Acute and Chronic Rib Conditions

The Chest Wall Injury and Reconstruction Center at MUSC Health treats patients with acute rib injuries as well as chronic rib conditions that require medical and surgical management based on patient centered treatment plans.

Conditions that are treated include: acute rib fractures, non-union rib fractures, chest wall instability, costal margin disruption, thoracoabdominal wall hernia, slipped rib syndrome, and rib tip syndrome.

Acute Rib Fractures

Acute rib fractures or broken ribs after an injury are extremely common. Ribs are often broken in falls, motor vehicle crashes, motorcycle crashes, or anything that hits the chest. These broken bones are extremely painful and can limit your ability to breathe well and move around. Traditional treatment of rib fractures revolved around deadening the pain with strong pain medications. Modern rib fracture management requires multiple specialty trained individuals to optimize patient recovery.

Medical Management: The initial treatment goals with rib fractures is to optimize pain control. This is best done through customizing a medication plan based on the patients symptoms and severity of pain. We use several different medications to target our patients pain in different ways. Through this approach, we can minimize the use of opioid medications and enhance patients recovery. Inadequate pain control can result in poor breathing and puts patients at risk of developing pneumonia.

Surgical Management: Over the past few years, we have realized that some patients benefit significantly from operating on broken ribs. For patients with 3 or more displaced rib fractures, or multiple fractures along the same ribs, surgical repair of the fractures improves their recovery by decreasing death, pneumonia, pain, and improving quality of life. At MUSC Health, we have the specialists that can perform this surgery utilizing modern-day technology and minimize the size and number of incisions needed for the repairs. Many of the surgeries we perform today can be done though a 10 cm incision instead of one that would have been 30-40 cm just a few years ago.

Recovery: At MUSC Health we have the team to help obtain a full recovery after rib fractures. Often patients have other broken bones or injuries. Our comprehensive team has the experience and expertise to address all these injuries as well. The ultimate recovery however relies on the experience of our therapy groups as well. We have respiratory therapists to improve patients ability to breath and avoid pneumonia. Physical and Occupational therapy work with our patients and improve their ability to move around, decrease pain, improve function of the injured body parts, and learn to take care of their daily needs. Only through this multispecialty approach to these injuries can patients optimally recover.

Non-Healing Rib Fractures

Non-Healing or Non-Union rib fractures can cause significant pain and disability. Patients with rib fractures that did not heal properly can have deformity, popping or clicking with breathing or movement, or significant pain in a certain part of their chest wall. Treating these fractures requires improving the bone healing to get the breaks to heal normally. This takes a unique approach to treating these injuries. Often, patients need diet or lifestyle modification to improve their bone healing before surgery. At the time of surgery, careful management of the fracture must be done while protecting surrounding structures like blood vessels and nerves must be done. Pain can not always be eliminated by operating on chronically broken ribs but many patients feel significant improvement in their symptoms.

Sternal Fractures

Sternal injuries and fractures can cause significant pain and limited use of the arms. The muscle in the front of the chest (Pectoralis Major) attaches the arm to the chest and plays a major role in moving the arm. If the fracture is displaced, or moves with the pulling of this muscle, it can cause significant pain. In the long term, this can lead to decreased function of the shoulder and possibly pneumonia. Surgery to repair this fracture can greatly improve pain and breathing.

Slipped Rib Syndrome

Slipped Rib Syndrome is characterized by severe pain in the back or lower rib cage when patients move or twist into certain positions. Some patients can even feel the ribs rubbing together or popping over each other. The pain comes from the nerve (intercostal nerve) that runs on the lower edge of every rib. Slipped rib syndrome is caused by the 10th rib pushing on the 9th rib nerve and the body interprets this as pain. Additionally, the 9th rib can do the same to the 8th rib. Both the 9th and 10th ribs have smaller cartilage attachments than the rest of the ribs that allows them to “slip” under the rib above them and irritate the nerve. The primary therapy for this condition is surgically stabilizing the ribs and removing their ability to push on the nerve of the rib above.

Thoracoabdominal wall Hernia / Costal Margin Disruption

This is a rare but significant injury that requires care of specialized hospitals like MUSC Health. When the ribs at the edge of the rib cage are fractured, if they do not heal normally patients can develop significant problems. The rib cage can open up and allow organs of the abdomen or chest to come out. This is called a hernia. A hernia including the chest and abdomen is extremely difficult to repair. The best approach is to repair this at the time of the initial rib fracture. If it is not repaired, and a hernia develops, evaluation and surgery at a chest wall reconstruction center will provide the best chance at an optimal recovery and elimination of the hernia.

Frequently Asked Questions About Acute Rib Injuries & Chronic Rib Conditions