Rib Injuries: Misdiagnosis and Pain Management

Rib issues

Hello, doctor.
My mother is 47 years old.
On December 7th, while cleaning, she accidentally fell off a ladder on the stairs and hit her rib area.
She went to the emergency room where the first X-ray diagnosed her with fractures of the seventh and ninth ribs.
However, today when she went for a pain injection, another X-ray was taken, and the orthopedic doctor said there were no fractures, indicating that the previous X-ray was incorrect (the emergency doctor misdiagnosed her).
Additionally, there are no external injuries; the painful area shows no bruising or any other abnormalities.
However, since the fall, she has been in significant pain if she does not take pain medication or receive injections.
I would like to ask for your thoughts or recommendations.
Thank you.

Miss Chen, 10~19 year old female. Ask Date: 2017/12/11

Dr. Chen Yongxue reply Orthopedics

Hello, rib fractures are often easily misdiagnosed.
Fortunately, even with a rib fracture, most cases are managed conservatively.
Typically, to confirm the diagnosis, an oblique X-ray of the ribs can be taken, or a CT scan may be utilized.
However, even after a definitive diagnosis, the primary focus remains on pain management, as it does not provide substantial benefits to the condition itself.
The thorough investigation often relates to insurance reimbursement issues.
It might be helpful to discuss this with your attending physician.
Thank you.

Reply Date: 2017/12/11

More Info

Rib injuries can be quite complex, and misdiagnosis is not uncommon due to the nature of the injury and the limitations of imaging techniques like X-rays. In your mother's case, it seems that she initially received a diagnosis of rib fractures, but subsequent imaging revealed no fractures. This discrepancy can occur for several reasons.

Firstly, rib injuries can manifest as rib contusions or costochondral injuries, which may not always be visible on X-rays. A contusion is essentially a bruise of the rib, which can cause significant pain without any visible fracture. Costochondritis, an inflammation of the cartilage connecting the ribs to the sternum, can also lead to severe pain and may be mistaken for a fracture.
In terms of pain management, it is crucial to address the pain effectively while allowing the body to heal. Since your mother is experiencing significant pain that is not alleviated by over-the-counter medications, it may be beneficial to explore a multi-faceted approach to pain management. Here are some suggestions:
1. Pain Medications: If over-the-counter pain relievers like ibuprofen or acetaminophen are not effective, a physician may prescribe stronger medications. Opioids may be considered for short-term use in severe cases, but they come with risks of dependence and should be used cautiously.

2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the rib cage and improve mobility. A physical therapist can provide exercises that are safe and effective for her condition.

3. Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation. Cold therapy is often recommended in the initial stages of injury to minimize swelling, while heat can help relax tight muscles and alleviate pain.

4. Rest and Activity Modification: It’s essential for your mother to rest and avoid activities that exacerbate her pain. However, complete immobilization is not advisable, as gentle movement can help prevent stiffness and promote healing.

5. Follow-Up Imaging: If pain persists despite treatment, further imaging studies such as a CT scan may be warranted to rule out any injuries that were not visible on the initial X-rays.

6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, chiropractic care, or massage therapy. However, it's essential to consult with a healthcare provider before starting any alternative treatments.

7. Psychological Support: Chronic pain can take a toll on mental health. If your mother is experiencing anxiety or depression related to her pain, psychological support or counseling may be beneficial.

In conclusion, rib injuries can be challenging to diagnose and manage, especially when initial assessments lead to misdiagnosis. It is crucial to maintain open communication with healthcare providers and advocate for further evaluation and treatment options if pain persists. Your mother's recovery may require a combination of medical treatment, physical therapy, and lifestyle adjustments to effectively manage her pain and promote healing.

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