age.

Ultimately, only an extensive medical examination can reveal whether the pain in the chest area is caused by a broken rib or a bruised rib. For this reason, people who develop severe pain on the chest after being subjected to external violence should consult a doctor as soon as possible.

Read more about this under: Symptoms of a broken rib.

causes

There can be a variety of causes for the development of an injury to the chest, for example a broken rib or a bruised rib. As a rule, the injury is caused by what is known as “blunt trauma”, i.e. a strong force applied to the chest.

Whether this violence only leads to a bruised rib or to a broken rib depends on various factors: For example, on whether the forces acting on the rib exceed the elastic range and whether there is an underlying disease such as osteoporosis, the basic stability of the bone structure is impaired.

In general, in healthy adults, it can be assumed that significantly stronger forces must act on the chest when a broken rib develops, all of which are caused by bruises.

In the following situations, for example, extreme forces can be exerted on the chest with fractures or bruises:

• Accidents (e.g. car accident),
• Falling on the chest
• Contact or martial arts (e.g. football or boxing),
• severe cough.

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General symptoms

Based on the symptoms alone, it is often difficult to decide whether you have a broken rib or a bruised rib.
In order to be able to rule out a fracture of the bony chest with certainty, an X-ray should always be taken in case of doubt. But even with the help of X-ray diagnostics of the bony chest, it can be difficult to differentiate between a broken rib and a bruised rib. In both cases, the intensity of the symptoms can be very different.

Bruised ribs

A bruised rib usually causes localized pain in the chest area. This pain can be very pronounced even at rest. Under physical exertion, i.e. even when coughing or breathing deeply, the intensity of the symptoms typically increases significantly.

Some of the affected patients experience difficulty breathing because of these symptoms (Dyspnea).

In addition, local pressure and compression pain in the area of ​​the affected thoracic segment can be provoked during the physical examination of a patient with bruised ribs. Only in rare cases does the pain typical of a bruised rib spread to the entire chest.

Also, dark bruises at the site of the violence are a sign of a bruised rib.

Broken rib

People who suffer from a broken rib often describe pain in the entire chest area, which increases significantly in intensity when inhaling or coughing.

Due to the significant increase in pain when breathing deeply, people who suffer from bruised ribs often experience a feeling of shortness of breath.

In addition, the symptoms felt by the affected patient increase significantly with external pressure on the affected rib area.

In the case of a fracture of the bony rib cage, as in the case of a simple bruise, bruises can often be found over the affected rib.

You may also be interested in the following article: These are the symptoms of a broken rib.

Can a broken rib be distinguished from bruised rib based on pain?

In general, the pain of a broken rib is perceived more strongly than that of a bruised rib. However, this is difficult as a measure to differentiate, since the pain information is made subjectively by the patient and there is therefore no uniform measure of when a rib bruise and when a rib fracture can be assumed.

In addition, the pain of a bruised rib as well as a broken rib decrease in the course of healing, so that the pain of a bruised rib at the beginning can also exceed the pain of a broken rib shortly before the complete healing.

In rare cases, a broken rib can lead to further nerve injuries that extend to more distant parts of the body. For example, it can damage the nerves that supply the heart. Consequently, the patient has pain in the heart without the heart as an organ being damaged. The phrenic nerve also runs near the ribs - it supplies the diaphragm and other abdominal organs. Almost all major nerves that supply organs or muscles below the lungs and that do not run in the spinal cord can be damaged by injuries caused by broken ribs.
From this one can conclude that pain radiating to other organs usually indicates a broken rib and rules out rib bruising.

The pain of a broken rib usually only differs from the pain of a bruised rib in terms of the severity and, in special cases, of the radiation to other organs.

Diagnosis - broken rib or bruised rib?

Diagnosing whether it is a broken rib or a bruised rib is very difficult to make based on the symptoms because they are far too similar.

Only in people who show no pain despite trauma and obvious impairment of the bony rib cage, the assumption is reasonable that there is no rib bruise but a broken rib. However, this phenomenon can only be observed in certain localizations of the rib fracture.

