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Bruised, fractured or broken ribs?

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I fell off my bike 2 days ago and landed very hard on my left side, with my arm overhead. I think my hip took most of the impact as it's very bruised and sore to walk, but as time goes on my ribs are becoming more sore. They don't hurt so much to the touch as they do to take deep breaths, and especially when I sneeze or laugh, I get very short of breath and almost wheeze when I lean over. The most painful spot us the rib just under my bra line, and also below my clavicle. I'm very active and am meant to be racing outrigger canoe this weekend. Does this sound like a broken or fractured rib, or worse?
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replied October 12th, 2011
Especially eHealthy

Unfortunately, the only way to know if you broke a rib, is to have it x-rayed. However, if you separated the costocartilage from the rib, that would not show up on the film, but would essentially be the same as a fracture.

It actually takes quite a bit of force to injure the underlying lung tissue. Occasionally, if there is a rib fracture with a sharp point, it could conceivably "puncture" the lung. But, you would have had significant pain from the beginning, pain on palpation, and pain with every movement and breath. These patients usually also have shortness of breath.

However, "bruised" ribs or injury to the intercostal muscles can also be quite uncomfortable. It can often take several weeks for the discomfort to subside.

Treatment for broken ribs is basically decreasing activity for comfort and wait for Mother Nature to take her course. Bruised ribs, torn intercostal muscles, separation of the costochondral cartilage are all also treated in the same manner.

Some physicians do not like to use a rib binder, as the patient tends to not take deep breaths with it on. Of course, the pain also keeps the patient from taking deep breaths. However, many patients feel a lot better with the binder in place as it supports the chest wall and offers some modicum of pain relief.

Shallow breathing can lead to atelectasis (collapse of some of the small alveoli), which in term can set the patient up for pneumonia.

But, as long as the patient removes the binder several times a day and does some deep breathing exercises (even though it hurts), then most physicians have no problem with their use.

But, again, the only way to differeniate between the injuries, is to have an examination and a CXR (chest x-ray). Occasionally, special x-rays or a CT scan may have to be done. So, you might want to see your physician, especially if you want to participate in canoe racing this weekend. That will also depend upon how much you hurt, of course.

Good luck.
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