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Rippenprellung
Symptoms and treatment of rib contusion
Ridge contusion (ridge contusion) is damage to the bony ribs caused by direct, blunt external force, often accompanied by no visible injury to the skin. In addition to swelling (edema) of the tissue occur in rib injuries of the smallest blood vessels (capillaries) and thus a blood leak in the surrounding tissue, which is usually visible as a bruise (hematoma).
contents
causes
symptoms
course
differential diagnosis
Ribcuff therapy
causes
The cause of the rib bruise is often a dull hull trauma, triggered for example by a violent shock or fall. The forces acting on the fabric, however, do not exceed the elasticity range of the ribs, which leads to the rib bruise and not the rib fracture. In older people, due to the age-related loss of elasticity of the tissue, rib fractures rather than rib ruptures occur. The blunt force results in tissue squeezing, causing swelling and bruising as well as painful irritation of nerve endings on the periosteum.
Contusion of the ribs is associated with considerable pain and restricted mobility. Image: www.fotolia.com © Sebastian Kaulitzki Symptoms rib contusion
In a rib bruise, the affected trunk area is "painful to the touch". Not always is a bruise or a small, patchy bleeding of the skin (ecchymosis) clearly visible. Because the ribs have an articulated connection to both the spine and sternum, the ribs may lift slightly as they breathe in to expand the rib cage. This allows a greater expansion of the lung in the chest and an increase in the lung volume during inhalation. Conversely, this mechanism allows the further lowering of the ribs, ie a reduction of the chest cross-section, when exhaling and coughing, with the help of the abdominal muscles. This mobility of the otherwise rather rigid rib cage is the reason that for those affected, in addition to pain when lifting one or both arms, pain during inhalation and exhalation and especially when coughing are observed. In order to avoid pain in the further course of treatment, the affected persons often take restraint, which in turn can lead to muscle tension. Typically, these tensions are to be located especially between the shoulder blades and the sternum.
course
The course of a rib bruise is individually very different and depends on the severity of the previous trauma. However, a course of four weeks and more is not uncommon.
differential diagnosis
Often the rupture of a rib can be distinguished from a rib rupture by a physician, but due to similar symptoms rupture of a rib fracture is not easy. Therefore, in case of doubt, diagnostic confirmation should always be performed using imaging techniques. Because in the case of a break there is a risk of internal injuries such as pneumothorax, caused by damage to the lung lining.
In pneumothorax, air from the lungs enters the otherwise evacuated space between the ribcage and the lungs so that the extension of one or both lungs upon inhalation may be severely restricted and severe gas exchange problems may occur in the lungs. Furthermore, in the investigation of the causes of the pain, a bony injury to the spine, a herniated disc, the inflammation of a nerve and internal diseases must be excluded in order to treat the injury appropriately.
therapy
The therapy is conservative, that is, surgery is not indicated. Pain is primarily treated with medication (non-steroidal anti-inflammatory drug). Immediately after the trauma, it makes sense to cool the affected area, both to relieve pain and counteract swelling. In the further course, medicines for swelling can also be prescribed by the doctor. An elastic bandage can be supportive but is rather the exception.
The patient is encouraged to keep his trunk as quiet as possible and to do without any sporting activities during the next few weeks.
As part of physiotherapy, various techniques may be useful:
Thus, the manual therapy achieves a stretching of the capsules of the small joints of the ribcage in order to possibly also preventively prevent movement restrictions. Warmth treatments, hydrotherapy and massages have a soothing effect on the circulation and blood circulation. Respiratory therapy is usually indicated only in very severe cases, to prevent pneumonia. Due to very severe pain, it is no longer possible for some affected persons to sufficiently cough up secretions that have accumulated in the bronchial tree. If this is not carried away, it provides a breeding ground for germs and bacteria. (Philipp Schulz, physiotherapist)