Definition
A rib fracture is a severance of the bony ribs. One or more ribs may break in the course of external force (serial rib fracture). The term rib contusion describes a bruise (technical term: contusion) in the area of the bony ribcage. A contusion of the ribs is usually the result of blunt trauma.
General Information
Injuries in the area of the ribs are typically very painful, regardless of whether it is a rib fracture or a rib contusion. It is difficult to distinguish between rib fractures and rib bruises solely on the basis of the symptoms caused by the impairment of the rib cage. In both cases, the pain is already pronounced at rest.
These complaints usually increase significantly in intensity during breathing. In addition, the course of the accident can provide only limited information about whether a rib fracture or rib contusion is present. In both cases, the injury is caused by external force acting on the ribcage.
As a rule, it can be assumed that the development of a rib fracture is associated with significantly greater violence. Nevertheless, even small forces can lead to fractures of the ribs in individual cases. In general, it can also be assumed that blunt force applied to the ribcage causes rib fractures more quickly in older people than in younger people and children.
The main reason for this is the decreasing elasticity of the ribcage with age. In the end, only a comprehensive medical examination can provide information about whether the pain in the area of the ribcage is caused by a broken or bruised rib. Persons who develop severe pain following an external violent impact on the ribcage should therefore consult a doctor as soon as possible.
Causes
There can be a variety of causes for an injury to the ribcage, such as a rib fracture or rib contusion. Usually the injury is caused by a so-called “blunt trauma”, i.e. a strong violent impact on the ribcage. Whether these violent effects only lead to a contusion of the ribs or already to a broken rib depends on various factors: For example, whether the forces acting on the rib exceed the elasticity range of the rib and whether an underlying disease, such as osteoporosis, impairs the basic stability of the bone structures.
Generally speaking, it can be assumed in healthy adults that significantly greater forces must be exerted on the ribcage during the development of a rib fracture, all in the case of rib contusion. In the following situations, for example, extreme forces may be exerted on the ribcage with fractures or contusions:
- Accidents (for example car accidents),
- Falls on the chest,
- Contact or martial arts (such as soccer or boxing),
- Strongly pronounced cough.
Based on the symptoms alone, it is often difficult to decide whether a rib fracture or a rib contusion is present. In order to be able to reliably rule out a fracture of the bony ribcage, an X-ray should always be taken in case of doubt.
But even with the help of X-ray diagnostics of the bony rib cage, it can be difficult to distinguish between rib fracture and rib contusion. In both cases, the intensity of the occurring symptoms can be very different. A rib contusion usually causes localized pain in the area of the ribcage.
This pain can be very severe even at rest. Under stress, even when coughing or breathing deeply, the intensity of the symptoms typically increases significantly. Some of the affected patients experience a feeling of shortness of breath (dyspnoea) due to these symptoms.
In addition, during the physical examination of a patient with rib contusion, local pressure and compression pain can be provoked in the area of the affected thoracic segment. Only in rare cases does the pain typical of a rib contusion radiate into the entire thorax. In addition, dark bruises at the site of the violent impact are a sign of a rib contusion.
Persons suffering from a rib fracture often describe pain in the area of the entire thorax, which increases significantly in intensity when inhaled or coughing.Due to the significant increase in pain when breathing deeply, people suffering from rib contusion often experience a feeling of breathlessness. In addition, the symptoms experienced by the affected patient increase significantly when external pressure is applied to the affected rib area. In the case of a fracture of the bony ribcage, bruising over the affected rib is also frequently found, just as in the case of a simple rib contusion.
In general, pain is perceived to be stronger in the case of a rib fracture than in the case of a rib contusion. However, this is difficult to distinguish as a measure for differentiation, since the pain information is subjectively provided by the patient and there is therefore no uniform measure of when a rib contusion is to be assumed and when a rib fracture is to be assumed. In addition, the pain of a rib contusion and a rib fracture decreases during the course of healing, so that the pain of a rib contusion at the beginning can also exceed the pain of a rib fracture shortly before complete healing.
In rare cases, a rib fracture can lead to further nerve injuries that extend to more distant parts of the body. For example, the nerves that supply the heart can be injured. As a result, the patient has pain in the heart without the heart as an organ being damaged.
The phrenic nerve also runs close to the ribs – it supplies the diaphragm and other abdominal organs. Almost all major nerves that supply organs or muscles below the lungs and do not run in the spinal cord can be damaged by broken ribs. From this it can be concluded that pain radiating to other organs usually indicates a rib fracture and rules out rib contusion. The pain of a rib fracture differs from the pain of a rib contusion normally only in the intensity and in special cases in the radiation to other organs.
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