A rib contusion, also called a bruised rib, can occur after a fall or blow to your chest area. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the skin. This causes the skin to become discolored.

Bruised rib - self care; Rib bruise; Bruised ribs; Rib contusion

Common causes of bruised ribs are car accidents, sports injuries, or falls. Severe or prolonged coughing can also cause bruised ribs.

• 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.

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.

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).

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

ICING

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.

PAIN MEDICINES

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.

BREATHING EXERCISES

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.

PRECAUTIONS

• 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.

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

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.