An exact differentiation as to whether there is a broken rib or a bruised rib can only be made through an extensive physical examination and subsequent imaging measures.

Diagnosis

In order to be able to differentiate whether pain in the chest is caused by a broken rib or a bruised rib, various diagnostic measures are available. Affected people should consult a doctor as soon as possible.

At the beginning there is usually a doctor-patient conversation, in which the possible course of the accident should be described in as much detail as possible. The symptoms that occurred after the trauma, such as pain and / or shortness of breath, can also be helpful in further diagnosis.
This is followed by an orienting physical examination of the affected rib segment. Under certain circumstances, this examination can provide a decisive indication of whether it is just a bruised rib or a broken rib.

• In the case of a broken rib, the broken edges can often be felt on the fractured rib. This means that the usual continuity of the bony rib is broken by a noticeable step or bulge.
• This would not be the case if there was a common bruise in the ribs.

A bruise that may be present can also help identify the affected segment of the rib.

In most cases, however, it turns out that the question of whether there is a broken rib or just a bruised rib can only be answered with the help of imaging procedures. Even when looking at a simple x-ray, it can be difficult to differentiate between the two clinical pictures. More precise statements can often only be made after a computed tomography or magnetic resonance tomography has been performed.

therapy

For the actual treatment, it usually makes no difference whether the affected patient suffers from a broken rib or a bruised rib.
This is especially the case when there are no more than two ribs on one half of the chest (so-called Serial rib fracture) are affected. Regardless of whether the discomfort is caused by a broken rib or a bruised rib, treatment is usually purely conservative (non-surgical).
Adequate pain therapy is necessary, regardless of whether there is a broken rib or a bruised rib, so that the affected patient can breathe in normally deeply despite the injury and does not fall into shallow breathing. In this way, the development of inflammatory processes in the area of ​​the lungs (pneumonia) can be prevented.

Since both diseases can lead to severe pain, especially during breathing, coughing and under exertion, the focus is on adequate pain relief. For this reason, symptomatic treatment is given first and affected patients are usually given pain reliever medication. Medicines from the group of NSAIDs (non-steroidal anti-inflammatory drugs), such as, for example, are particularly suitable

• Ibuprofen,
• Naproxen,
• Paracetamol,
• Diclofenac or
• Metamizole.

In addition, the external application of ointments, creams or gels containing NSAIDs is recommended. However, the actual effectiveness of these agents is still controversial today.

If the affected patient also suffers from a dry cough, the administration of a cough suppressant drug (e.g. dihydrocodeine or dextromethorphan) can be useful.

In particularly pronounced cases, the treating doctor can also use the weakly effective opioid Tramadol be prescribed.

If the pain even interferes with normal breathing, there is an option to do something called a nerve block. With this method of treatment, the patient is given an injection with a local anesthetic. The injection is given immediately in the area of ​​the nerve supplying the affected rib.
Careful cooling of the affected rib segment can also help prevent swelling and relieve pain.

In the case of a broken rib, special breathing training may also be necessary. Any restriction of the normal ability to breathe must be prevented urgently in people with injuries to the ribs. For this reason, even a broken rib should no longer be treated with a bandage.

Surgical treatment measures are not necessary for a bruised rib. Surgical treatment is rarely used nowadays, even if there is a broken rib. Make an exception

• Serial rib fractures, in which the chest wall becomes unstable,
• suspended break ends and
• Injuries to vessels or internal organs in the area of ​​the fractured rib.

The most important therapy element, however, is physical protection. Above all, this means that any sporting activity should be avoided until the rib has healed completely.

forecast

The prognosis is very good regardless of whether the rib is broken or bruised.

In most cases, the injury to the bony chest heals completely within a period of three to a maximum of six weeks.
The healing time also depends on whether there is just a bruise or actually a break. While the bruise usually heals within three weeks, with fractures it can take up to eight weeks for the fracture to heal completely and for the bone substance to match its original density.

After the disease has completely healed, the affected patient usually does not suffer any consequential damage. Important nerve fibers can only be injured in severely displaced rib fractures. As a result, what is known as "intercostal neuralgia" or "intercostal neuralgia" can develop.