Bruised rib care

If your pain is not severe, you can use ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) for pain relief. You can buy these pain medicines at the store.

3 Reasons You Might Have Rib Cage Pain

Learn the symptoms of each condition and what treatment to expect.

Pain in your chest can be scary — you may even be worried you’re having a heart attack. But the pain you’re experiencing might not actually be coming from one of your organs. The ribs themselves, and the area surrounding them, can also cause discomfort. Here are three conditions that can cause rib cage pain, and the telltale symptoms doctors use to tell them apart.

1. Bruised or fractured rib

Your rib cage provides a crucial function: to protect your heart, lungs and other vital organs. But this may also mean they take the brunt of the damage in the case of trauma, such as a car accident, steep fall, physical assault or even intense coughing. A bruised rib means the bone is not actually cracked, but it still may have sustained damage. Symptoms for bruised and broken ribs are much the same: pain, particularly when breathing or coughing.

Telltale sign: Injured ribs cause pain when breathing, coughing, twisting or bending.

Your doctor may order a chest X-ray to determine if you’ve fractured your rib. If you have, a CT scan will help determine whether your lungs have been injured.

Ribs obviously can’t be put in a cast or immobilized, like other broken bones. Plus, they need to keep moving when you breathe. Even if it hurts, it’s important to breathe deeply, so you can keep your lungs clear. Failing to do so may result in pneumonia. Respiratory complications, like pneumonia, occur in nearly a third of patients with rib fractures. Your doctor may give you a device to breathe into, to help improve your lung function, and pain medications to make breathing easier, until your broken or bruised rib heals.

2. Costochondritis

You may not have heard of this condition, but it’s actually a common cause of rib cage pain. All but two of your ribs are attached to your sternum, or breastbone, by cartilage.

“This area where the ribs meet the breastbone, called costosternal joints, can become inflamed,” says Rose Taroyan, MD, a family medicine physician at Keck Medicine of USC and clinical associate professor of family medicine at the Keck School of Medicine of USC.

Dr. Taroyan explains that costochondritis causes pain (it can be either sharp or dull) and tenderness in your chest. It may result from a blow to the chest, heavy lifting or hard exercise, or sustained coughing and sneezing.

Telltale sign: When the area where the rib meets the breastbone is pressed, you’ll feel pain.

Your doctor may order an electrocardiogram to rule out any cardiac issues. Depending on whether you have any other symptoms, your doctor may also order additional tests. If you’re diagnosed with costochondritis, though, it usually goes away on its own in a few days to a few weeks.

“You can do stretching exercises, put a heating pad on the painful area a few times a day, and take pain relievers, such as acetaminophen or ibuprofen,” Dr. Taroyan says. “And any activity you do that causes or reliably exacerbates the pain should be reduced and/or stopped, at least temporarily.”

3. Pleurisy

Lining the inside of your chest cavity and the outside of your lungs are two layers of tissue called pleura; the area between these layers is called the pleural space. The layers generally glide against each other smoothly as you inhale and exhale.

With pleurisy, the layers become inflamed due to a viral infection, pneumonia or other medical condition and rub together roughly, causing pain every time you breathe or cough. Fluid may also collect in the pleural space, causing shortness of breath.

Telltale sign: Doctors can actually hear the membranes rubbing together, called a friction rub, when they listen to your chest with a stethoscope.

Based on your symptoms, your doctor may order imaging or blood tests to help determine the underlying cause of the pleurisy and to see if fluid has built up. If it has, the fluid may need to be drained. If the fluid is a result of a bacterial infection, you’ll be given antibiotics. If it’s from a virus, it may have to run its course, but over-the-counter pain relievers may help to reduce your symptoms.

With any rib cage pain, if you can’t breathe, your skin turns blue or you have severe chest pain, call 911 or go to the emergency room right away.

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Bruised rib care

The ribs are the skeletal protection for the lungs and the chest cavity. The ribs and rib muscles expand and contract with normal breathing.

Causes

• A rib bruise due to a blunt force may cause bleeding and injury to the tissues under the skin.
• Depending on the force of the blow, you may have other injuries, such as broken ribs or damage to the lungs, liver, spleen or kidney. This is more likely in car accidents or falls from a great height.

