DEFINITION--Injury and displacement of a rib where it joins the sternum (breastbone) or spinal column. DISLOCATION means the rib and adjoining bones no longer touch each other. SUBLUXATION is a minor dislocation in which the joint surfaces still touch, but not in normal relation to each other.
BODY PARTS INVOLVED
Rib and sternum or spinal column.
Ligaments attaching ribs to the sternum or spinal column.
Soft tissue surrounding the dislocation or subluxation site, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.
SIGNS & SYMPTOMS
Excruciating pain at the time of injury.
Loss of function of the injured rib, causing breathing difficulty.
Severe pain when moving.
Visible deformity (lump) if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising over the rib.
Pain when taking a deep breath, coughing or laughing.
Numbness or paralysis of other ribs below the dislocation or subluxation from pressure, pinching or cutting of blood vessels or nerves.
Direct blow to the ribs.
End result of a severe rib sprain.
RISK INCREASES WITH
Contact sports, especially football, boxing, wrestling, basketball or hockey.
Previous rib dislocation or sprain.
Repeated chest injury.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
Warm up adequately before physical activity.
After healing, wear protective devices, such as wrapped elastic bandages or a special rib vest, to prevent reinjury during participation in contact sports.
Consider avoiding contact sports if treatment is unsuccessful in restoring strong, normal rib connections.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Surgery (rare) to restore the rib to its normal position and repair torn ligaments and tendons.
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the chest and spine.
AT THE TIME OF INJURY:
Pressure or damage to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissue.
Injury to the underlying lung.
AFTER TREATMENT OR SURGERY:
Excessive internal bleeding.
Impaired blood supply to the dislocated area.
Death of bone cells due to interruption of the blood supply.
Infection introduced during surgical treatment.
Continuing dislocations, often with progressively less provocation.
Prolonged healing if activity is resumed too soon.
Unstable or arthritic rib joints following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the chest may require padding and gentle compression with an elasticized bandage. Injured ligaments require a minimum of 6 weeks to heal.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor may manipulate the dislocated rib to return it to its normal position. Manipulation should be done within 6 hours, if possible. After that time, internal bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CAREAt home:
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 48 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured chest with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Stool softeners after manipulation to prevent constipation due to decreased activity.
Antibiotics to fight infection if surgery is necessary.
Begin reconditioning the chest area after clearance from your doctor.
If surgery is necessary, resume normal activities and reconditioning gradually after surgery. Don't drive until healing is complete.
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Your doctor may suggest vitamin and mineral supplements to promote healing.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
Any of the following occur after chest injury:
The skin of the chest wall becomes numb, pale or cold.
You experience nausea or vomiting.
You feel very short of breath or have an extreme air hunger.
Any of the following occur after surgery:
Increasing pain, swelling or drainage in the surgical area.
Numbness or loss of feeling below the dislocation site.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Rib dislocations that you can "pop" back into normal position occur repeatedly.