RIB SPRAIN AT THE BREASTBONE (STERNUM) (Osteo-chondral Sprain; Costral-Chondral Sprain)
DEFINITION--Violent overstretching of one or more ligaments in the chest where ribs attach to the breastbone (sternum). Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a SPRAIN-FRACTURE. There are 3 types of sprains:Mild (Grade I)--Tearing of some ligament fibers. There is no loss of function.
Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function.
Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.
BODY PARTS INVOLVED
Any ligament that attaches a rib to the breastbone.
Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.
SIGNS & SYMPTOMS
Severe pain at the time of injury.
Discomfort with deep breathing.
Pain on rotating the chest.
Swelling and tenderness at the injury site.
Visible bruising soon after injury.
CAUSESStress on a ligament that temporarily forces or pries the rib attachments to the breastbone out of their normal location. Sprains in the chest occur frequently in contact sports.
RISK INCREASES WITH
Previous chest injury.
Poor muscle conditioning.
Inadequate protection from equipment.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up before practice or competition.
Wear protective equipment appropriate for your sport.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of tape or an elastic bandage.
Self-care during rehabilitation.
Physical therapy (moderate or severe sprain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the breastbone and ribs to rule out fractures.
Prolonged healing time if usual activities are resumed too soon.
Proneness to repeated injury.
Inflammation at the ligament attachment to bone (periostitis).
Prolonged disability (sometimes).
Unstable or arthritic rib attachment to the sternum following repeated injury.
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:
Mild sprains--2 to 6 weeks.
Moderate sprains--6 to 8 weeks.
Severe sprains--8 to 10 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CAREIf the doctor does not apply tape or an elastic bandage:
Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually after clearance from your doctor.
DIETDuring 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.
Begin daily rehabilitation exercises when supportive wrapping is no longer necessary.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe osteo-chondral sprain, or a mild sprain persists longer than 2 weeks.
Pain, swelling or bruising worsens despite treatment.