You have 24 rib bones encasing your chest. The twelve
ribs on each side are attached to your spine at
joints called costovertebral joints. Starting with
the first rib located at the top of your chest,
close to your shoulder, the top seven ribs on each
side wrap around your lungs and attach to your breastbone,
called the sternum. The three ribs below are not
attached to your breastbone, but are attached to
the ribs above them with cartilage. Your bottom
two ribs, called floating ribs, are attached to
your spine only. Muscles attach to your ribs to
control expansion and contraction of your chest
cavity, which draws air in and out of your lungs
as you breath. Muscles attached to your ribs also
control movement in your upper body and shoulders.
Rib fractures rarely occur during sports and activities.
However, when you suspect a rib fracture, you should
seek medical treatment as soon as possible because
there is a risk of cracked ribs injuring your lungs,
kidneys, spleen, and other organs. Ribs can be fractured
in two ways:
Direct
– A blow to your chest, such as may occur
when you are tackled or other people fall on top
of you.
Indirect
– Muscles attached to your ribs can pull in
different directions and cause a crack in the bone.
Repetitive muscle strain also can cause an avulsion
fracture, which means the muscle activity pulls
a piece of bone off the site where the tendon attaches
the muscle to the bone.
Causes
Rib fractures caused by direct
impact are rare in sports. They can occur in collision
sports such as football, hockey, or rugby. The impact
can damage one or more of your ribs where the blow
hits the bone. A blow can also can be dispersed
from the site of contact and compress a wider area
of your chest. The compression can cause multiple
fractures. Athletes who engage in repetitive arm
and upper body motions, such as baseball and tennis
players, can put rhythmic, violent stress on their
ribs as the muscles attached to the ribs pull in
different directions. A common example of an indirect
rib fracture is in the first rib, at the top of
your chest, close to your shoulder. Certain shoulder
muscles pull up on the rear portion of your rib
as you lift your arm and other muscles in the abdomen
pull down on the front of your rib as your trunk
swings forward. The repetitive, opposing forces
can cause a crack somewhere in the thinnest portion
of the middle region of your first rib. Golfers
may suffer an indirect rib fracture in their bottom
two floating ribs caused by the opposing muscle
forces required to swing the golf club.
Whether your rib fracture develops slowly or occurs
immediately after an impact, you should have your
physician examine you as soon as possible. Rib fractures
can be associated with dangerous injuries to your
lungs, kidneys, spleen, and other internal organs.
These complications may immediately need special
medical attention. If left untreated, even minor
rib fractures that do not cause much pain may continue
to worsen until the bone suffers a larger crack.
The most common treatment for rib fractures that
do not have complications is called symptomatic
treatment. This means physicians take whatever steps
are necessary to ease your pain and calm the symptoms
down so you can breath. Fortunately, most rib fractures
are quite benign injuries that do not require surgery
and heal with rest, medication, stretching, and
strengthening.
Medical
Evaluation
There usually are three parts to a medical evaluation:
medical history, a physical examination, and tests
that your doctor may order.
MEDICAL
HISTORY
Your physician likely will
ask about your activities, which may have caused
your rib fracture. You will probably be asked when
the soreness or pain began. If you have had any
prior rib injuries, your physician will ask about
the treatments you have tried in the past. Physicians
generally suspect a minor rib fracture or stress
fracture when patients have a history of pain in
their chest that affects them during activity and
some difficulty taking deep breaths. Severe, cracked
ribs usually can be diagnosed immediately after
the injury. Physicians also typically ask about
other conditions, such as diabetes and allergies,
and medications currently being taken. You may also
be asked about your physical and athletic goals
– information that will help decide what treatment
might be best for you in achieving those goals.
Your physician typically
presses on your rib cage from different areas to
pinpoint your pain. After a direct fracture, you
ordinarily feel pain and tenderness when your physician
presses directly over the area of the bone that
has cracked. Compressing the front and back of your
chest may cause pain in your side if you have suffered
a fracture in the middle of a rib. Physicians usually
examine your shoulders for injury if you complain
of pain in your upper chest. You also commonly have
your breathing and lung function checked with a
stethoscope. If you have suffered a rib fracture
in your lower ribs, physicians ordinarily check
for spleen, kidney, and liver damage. The physical
exam may not reveal conclusive symptoms of a stress
fracture or indirect fracture if it is not causing
you much pain. You may notice tenderness when your
physician presses on the damaged area during a deep
breath when your chest cage is expanded.
TESTS
X-rays taken from different
angles typically can reveal the location of your
rib fracture. If X-rays are unclear, a bone scan
may be ordered. A radioactive dye is injected into
your bloodstream, which can help your physician
see your body's immune or healing response
to a fracture.
Direct
– A blow to your chest, such as may occur
when you are tackled or other people fall on top
of you.