Symptoms

The main symptoms are pain, swelling, and skin discoloration.

• The skin overlying the bruise may turn blue, purple, or yellow.
• The bruised area is tender and sore.
• You may feel pain both when you move and while at rest.
• Breathing, coughing, laughing, or sneezing can all cause or increase pain.

What to Expect

Bruised ribs recover in the same manner as fractured ribs, but a bruise takes less time to recover than a rib fracture.

• Healing takes about 4 to 6 weeks.
• An x-ray, MRI, or CT scan is rarely needed to confirm the diagnosis. Imaging studies may be needed to check for more serious injuries, such as a rib fracture or damage to internal organs.
• You will not have a belt or a bandage around your chest because these would keep your ribs from moving when you breathe or cough. This may lead to lung infection (pneumonia).

Self-care at Home

Here are some ways to help relieve pain and discomfort as you heal.

Icing helps reduce swelling by decreasing the blood flow in the area. It also numbs the area and helps relieve pain.

• Apply an ice pack to the injured area for 20 minutes, 2 to 3 times per day for the first one to two days.
• Wrap the ice pack in a cloth before applying to the injured area.

If your pain is not severe, you can use ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) for pain relief. You can buy these pain medicines at the store.

• Talk with your health care provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or by your provider.

Acetaminophen (Tylenol) may also be used for pain by most people.

• Do not take this medication if you have liver disease or reduced liver function.
• Do not take more than the amount recommended on the bottle or by your provider.

If your pain is severe, you may need prescription pain medicines (narcotics) to keep your pain under control while your bruise heals.

• Take these medicines on the schedule your provider prescribed.
• Do not drink alcohol, drive, or operate heavy machinery while you are taking these medicines.
• To avoid becoming constipated, drink more fluids, eat high-fiber foods, and use stool softeners.
• To avoid nausea or vomiting, try taking your pain medicines with food.

Tell your provider about any other medicines you are taking as drug interactions may occur.

Being in pain when you breathe can cause you to take shallow breaths. If you take shallow breaths for too long, it can put you at risk for pneumonia. To help prevent problems, your provider may recommend deep breathing exercises.

• Do slow deep-breathing and gentle coughing exercises every 2 hours, to get rid of the mucous from your lungs and prevent partial lung collapse. Your provider may have you blow into a special device that measures how much air you move with each breath (spirometer).
• Take 10 deep breaths every hour, even if you awaken during the first few nights.
• Holding a pillow or blanket against your injured rib can make the deep breaths less painful. You may need to take your pain medicine first.
• Your provider may have you use a spirometer to help with the breathing exercises.
• It can be painful but it is important that you do these exercises.

• Do not rest in bed all day. This can cause fluid to build up in your lungs.
• Don’t smoke or use any tobacco products.
• Try to sleep in a comfortable semi-upright position for the first few nights. You can do this by placing a few pillows under your neck and upper back. This position will help you breathe more comfortably.
• Begin to sleep on your unaffected side a few days after injury. This will aid in breathing.
• Avoid strenuous activities such as heavy lifting, pushing, and pulling, or movements that cause pain.
• Be careful during activities and avoid bumping the injured area.
• You may slowly start your normal day-to-day activities (after talking to your provider), as your pain decreases and your bruise heals.

When to Call the Doctor

You should contact your provider right away if you have:

• Pain that does not allow deep breathing or coughing despite using pain relievers
• Fever
• Cough or an increase in mucus that you cough up
• Coughing up blood
• Shortness of breath
• Side effects of pain medicine such as nausea, vomiting, or constipation, or allergic reactions, such as skin rashes, facial swelling, or difficulty breathing

References

Eiff MP, Hatch RL, Higgins MK. Rib fractures. In: Eiff MP, Hatch R, Higgins MK, eds. Fracture Management for Primary Care and Emergency Medicine. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 18.

Major NM. CT in musculoskeletal trauma. In: Webb WR, Brant WE, Major NM, eds. Fundamentals of Body CT. 5th ed. St Louis, MO: Elsevier; 2020:chap 19.

Raja AS. Thoracic trauma. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 37.

Yeh DD, Lee J. Trauma and blast injuries. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 104.

Version Info

Last reviewed on: 4/24/2023

Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.