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Rib Cartilage Injuries: Implications for Athletes and Rehabilitation Strategies

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Read this article to learn about rib cartilage injuries, their symptoms, causes, and treatments.

Written byDr. Pooja Tiwari

Medically reviewed byDr. Anuj Gupta

Published At October 11, 2023
Reviewed AtDecember 28, 2023

Introduction

The rib cage is present in the upper body, protects all the internal organs located below the rib cage, such as the heart and lungs, and helps to breathe. Bruises, fractured bones, and torn ligaments and cartilage are all forms of rib injuries. Rib injuries are fatal and life-threatening as they can cause injury to the lung or blood vessels. Car accidents and trauma result in rib injuries. Treatments are available for relieving pain during the process of healing.

What Is a Rib Cage?

Twenty-four bones (12 pairs) are present in the rib cage. Every rib is attached to the spine at the back, and seven pairs of ribs are attached to the sternum in the front part of the body. The sternum is also known as the breast bone. Costal cartilages help in the attachment of ribs to the sternum. The seven pairs of ribs attached to the sternum are known as true ribs. The next three ribs are known as false ribs. Three pairs of false ribs are attached to the last pair of true ribs. And the last two pairs of ribs are known as floating ribs, as they are not attached to any of the rib or sternum. Intercostal muscles (present between the ribs) and some ligaments support the rib cage and help expand and contract while breathing.

What Are the Different Rib Cartilage Injuries?

Different kinds of rib cartilage injuries are listed below -

1. Soft Tissue Injuries of the Rib Cage - Intercostal muscles and the costal cartilage are commonly affected. Common injuries are listed below -

  • Bruises - These are the most common finding in the case of a rib injury. Ruptured blood vessels cause blood accumulation and appear as blue or black marks over the chest.

  • The Intercostal Muscles Strain - These muscles expand and contract the rib cage while breathing. Sudden twisting movement, excessive exercise, or sports can cause strain in these muscles. These strains are painful, and the affected person feels discomfort.

  • Rib Separation - This is also known as costochondral separation. Torn ribs lose their attachment to the sternum.

2. Fracture of Ribs - Ribs are designed to withstand the forces and resist fractures. But they can get fractured in case of massive injury to the ribs. The outer surface (curvature of ribs) of the ribs is the weakest point to get fractured. Chances of rib fracture are higher in older people and lesser in children

3. Flail Chest - This is the most serious and common rib injury. It includes fractures of more than three ribs, each broken in more than two places. Paradoxical movement is the sign seen in the case of a flail chest. Paradoxical movement means reverse movement of the rib cage while breathing, which means contraction of the rib cage on inhalation and expansion of the rib cage on exhalation. Direct, forceful injury results in a flail chest. Paradoxical movement of the ribs changes the air pressure within the lungs and results in complications. Intubation of a windpipe and providing oxygen help in the maintenance of air pressure.

What Causes Rib Cartilage Injuries?

Rib injuries are caused due to direct injury to the ribs. Blunt injuries to the ribs are caused due to the following reasons -

  • Accidents - Motor vehicle accidents are a common cause of rib fractures. During accidents, drivers suffer rib fractures because of direct injury to the chest with the steering wheel.

  • Injury With Heavy load - If any kind of heavy object like a big stone or motor vehicle crushed the ribs.

  • Sports Injuries - Contact sports can cause rib injuries. A direct ball or golf stick hit can result in rib fractures. Sports like kabaddi and wrestling can also cause fractures of the ribs.

  • Falling - Falling directly on the ribs from some height results in rib fractures. Older people have more chances of falling and breaking their ribs.

  • Fight - Direct, forceful punch on the ribs or assault with the bat or hockey stick can cause rib fracture.

What Are the Symptoms of Rib Cartilage Injuries?

Depending upon the severity and injury, symptoms of rib injuries are listed below -

  • Pain in the affected area.

  • Pain while breathing.

  • Frictional sound on touching the fractured ribs.

  • Deformity of the ribcage.

  • Difficulty in breathing.

  • Discomfort while coughing and sneezing.

How to Diagnose Rib Cartilage Injuries?

Diagnosis of rib cartilage injuries can be made by following tests -

  • The doctor will ask for medical history to rule out diseases and a history of injury.

  • Physical examination of the chest helps in the diagnosis. In the case of rib fracture, deformity in the bone will be visible.

  • Digital imaging, such as X-rays, is helpful for the visualization of fractured ribs.

What Treatments Are Available for Rib Cartilage Injuries?

