Can Rib Injuries Worsen After Activity? Your Symptoms

Rib fracture after three weeks of activity following a collision?

On February 8th, I was elbowed forcefully from behind by a stranger at the market, impacting the last one or two ribs on my right side.
The impact was quite deep and extremely painful.
However, I felt that seeking emergency care would be a waste of medical resources compared to those in critical condition, so I waited until the following week after the New Year to visit a nearby family medicine clinic.
After a chest X-ray (with standard positioning and one with my right arm raised), it was determined that there were no obvious fractures, and I likely had a deep muscle strain.
I was given a week's supply of pain relief patches and muscle relaxants to take home, and I subsequently stopped most physical activities, opting for mostly static activities instead.
However, I am still experiencing pain, and last night while lying in bed and trying to get up, I heard a cracking sound near the area that was impacted.
I am unsure if it was from my spine or ribs.
Although the pain seems to be about the same and there are no visible changes, the sound has me worried as it has never occurred before.
I would like to know if a small rib fracture could potentially worsen or even break completely with activity.
Should I seek medical attention again or just monitor the situation?

Niming, 10~19 year old female. Ask Date: 2024/03/04

Dr. Chen Bochen reply Orthopedics

The self-healing capacity of the ribs is quite good, and the likelihood of fractures from typical impacts is low, unless there is a severe blow from a car accident or hard objects (such as iron bars, steel plates, or baseball bats).
Osteoporosis in the elderly is a different consideration.
However, if you do happen to experience a rib fracture, 95% of rib fractures will heal on their own without surgery (approximately within 1-2 months), so there is no need to worry too much.
If the pain persists for more than 2 months, then you should go to the hospital for an examination.

Reply Date: 2024/03/04

More Info

Rib injuries, particularly those that involve soft tissue damage or minor fractures, can indeed worsen after physical activity. When you experienced the impact from the elbow to your ribs, it is possible that you sustained a contusion or a strain in the surrounding muscles, which can lead to persistent pain. The fact that you heard a "pop" or "crack" sound when you moved could indicate a few things, including the possibility of a small fracture or a change in the alignment of the ribcage or spine.

Rib injuries are often assessed through imaging studies like X-rays, which can identify fractures but may not always reveal soft tissue injuries or very small fractures. Since your initial X-ray did not show any obvious fractures, it suggests that there may not be a significant bony injury. However, the ongoing pain and the sound you heard during movement warrant further evaluation.
It's important to understand that rib injuries can lead to complications if not monitored properly. For instance, if there is a small fracture that is not healing correctly, it could potentially worsen with activity, leading to a more significant injury or even a complete fracture. Additionally, the muscles and ligaments surrounding the ribs can become strained or inflamed, causing persistent pain that may not resolve without appropriate treatment.

Given your symptoms and the recent sound you experienced, it would be prudent to seek further medical attention. A follow-up visit to your healthcare provider is advisable, where they may recommend additional imaging, such as a CT scan, to get a clearer picture of the injury. This can help rule out any complications and guide appropriate treatment.

In the meantime, it is essential to manage your activity levels. While rest is crucial, gentle movements and breathing exercises can help maintain mobility and prevent stiffness. Over-the-counter pain relief medications, such as ibuprofen or acetaminophen, can also help manage pain and inflammation. Applying ice to the affected area may reduce swelling and discomfort.

If you notice any worsening of symptoms, such as increased pain, difficulty breathing, or any signs of infection (like fever or increased redness), you should seek immediate medical attention.
In summary, while rib injuries can sometimes be minor, the potential for worsening symptoms with activity is real. Given your ongoing pain and the new sound you experienced, it is wise to consult with a healthcare professional for a thorough evaluation and to ensure that you receive the appropriate care to facilitate healing.

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