chest wall injuries

Monday, March 18, 2013

There is a great regional rivalry when it comes to barbeque and which style makes ribs taste better. Is it the marinated Memphis, the Kansas City rub, the Carolina vinegar or the plain smoke of Texas? Regardless, we rarely think of the meat we eat as the muscles that help animals, including us humans, breathe. For those who have bruised or broken rib, or like David Wright of the Mets, pulled a rib muscle, it is an injury that is hard to ignore and harder to fix. After injuring an intercostal muscle, Mr. wright couldn’t play for the US national baseball team and returned to spring training to try to mend before the start of the baseball season.

Intercostal muscles are those that are attached to and located between the ribs and are responsible for moving the chest wall during breathing.  We breathe like a bellows with the ribs swinging out and the diaphragm (the muscle that divides the chest and abdomen) pushing down, sucking air into the lungs. Exhaling reverses the process and air is pushed out of the lungs. There are three layers of intercostal muscles that do the work of the rib movement, the external intercostal, the internal intercostals and the innermost intercostals, share the work of breathing and any injury to these muscles affects the ability of air to get into and out of the lungs. The muscle is often injured with a twisting motion; imagine a batter swinging while at bat, or lunging for a line drive in the field. But the injury can also be due to a direct blow, where the ribs don’t break but the muscle take the brunt of the injury.

Muscles don’t like to be hurt and when injured, go into spasm to protect themselves. The diagnosis is usually pretty easy. The patient often knows that they fell or twisted with immediate onset of pain. Sometimes, though the mechanism of injury is a little tougher to find and may be as simple as an aggressive cough or sneeze. Often a chest x-ray is done and not to look for broken ribs. Instead, the most important consideration is the under lying lung. Did the injury cause a collapsed lung (pneumothorax) or a pulmonary contusion (bruise)? It isn’t worth the extra x-rays and radiation to look for a broken rib, since it doesn’t affect treatment.

Chest wall pain, whether it is from the rib or intercostal muscle causes the body not to want to take a deep breath. It hurts too much and the body isn’t stupid. This is not necessarily a good thing when it comes to the ability to breathe. Failure to take a deep breath prevents the lung from fully expanding and those dark and warm crevices are prime breeding grounds for infection, leading to pneumonia. For that reason, treatment is focused on pain control and deep breaths. This plan, however, delays healing, trading length of recovery for pneumonia prevention.

Normally when a muscle is injured, the treatment is rest, ice and compression, allowing the damage to heal. Hurt your arm and a sling is prescribed. Hurt your leg and you get crutches. But the opposite treatment is recommended for the chest wall injury and with every breath the injured muscle fibers are ripped and stretched, delaying the healing process.

It may take 4-6 weeks for an injury to heal. Sleeping is tough and many patients find that sleeping upright or in a recliner is easier, since the ribs don’t have to lift up against gravity like they do when lying flat. Still after a few hours of sleep, those muscles go into spasm and the first twist and move in the morning after they finally get comfortable can be excruciating and dreaded beginning on morning number 2. Fortunately, one morning, perhaps in a couple of weeks, that first move hurts a little less and there is a light at the end of the tunnel.

Ice is one of the basics of treatment, as is ibuprofen as anti-inflammatory, but wrapping ribs prevents deep breaths and is no longer recommended. Instead, many patients get sent home with an incentive spirometer, a plastic toy that gives a visual clue about how deep the needed breath has to be. All this suffering is inflicted to prevent pneumonia, the lung infection characterized by fever, cough and shortness of breath.

Intercostal muscle injuries are frustrating. While Mr. Wright and the Mets hope that he heals quickly and is ready for opening day, there is no quick fix to shorten the recovery time.  And just like barbeque, you know it’s ready, when it’s ready…a not a moment sooner.

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20 Responses to chest wall injuries

  1. China says:

    4-6 weeks to get cured? That isn’t at all near good. My mother reached to her third day, and she was crying.

  2. Teresa McCleney says:

    I thought I was literally dying. Been 4 weeks for me and still hurting real bad

  3. jenny says:

    I am on my third week and it is still hurting

  4. M.k.sharma says:

    I had probably strained chest muscle due to a fall from bed being drunk. It hurts while sleeping especially while changing sides. Any home remedies please suggest.

