Broken or bruised ribs (chest wall injuries)

Urgent and Emergency Care Centre

Chest wall injuries include:

fractured (broken) ribs
bruised chest wall
broken sternum (breastbone)

Broken or bruised ribs are usually caused by a fall, a blow to the chest or severe coughing.

Symptoms include:

strong pain in your chest area, particularly when you breathe in or cough
swelling or tenderness around the affected ribs
sometimes bruising on the skin
feeling or hearing a crack if it's a broken rib

Ribs cannot be easily splinted or supported like other bones, so they're usually left to heal naturally.

There's often no need for an X-ray to confirm a broken rib because the treatment and recommendations for care would be the same as if it was not broken.

Sometimes, you may need further investigations such as an X-ray or CT scan to check for injury to your lungs and other organs beneath the ribs.

Treatment for these types of chest wall injuries is usually the same. It consists of good pain relief and regular breathing exercises.

Rib injuries can take 4 to 6 weeks to heal.

How do I treat my pain?

The aim is to keep your pain under control and not to wait until it is very bad before treating it.

If you find that regular pain relief is not controlling your pain, you may need to stay in hospital for stronger pain medication, local anaesthetic injections to your chest wall or epidural pain relief.

Good pain relief will help you to be able to take deep breaths, cough and move around. This is important as doing this reduces your chances of getting a chest infection.

Pain relief can include a combination of:

Paracetamol

Paracetamol is a very effective pain medication when taken regularly and can reduce the amount of strong pain medication you will need. It rarely causes any side effects when taken in normal doses.

Non-steroidal Anti-inflammatory Pain Medication (NSAIDs)

(Ibuprofen, also known as Brufen or Nurofen, Diclofenac, Naproxen, Cox-2 Inhibitiors like Celecoxib and Etoricoxib)

NSAIDs are very effective for mild to moderate pain. They should be taken regularly if tolerated, but stick to one medication of the NSAIDS group, there is no benefit in combining different NSAIDS and it may cause additional side effects.

Most people can have NSAIDs but they can occasionally cause sickness and indigestion, please stop taking them if you develop these symptoms. If you have had a stomach ulcer in the past, or have problems with your heart, liver or kidneys you may not be able to take NSAIDs . NSAIDS can be taken with paracetamol if needed.

Opioids

There are 2 types of opioids:

weak opioids - tramadol, codeine and dihydrocodeine
strong opioids - You may be prescribed morphine or oxycodone whilst in hospital. Opioids can sometimes cause light-headedness, drowsiness nausea.
They can cause constipation which can be treated with laxatives.
Dependence, higher tolerance and addiction can happen as a result of repeated use, so we recommend to only use them for a short amount of time.

All opioids can cause drowsiness and affect the ability to drive safely.

Epidural/local anaesthetic techniques

If you have multiple rib fractures or you find that regular pain medication is not controlling your pain, you may be offered an epidural or a nerve block such as an erector spinae plane block, serratus anterior block or a paravertebral block.

Epidural and local anaesthetic blocks work by blocking the pain signal travelling along the nerves supplying your ribs.

The nerve blocks are given as an injection through your skin, often using an ultrasound machine to identify where the nerves are.

Epidural pain relief is given through a small tube which the anaesthetist inserts between the vertebrae (bones) of your spine. The tube is then connected to a pump which delivers a set dose of pain relief.

Patient controlled analgesia (PCA)

Patient controlled analgesia (PCA) is an alternative to an epidural or nerve block.

PCA is a small computerised pump containing strong pain medication, such as morphine or oxycodone connected to your drip. This allows you to control your pain relief.

Breathing exercises

Breathing exercises help to ensure lungs get fully inflated to avoid a build up of secretions (fluid) which can lead to chest infections.

Every hour take 10 slow deep breaths to top of your in breath and hold there for 2 to 3 seconds, if you can.

Ice packs

During the first few days you can try an ice pack wrapped in a towel held against the injured chest wall.

Try holding a pillow or folded towel against your injured chest wall when sneezing or coughing.

Smoking and vaping

Smoking slows healing, consider stopping. Support is available via your GP.

Is there anything I should avoid doing?

You should limit heavy lifting and contact sports for 4 to 6 weeks.

What exercises will help my recovery?

Whilst seated, fold your arms and gently rotate your upper body from side to side.

Whilst seated, allow your upper body to ‘slouch’ and then slowly draw up to full height, with your shoulders back, in a big stretch.

If you have a broken or bruised rib and:

your pain has not improved within a few weeks
you're coughing up yellow or green mucus
you have a very high temperature (fever) of 38°C or above, or feel hot and shivery

You might need stronger painkillers or have a chest infection that needs antibiotics.

Ask for an urgent GP appointment or get help by calling 111 or visit 111 online.