March 1, 2013
Dear Mayo Clinic:
My husband, 71, slipped on the stairs and now has a painful area on his rib cage. He has fractured a rib before and says there is no way to treat it, so he has not gone to the doctor. Is it true that nothing can be done? Does he need to see a doctor?
It is true that usually not much can be done for a fractured rib that isn't moved out of normal position and alignment (displaced). Treatment for a rib fracture is usually limited to providing adequate pain control, avoiding strenuous activities and letting it heal. But your husband should be seen by a doctor to rule out other underlying injuries.
Rib fractures are one of the most common types of fracture in older adults. In one study that looked at causes of rib fracture in older adults, about 25 percent of fractures were caused by major trauma, such as a car accident. These account for the most severe injuries, where multiple ribs are fractured, and when fractured bone ends are displaced. Displaced bones can cause many life-threatening complications, and emergency care is appropriate in most cases of major trauma and for anyone with three or more fractured or displaced ribs.
But most causes of rib fracture don't occur as a result of major trauma. In the same study, one-third of the rib fracture causes were due to moderate trauma, such as falling from a standing height. And for about 40 percent of the fractures in the study, there was no identifiable trauma that caused the fracture, which means that nontraumatic events — such as the repeated stress of a coughing spell or swinging a golf club — may have caused it. This may be more likely to occur in someone with weakened bones due to osteoporosis. A tiny percentage of fractures had a direct pathological cause, such as a cancer that had spread to rib bones.
Rib fractures that are the result of mild to moderate trauma or repeated stress on the bone are usually less severe initially, but can be very painful. Pain often occurs when you take a deep breath. It's often possible to isolate a spot on the bone that hurts to the touch or that hurts when you bend or twist.
Serious complications requiring prompt medical intervention — such as lung bruising and swelling, bleeding into or around the lungs, or a collapsed lung — can occur after rib fracture due to minor to moderate trauma. Such complications may require insertion of a chest tube or other surgery, blood transfusion, and artificial ventilation. Emergency care may be necessary if the injured person has lightheadedness, shortness of breath or significant chest pain, particularly if it's worsening.
Even if a suspected fractured rib doesn't require emergency care, it's still important to see a primary care physician for diagnosis and possible treatment.
Controlling pain of a rib fracture is critical so that you can breathe deeply and cough. When pain prevents you from doing this, the risk of developing pneumonia rises. In fact, pneumonia is the most prevalent and serious complication of rib fractures in older adults, occurring in roughly 30 to 35 percent of adults age 65 and older.
Pain control may include nonprescription drugs such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). If these aren't enough, your husband's doctor may prescribe stronger medications. For severe fractures, regional anesthesia may be considered.
Most nondisplaced rib fractures heal within six weeks. Although pain will gradually subside over this time, your husband will likely experience some pain flare-ups because it's hard to totally avoid movement of the healing rib. In some cases, application of a prescribed trunk support, for limited periods, may help to decrease the pain. I recommend he see his doctor, who can rule out any underlying issues and help with pain control. Many people return to their daily activities in less than six weeks.
— Mehrsheed Sinaki, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.