What is damaged in a chest injury?
The ribs are connected to each other by intercostal muscles; vessels and a nerve run along the lower edge of each rib. When struck, it is these structures that suffer: tears of muscle fibers, hemorrhage, swelling and irritation of the intercostal nerve occur. The periosteum of the rib is very sensitive, so the pain can be severe even without a fracture. Breathing constantly stretches the damaged area, and it is impossible to provide rest to the tissues - this explains the protracted nature of the pain.
- Damage to the intercostal muscles
- Bruise of the periosteum of the rib
- Hemorrhage into soft tissues
- Intercostal nerve irritation
- Possible lung bruise with a strong blow
Symptoms
The pain appears immediately and is localized at the point of impact. It intensifies with a deep breath, coughing, sneezing, laughing, turning and trying to lie on the sore side. After a day or two, a bruise appears and there may be swelling. A person instinctively breathes shallowly and holds his chest with his hand. The general condition of an isolated bruise does not suffer: there is no shortness of breath at rest, fever or weakness. At night, pain often makes it difficult to find a comfortable position.
- Local pain at the site of impact
- Increased pain when inhaling and coughing
- Bruising and swelling
- Pain on pressure
- Shallow gentle breathing
- Difficulty lying on the injured side
How to distinguish a bruise from a fracture
It is difficult to distinguish them clinically because the pain in both cases is severe. A fracture is indicated by point pain strictly above one rib, a crunch at the time of injury, pain when the chest is compressed in the anteroposterior direction, and a clicking sensation when breathing. An x-ray can clarify the diagnosis, but it does not show fractures of the cartilaginous part and fresh cracks, so if the pain persists, a computed tomography is sometimes needed. The practical meaning of the difference is small: treatment for an uncomplicated rib fracture is almost the same as for a bruise.
- Chest X-ray in two projections
- Computed tomography for unclear picture and severe injury
- Ultrasound of the pleural cavity to look for fluid and air
- Signs of a fracture: crunching, pinpoint pain, pain when squeezing the chest
- Treatment of an uncomplicated fracture is similar to treatment of a bruise.
Dangerous complications
It is not the bruise itself that is dangerous, but what may be hidden behind it. A strong blow can damage the lung with the development of pneumothorax or hemothorax, cause a bruise of the lung or heart, and if the lower ribs are hit, it can rupture the spleen or liver. These conditions are manifested by shortness of breath, weakness, drop in blood pressure and abdominal pain, sometimes after several hours. The second complication is congestive pneumonia due to shallow breathing, especially in the elderly and smokers.
- Pneumothorax and hemothorax
- Lung contusion
- Damage to the spleen or liver from a blow to the lower ribs
- Congestive pneumonia due to gentle breathing
- Protracted intercostal neuralgia
Treatment and recovery
Treatment is aimed at pain relief so that the person can breathe normally. In the first two days, cold is applied for 15 minutes several times a day, then they switch to rest and a gentle regimen. The doctor selects painkillers; if the pain is severe, an intercostal blockade is possible. You should not bandage the chest tightly: this limits ventilation of the lungs and increases the risk of pneumonia. On the contrary, take deep breaths and cough several times a day, pressing a pillow to your chest. Heavy exercise and sports are postponed until the pain completely subsides.
- Cold in the first 48 hours
- Painkillers as prescribed by a doctor
- Breathing exercises with deep breaths
- Coughing with a pillow pressed to your chest
- No tight chest bandaging
- Sleep on your back or healthy side with a pillow under your chest