Rib Fracture (Broken Rib)

Symptoms

• sharp, localized chest or side pain, often at the point of impact
• pain that worsens with deep breaths, coughing, sneezing, laughing, twisting or lying on the affected side
• tenderness when pressing on the rib
• bruising or swelling
• a crunching or grinding feeling (crepitus)
• shallow breathing to avoid pain

Broken rib vs bruised rib

They feel similar and are treated the same way unless there are complications. A fracture is more likely if:

• pain is very sharp at one point
• you felt or heard a crack
• pressing on the rib cage away from the injury causes pain at the injury site
• there is a crunching feeling

Causes and risk factors

• falls, especially in older adults
• motor vehicle crashes
• contact sports, horse riding and cycling
• assault
• CPR
• stress fractures: from repetitive activity such as rowing or golf, or severe coughing
• weakened bones: osteoporosis or cancer that has spread to bone, where fractures can happen with minor force

Dangerous complications

• pneumothorax: a broken rib end punctures the lung, which collapses; sudden breathlessness and sharp pain
• hemothorax: bleeding into the chest
• pulmonary contusion: bruising of the lung tissue
• flail chest: three or more adjacent ribs broken in two places, so a segment moves abnormally; an emergency
• pneumonia: the most common complication, especially in older adults, from shallow breathing and not coughing
• organ injury: lower rib fractures can injure the spleen, liver or kidneys; upper rib fractures can injure major blood vessels

The risk of complications and death rises with age and with the number of ribs broken.

Diagnosis

• examination: tenderness, breathing, oxygen levels, lung sounds
• chest X-ray: looks for collapsed lung or blood; it misses many simple rib cracks, which does not change treatment
• CT scan: for high-energy injuries, multiple fractures, older adults or suspected internal injury
• ultrasound: can detect fractures and air or fluid around the lung
• bone density scan if a fracture happened with minimal force

A young, healthy person with a minor injury and normal breathing may not need any imaging.

Treatment

Pain control

Good pain relief lets you breathe deeply and cough, which prevents pneumonia:

• acetaminophen (paracetamol) taken regularly
• ibuprofen or naproxen if safe for you; follow the label dose and avoid with kidney problems, stomach ulcers or some heart conditions
• ice packs for 15 to 20 minutes several times a day in the first 2 days
• stronger medicines or nerve blocks in hospital for multiple fractures

Breathing exercises

• take 10 slow, deep breaths every hour while awake
• cough regularly, hugging a pillow against the chest
• use an incentive spirometer if given one

Daily activity

• keep moving and walking; avoid bed rest
• avoid heavy lifting, pushing, pulling and contact sports for at least 4 to 6 weeks
• do not wrap or strap the chest tightly, which restricts breathing
• stop smoking, which slows healing and raises pneumonia risk

Sleeping with a broken rib

• sleep slightly upright on pillows or in a recliner for the first few nights
• if lying on your side, lie on the injured side; it can splint the ribs and let the healthy side expand
• take pain relief before bed

Surgery

Surgical rib fixation with plates is considered for flail chest, severely displaced fractures, failure to wean from a ventilator, or ongoing severe pain and deformity.

Recovery

• most rib fractures heal in about 6 weeks
• pain usually improves noticeably after 2 to 3 weeks
• some people have lingering pain or intercostal neuralgia (nerve pain along the rib) for months

Frequently asked questions

How do I know if my rib is broken?

Signs include sharp pain at one spot that worsens with breathing, coughing or moving, tenderness, bruising and sometimes a crunching feeling. A bruised rib feels similar. Seek urgent care if you are short of breath, cough blood or had a high-energy injury.

How long does a broken rib take to heal?

Most broken ribs heal in about 6 weeks. Pain often improves after 2 to 3 weeks, though some discomfort may last longer. Recovery can be slower in older adults or with multiple fractures.

What should you not do with a broken rib?

Do not wrap your chest tightly, stay in bed, avoid coughing, lift heavy objects or play contact sports. Do not smoke. These can cause pneumonia or delay healing. Keep moving and do regular deep breathing exercises.

Can a broken rib puncture a lung?

Yes. A displaced rib fracture can puncture the lung and cause a collapsed lung (pneumothorax) or bleeding into the chest. Sudden or worsening shortness of breath after a rib injury needs emergency care.

What is the best sleeping position with a broken rib?

Many people find sleeping semi-upright, propped on pillows or in a recliner, most comfortable for the first few nights. Lying on the injured side can also help by supporting the ribs. Take pain relief before bed.