Fractured Ribs

THE CLINICAL SYNDROME

Fractured ribs are one of the most common causes of chest wall pain. They are most commonly associated with trauma to the chest wall. In osteoporotic patients or in patients with primary tumors or metastic disease involving the ribs, they may occur with coughing (tussive fractures) or spontaneously.

The pain and functional disability associated with fracture ribs is determined in large part by the severity of injury (e.g., the number of ribs involved), the nature of the injury (e.g., partial or complete fractures, free-floating fragments), and the amount of damage to surrounding structures including the intercostal nerves and pleura. The severity of pain associated with fracture ribs may range from a dull, deep ache with partial osteoporotic fractures to severe sharp, stabbing pain that limits the patient’s ability to maintain adequate pulmonary toilet.

SIGNS AND SYMPTOMS

Rib fractures are aggravated by deep inspiration, coughing, and any movements of the chest wall. Palpation of the affected ribs may elicit pain and reflex spasm of the musculature of the chest wall. Ecchymosis overlying the fractures may be present. The clinician should be aware of the possibility of pneumothorax or hemopneumothorax. Damage to the intercostal nerves may produce severe pain and result in reflex splinting of the chest wall, further compromising the patient’s pulmonary status. Failure to aggressively treat this pain and splinting may result in a negative cycle of hypoventilation, atelectasis, and ultimately pneumonia.

The pain of fractured ribs is amendable to intercostal nerve block with local anesthetic and steroid.

TREATMENT

Initial treatment of rib fracture pain should include a combination of simple analgesics and the nonsteroidal anti-inflammatory drugs or the cyclooxygenase-2 inhibitors. If these medications do not adequately control the patient’s symptomatology, short-acting potent opioid analgesics such as hydrocodone represent a reasonable next step.

The local application of heat and cold may also be beneficial to provide symptomatic relief of the pain of rib fracture. The use of an elastic rib belt may also help provide symptomatic relief. For patients who do not respond to these treatment modalities, the following injection technique using local anesthetic and steroid should be implemented to avoid pulmonary complications.

The patient is placed in the prone position with the patient’s arms hanging loosely off the side of the cart. Alternatively, this block can be done with the patient in the sitting or lateral position. The rib to be blocked is identified by palpating its path at the posterior axillary line. Because of the overlapping innervation of the chest and upper abdominal wall, the intercostal nerves above and below the nerve suspected or subserving the painful condition will have to be blocked. Intercostal nerve block is a simple technique that can produce dramatic relief for patients suffering from rib fractures.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.