The Difference Between Bruised, Broken, and Fractured Ribs

Rib injuries are common, but the terms used to describe them can be confusing. A rib might be described as bruised, broken, or fractured. While the symptoms, diagnosis, and treatment are similar, the conditions themselves can differ. While a rib injury itself may not be life-threatening, in some cases, complications associated with rib injury can be.

Rib injuries can occur in any person who sustains an injury to the chest, such as during a car accident. Elderly people with low bone density who are prone to falls may be more likely to experience rib injuries.

Children have more flexible ribcages—the bones may bend rather than break. However, young people who engage in rigorous athletics or competitive sports may be more at risk for rib injuries.

Chest Anatomy

The chest, also called the thorax, contains several key anatomical structures and organs. The ribcage protects some of the most important organs, including the lungs and the heart. The ribcage contains 12 ribs total on each side, divided into three different types.

The first seven ribs attach to a bone in the front of the chest called the sternum or breastbone. Three ribs (numbers 8-10) are called "false" ribs because they attach to the cartilage (not bone) of the ribs above them. Ribs 11 and 12 are known as "floating" ribs as they aren't attached to the sternum or to other ribs. Rather, their point of attachment is only at the back of the chest on the vertebrae.

The organs contained in the thoracic cavity, those found in the adjacent abdominal cavity, as well as the spine are also vulnerable to injury as the result of chest trauma.

Bruised, Broken, or Fractured?

The chest wall can become injured in a variety of ways. Most often these injuries are the result of blunt force trauma sustained during an event such as a car accident or fall. These structures can become damaged on impact while performing their job of protecting vital organs, such as the heart and lungs.

Bruised Ribs

The bones of the ribcage and sternum can break (fracture) and the muscles of the chest that support the ribcage can also be injured, strained, or bruised. The term "bruised rib" is sometimes used to describe an injury where the ribs are hurt, but they are not broken. In this case, it is not the bones that are involved.

The pain of a bruised rib is actually from the strain or injury of the tissue, cartilage, and muscles of the chest wall. While a bruise does not sound as serious as a break, injuries to these surrounding tissues can be quite painful.

Ribs can experience breaks just like the other bones of the body. They can even develop stress fractures from overuse, especially in athletes. However, unlike an arm or a leg, a broken rib cannot be set or put into a cast. It's also not easy to keep a broken rib rested until it heals—the entire ribcage moves as the lungs expand when a person breathes.

Fractures

A "fractured" or "broken" rib refers to the same injury, one in which the bones of the ribcage are involved as opposed to only the surrounding supportive tissue, cartilage, and muscle of the chest wall (as with a bruised rib).

The sternum, which serves as a point of articulation for ribs, can also become injured. The term "cracked" rib is also sometimes used to describe a broken rib or sternum.

After a trauma such as a car accident, a person may experience injuries to both the bony structures and supporting tissue of the chest wall. Both types of injury in isolation have similar symptoms and can be treated using basically the same method.

Symptoms

Both bruised and broken ribs can be extremely painful. Furthermore, unlike injuries that occur in other areas of the body, such as an arm or a leg, which can be wrapped, put in a cast, or more easily rested with crutches or a sling as they heal, the chest wall and ribcage move every time a person breathes.

These structures are also engaged during normal movement of the body, much of which is initiated in the torso. Injuries to the ribs and surrounding tissue often cause normal movement and even breathing to be very painful. However, these activities are not easily avoided—in fact, attempts to do so can worsen the condition or lead to complications.

Symptoms of bruised or broken ribs include:

• Sharp pain
• Tenderness
• Swelling or visible bruising

This sharp pain may get worse when twisting the torso, moving the shoulders or arms, breathing in, and coughing.

Sometimes people report an audible "snap" or "crack" as the injury occurs, which may indicate that a bone has broken. Some people also report feeling a "popping" sensation.

If the injury is very severe or multiple ribs have been broken, a person's chest may appear visibly deformed on an exam. If a person's chest moves in an odd way when she breathes (called paradoxical movement) it can be a sign of a serious condition known as flail chest—this results when the ribs become detached from the chest.

With flail chest, the movement of the chest when a person breathes will be abnormal. When a person with this condition breathes in, his chest will move inward rather than outward. Flail chest is indicative of significant trauma and is often associated with other severe injuries to the body.