    • bwedro@charter.net says:

      Treatment for chest wall injuries include ice chest wall, deep breath and ibuprofen or acetaminophen as needed for pain. Of course, prevention is always a good idea and avoiding excessive alcohol consumption is always wise

  5. Tammy says:

    Was hit from behind in a car accident sitting at a red light. The lady who hit us said her foot slipped off the brake but she hit us so hard we hit the car ahead of us. I broke 3 ribs and my Styrofoam cup that was in the cup holder was also crushes (it closed). I was hurt from Oct 16 to March 4 eventually the dr just said I didn’t need to continue going in, it will still take some time just be careful what I do. So yes it depends on how bad you injure yourself before you start feeling better. There is no feel good way to sleep.

  6. Lorraine says:

    Am 85 fell out of bed at 2:00 a.m. (Still thinking was pushed out.) LOL Anyway, its been going on 3 weeks and am still hurting, but I force myself to breathe deeply anyway because I am scared of pneumonia. They only gave me a 7 day supply of medication and no refills, so am taking several aspirins a day. And, that sure helps. But, going to bed, even getting into bed just plain hurts. Also, I wear support hose and putting them on is not too bad but taking them off…well, I bear the pain. But, day by day, little by little I can feel the improvement and I cough as deeply as I can do keep the lungs clear and it is working. And, so I say to myself: “This, too, shall pass.” …. just hang in there and we’ll get better when we give the old bod a chance.

  7. PJ says:

    I was hit really hard on the chest ( between the collar bone and the breast ) by my dog who thought playing cannon ball would be amusing..( he’s one heavy round Pug) That was at the end of September. I was told it was intercostal Muscles. The Pain was extremely annoying and i tried to sleep through it. I got breathless and very confused. My Doctor never told me to breath deeply or to cough. I tried to continue my life as normal but after several Panic attacks It was very scary and i took to just hiding in my home and resting.. It has subsided alot but i still get alot of random twitching and i can a weakness in my arm which is so annoying and adding to feelings of anxiety. I still cough on and off.. I just wish the twitching and the dull annoying ache would hurry and heal up. lol

  8. […] the ability to return to play will depend upon how much pain he has from his chest wall. Bruised ribs hurt and it can be tough to take a deep breath, and twist and turn. For mere mortals, chest wall pain […]

  9. Abby Robertson says:

    four weeks and counting from a dumb yoga pose! Seems that this is lasting forever. I do notice that when I don’t move much during the day, it feels better at night. ugh…Tell me. Does anyone recommend massage or does this prolong it further?

  10. Raz says:

    I am currently suffering from this now – had it once before in 2011, but this time is much worse, I haven’t got a clue how it occurred 🙁 Has anyone found anything that helps other than the ice pack, meds, etc that has been mentioned above?

  11. Judy Amuso says:

    I fell full force into a marble table and hit with my left breast and chest. Nothing broken per CAT scan, but am in a lot of pain after 2 wks. No problem inhaling/exhaling. Keeping ice on and taking Tylenol. How long can this take to heal?

    • bwedro@charter.net says:

      Chest wall injuries can take 4-6 weeks to heal. It’s not like hurting an arm and resting it in a sling, or injuring a leg and using crutches. Breathing 12-14 times a minutes irritates the chest area that is damaged and prolongs the time that it takes to recover.

  12. Diana-Maria Rosario says:

    I took a full force chest blow when my 100 lb. Dog took off running and knocked me to the ground, but first I fell head first into a wooden post got a concussion, scraped my face against a steel fence before landing right on my sternum. Went to emergency and nothing broken. It’s my 3rd day and I can’t breathe in very well. Got sent home with pain meds. My face is completely purple on one side with black eye. I can’t lift my arms due to chest pain to even comb my hair. Should I go see my primary doctor? What else can be done? Because it looks like I just have to wait. Worried about pneumonia.

  13. Nadim roshan says:

    How long will it take for the shortness of breath to go away if i suffered from a pulmonary contution?

    • bwedro@charter.net says:

      All depends on how much lung tissue is involved and whether any other complications occurred. It may take weeks or longer. It would be wise to check with your doc.

  14. Linda Hodgkin says:

    Hi… I was in a car accident 7 years ago and I’m still having a problem with one spot . I believe this rib was broken in more than one place. Is it too late to have it fixed surgically ?

  15. stephen paraskivas says:

    I was reared ended in a car accident almost 2 years ago !! and no one knows what to do?? HELP PLEASE!!

  16. Jay Bicknell says:

    I just slipped on a slippery slope, and fell full force flat on my back, and head striking dirt not frozen yet, and had my air blown out. It took what seemed like a full minute to force myself to breath. I checked all the parts, and they seemed to work. However it was a struggle to get up, and as the day wore on my right chest, and side ribs are sore as hell like I was hit with a 2×4. Hard to move, and breath. No back pain, just right chest. VA doctor in the AM.

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