The Difference Between Bruised, Broken, and Fractured Ribs

If you hurt your ribs, you may hear the terms bruised, broken, or fractured. They're similar injuries but have some key differences.

You can injure a rib any time there's chest trauma. Car accidents and sports are common causes.

This article explains chest anatomy, the differences between common terms, symptoms and risk factors of rib injuries, and how they're diagnosed and treated.

Chest Anatomy

The chest, or thorax, contains several important structures and organs. The ribcage protects some of the most important organs. That includes the heart and lungs.

The ribcage contains 12 bones on each side, divided into three different types:

• The first seven ribs attach to the sternum (breastbone).
• Ribs 8, 9, and 10 are called "false" ribs because. They attach to the cartilage—not bone—of the ribs above them.
• Ribs 11 and 12 are called "floating" ribs. They aren't attached to the sternum or to other ribs. Their only attachment point is the vertebrae (bones of the spine).

Chest trauma puts not only the ribs at risk. It can also damage the sternum, spine, and organs in the chest and abdomen.

Bruised, Broken, or Fractured?

The chest wall can become injured in many ways. Most often, it's the result of blunt force trauma during a car accident or fall.

The bones of the ribcage and sternum can break/fracture. The muscles supporting the ribcage can also be injured, strained, or bruised.

To understand your injury, it may help to know what healthcare providers mean when they use different terms.

Bruised Ribs

The term "bruised rib" is used when the ribs are hurt but the bones aren't involved.

The pain of a bruised rib comes from the strain or damage to:

• Soft tissues
• Cartilage
• Muscles of the chest wall

It doesn't sound as serious as a break. Still, these injuries can be quite painful.

Breaks/Fractures

A "fracture" or "break" are the same injury. Rib fractures can be regular breaks or stress fractures. Those can be caused by overuse. They're common in athletes.

The sternum can also be fractured. The term "cracked" rib is sometimes used to describe a broken rib or sternum.

Symptoms

Any rib injury can be extremely painful. It's harder to manage than pain in some places.

Unlike an arm or leg, your ribs can't be immobilized with a cast or brace. They move every time you take a breath.

These structures are also part of most normal body movements. It can make you want to hold still.

But that's a bad idea—it can make the injury worse 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 you twist at the waist, move your arms or shoulders, inhale, or cough.

You may hear a "snap" or "crack" when the injury occurs. Others feel something "pop." That can mean a bone is broken.

Symptoms of Serious Injuries

With serious rib injuries, your chest may be visibly deformed. This can be a sign of multiple broken ribs.

A major rib injury can lead to flail chest. It makes your chest movement the opposite of what it should be when you breathe. This is called paradoxical movement.

In flail chest, at least three ribs are broken in two or more places. It's usually caused by severe trauma, like a car accident.

Flail chest is a medical emergency. If you see or experience it, get immediate medical attention.

Complications

Pneumonia is a common complication of broken ribs. It develops when you resist coughing because of the pain.

In one study, one broken rib increased your risk by about 4%. Two broken ribs raised it to more than 17%.

Other risk factors for pneumonia after rib fracture are:

• Being male
• Drinking alcohol regularly
• More use of IV (intravenous) fluid right after injury
• Being over 65
• Chronic obstructive pulmonary disease (COPD)

A condition called pneumothorax (collapsed lung) can develop if a broken rib injures a lung.

Broken ribs can damage other nearby organs as well. That can lead to hemothorax (bleeding into the chest cavity).

Risk Factors

You're more at-risk for rib fractures if you:

• Have osteoporosis (low bone density)
• Are prone to falls
• Are over 65
• Have COPD or a chronic cough
• Smoke cigarettes
• Play contact sports
• Play sports with repetitive upper-body motions, like rowing (stress fractures)

Young children have a lower risk of rib fractures. That's because their ribcages are more flexible.

Diagnosis

Rib injuries are often diagnosed based on your symptoms and a physical exam. Sometimes more tests are needed.

Tests

You may be sent for an X-ray or computed tomography (CT) scan if:

• Your provider isn't sure about the diagnosis
• You're at high risk for complications
• The injury could make an existing medical condition worse
• The trauma may have injured nearby organs

Injuries in Children

Children with rib injuries should get a more thorough diagnostic process.

Because of their ribcages' flexibility, it takes a lot to break a child's rib. That level of trauma is especially likely to damage organs.

Additional tests and evaluations can help determine whether there's damage to more than just the ribs.

Treatment

Unlike an arm or a leg, a broken rib can't be set or put into a cast. It's not easy to keep a broken rib rested until it heals. Your entire ribcage moves with each breath.

The primary treatment for rib injuries is time. It typically takes between four and six weeks for bruised or broken ribs to heal. Some breaks may take longer.

Don't try to manage your rib pain by:

• Reducing movement
• Binding your torso to prevent movement
• Avoiding coughs or deep breaths

These things can make complications more likely.

While you heal, the main goal of treatment is to manage pain and prevent complications.

Over-the-counter (OTC) painkillers, such as Advil (ibuprofen) or Tylenol (acetaminophen), can help. If you need stronger painkillers, talk to your healthcare provider.

You may need to get extra rest. Consider taking a few days off from work or school to help with healing.

Things that may help with your recovery include:

• Sitting upright: Rib pain may get worse when you lie down. That can make it hard to sleep. Try sleeping upright in a chair, instead. This can also help with breathing.
• Coughing with a pillow: To lessen the pain of coughing, hold a pillow against your chest. It absorbs the impact of sudden movement.
• Breathing normally: The pain can make you take shallow breaths. Try to breath as normally as you can to prevent pneumonia. Ask your provider about breathing exercises that may help.
• Avoiding smoking: Smoking delays bone healing, so try to stop or cut down.

Summary

A "bruised rib" doesn't involve bone injures. Fractures (or breaks) do. Rib injuries can be highly painful.

Pneumonia and other serious conditions are possible complications. Get immediate help for trouble breathing or other concerning serious symptoms.

Age, illness, and playing sports raise your risk of rib injuries. They're usually diagnosed based on symptoms and an exam. Imaging may be used.

The main treatment is time. Also try ice packs, OTC pain medicine, and sleeping upright.

A Word From Verywell

To be safe, always get medical attention for a hard blow to the ribs and chest. Rib injuries aren't usually life-threatening. But some can lead to complications that are.

Try to be patient while your ribs heal. It can be hard to deal with the pain and limited activity. But the discomfort should gradually go away. If it doesn't, talk to your healthcare provider.