Risk Factors

While any person who experiences trauma to the chest are at risk for complications, older people or people who have low bone density (osteoporosis) are more likely to not only experience broken ribs but to develop complications from the injury, such as pneumonia.

Persistent coughing can also lead to rib injuries and would be more common in people who smoke or have conditions like chronic obstructive pulmonary disease (COPD).

Young adults who engage in competitive sports may be more likely to experience a chest injury, but they can also be at risk for stress fractures affecting the ribs if they participate in an athletic activity that requires repetitive motion (such as rowing).

Diagnosis

Rib injuries are fairly common, but the exact incidence isn't known. Since there is not much that can be done for rib injuries other than treating the symptoms and helping people avoid complications, medical intervention is usually minimal and supportive.

Tests

Most of the time, a doctor will be able to diagnose a rib injury based on a person's symptoms and a physical exam. Imaging tests like an X-ray or CT scan may not always be performed. Even when radiologic imaging tests are used, broken ribs do not always show up on an X-ray.

Rather than to look for a broken bone, a doctor is more likely to order imaging tests to make sure a person with a rib injury doesn't have other complications. If a person has been in an accident, the presence of rib fractures can indicate the possibility of more serious injuries to nearby organs, including those in the abdomen.

Imaging may also be needed if a person is at high risk for complications or has an underlying medical condition that could be made worse by the injury.

Injuries in Children

Exceptions may be cases involving children, which typically warrant a more thorough medical investigation. When impact trauma occurs, the bones of a child's ribcage are more likely to bend than break because they are more elastic than adult bones. If a child's ribs are broken, it indicates a major trauma or abuse may have been sustained.

Additional tests and evaluation may be needed to determine if other organs have been damaged as well as to determine the nature of such severe trauma.

Complications

In some cases, rib injuries can result in more serious conditions or complications, some of which may be life-threatening. Pneumonia can result from chest infections that develop when a person resists coughing due to pain. A condition called a pneumothorax can develop if a broken rib injures a lung.

Other nearby organs may also be injured by ribs, or as a result of the impact, and can cause bleeding into the chest cavity (hemothorax).

Treatment

The primary treatment for rib injuries is time. It typically takes between four to six weeks for either type of injury to heal, though fractures (breaks) may take even longer.

Rib injuries can be very uncomfortable and a person may be tempted to reduce mobility, avoid coughing or breathing deeply, and "binding" the torso to restrict movement. However, these interventions may put them at risk for complications and should be avoided.

While a person is healing from a rib injury, the main goal of treatment is to help them manage pain and prevent any complications from developing. Several over-the-counter (OTC) painkillers, such as ibuprofen, can be taken while healing from a rib injury. Stronger painkillers, if needed, can be prescribed by a doctor.

The pain and discomfort from rib injuries can be managed, though a person might need to make some temporary adjustments, even taking time off of work, during the first few days after the injury is sustained.

Sit Upright

Some people will particularly notice the pain and tenderness at night when they are in bed trying to go to sleep. In these cases, it can be helpful to avoid lying completely flat. A person may even sleep a few nights sitting up in a chair to ease the pain.

In addition to helping with discomfort, upright positions can also help with breathing. When coughing, some people find it helpful to hold a pillow against their chest to absorb the sudden movement and steady the torso.

Breathe Normally

The pain of rib injuries may make a person breathe more shallowly and avoid coughing. However, breathing normally and coughing when the need arises are important for preventing complications. Doing breathing exercises throughout the day can also help.

Avoid Smoking

Reducing or stopping smoking will benefit the healing process after a rib injury, as smoking has been shown to delay bone healing.

Additional Complications

In severe cases, such as if a complication like pneumothorax or flail chest develops, additional treatment such as surgery or procedures may be necessary. Nearby organs can be damaged when an impact severe enough to injure multiple ribs is sustained.

If a person develops flail chest, they need to seek emergency medical treatment right away as this injury is associated with other serious traumatic injuries. People with the condition may require surgical stabilization. It may require time spent on a ventilator to help with breathing while the body is healing from the injury.

A Word From Verywell

Rib injuries are common and range from minor injuries to severe trauma. While the symptoms, diagnosis, and treatment of broken and bruised ribs are similar, the conditions are distinct. Be sure to contact your doctor or healthcare professional if you have pain associated with your ribcage. While the condition may not be serious in most cases, the complications related to them can potentially become life-threatening.