Rib fractures can not be treated like other fractures. The main motive of treatment is to provide relief from pain during injury healing. Rib fractures take up to one and a half months, and torn and detached ribs require three months to heal completely. Treatment of rib injuries includes -

  • Plenty of Rest - No vigorous exercises and sports are allowed.

  • Medicine - Painkillers should be prescribed for pain relief.

  • Ice - Ice application helps in reducing pain and inflammation.

  • Flail Chest - In case of a flail chest or severe rib injury, intubation for mechanical breathing will be helpful.

What Are the Complications of Rib Cartilage Injuries?

Rips protect the vital organ (heart, lungs) located below the ribs. Injury to the rib cartilage can affect these organs and result in life-threatening conditions. Some complications are listed below -

  • Pneumothorax is caused in the case of a fractured rib. If a broken rib punctures the lung, it causes severe breathing difficulties, blood spitting, and pain.

  • Rib injuries ended in tearing up the coronary artery and the aorta.

  • Sometimes, fractured ribs rupture the spleen.

Conclusion

Rib injuries are not very common yet very serious. Rib fractures are seen in cases of accidents, sports injuries, and fights. Ribs provide protection to the lungs, heart, and blood vessels. Any serious injury to the ribs can affect these vital organs and turn into life-threatening conditions. An affected person can feel pain and discomfort while moving in case of severe injury, and breathing difficulty occurs. Rib injuries take almost three months to fully recover.

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Frequently Asked Questions

Occupational injury is caused by the direct contact of large machinery on the chest wall, which results in rib cartilage fractures or dislocations. Car injuries are caused by high-impact accidents. A fall injures the rib cage directly.

They mostly occur after a physical trauma in the middle and lower ribs, but they can also be caused by a direct blow to the chest wall and intense muscular contractions. Any action that requires vigorous or excessive body twisting or arm swinging might cause tension in these muscles. Golf and tennis are typical causes of this type of injury.

Rib cartilage injury is caused by a direct hit to the chest or the cartilage that supports the ribs. Broken ribs are caused by fractures in the rib and sternal bones. An X-ray or CT scan may be necessary in certain circumstances, but both can typically be identified with an evaluation of signs and a physical examination.

The treatment options include,


- Rest.


- Pain relievers.


- NSAIDs or non-steroidal anti-inflammatory medicines.


- Avoiding sports and other activities that exacerbate the injury.


- Ice packs may be useful in the early stages of inflammation.

Rib cartilage injuries heal completely in six to twelve weeks. But, the limited blood flow to the area can cause healing to extend for up to six months. It is recommended to get enough sleep and refrain from vigorous exercise to lessen cartilage inflammation.

The ribs protect essential organs including the heart and lungs. Therefore, chest trauma can be fatal. For example, a pneumothorax is a lung collapse caused by alterations in the chest pressure. Almost 19 % of the deaths have been observed in older persons with three or four rib fractures.

Among patients with isolated rib fractures, about 66 percent had prolonged disabilities and 64 percent had chronic chest wall pain. Chronic pain affects the quality of life in thirteen percent of patients with minor rib fractures.

Breathing exercises are the primary form of rehabilitation. Chest-stretching activities are also beneficial for people with broken ribs. Each type should be performed slowly and gently with a gradual increase in intensity.

- Wear appropriate safety gear during contact sports.


- Reduce the possibility of falling in the house. Remove any unnecessary items from the floors. Clean up spills as soon as possible.


- It is important to consume adequate calcium and vitamin D in the diet to maintain strong bones.

Deep breathing is quite painful due to the cartilage damage, especially during coughing. One of the main symptoms of a rib fracture is that breathing deeply exacerbates the discomfort. Breathing difficulties brought on by rib fracture pain can result in a chest infection.

Minor damage to the rib cartilage will heal on its own in a few days or even weeks. However, certain cases with multiple bicortical displaced rib fractures should be stabilized surgically, especially if there is a flail chest or a simultaneous ipsilateral displaced midshaft clavicular fracture or sternal fracture.

The main difference between rib cartilage injury and costochondritis is the location of the injured or inflamed cartilage. Injuries to the rib cartilage are caused by trauma or repetitive strain, and they involve injury to the cartilage that connects the ribs. Costochondritis is characterized by cartilage inflammation at the costosternal or costochondral connections.

Avoid sports and other activities that worsen the injury. Ice packs can help decrease inflammation. In cases with severe flail chest, mechanical ventilation (support with breathing) may be required.

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Dr. Anuj Gupta

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