A rib bruise is damage to the soft tissues of the chest as a result of a strong blow. At the same time, the integrity of the skin and bones is preserved.
As for the severity of such an injury, the purpose of the ribs is precisely to protect the internal organs from damage. However, such a bruise is always particularly painful, and can sometimes be accompanied by the development of a serious illness.
What organs can be damaged by a chest contusion?
When the chest is contused, the skin, muscles, subcutaneous tissue are most often injured, internal organs and bones are not damaged. The lesion can be isolated or, in case of high-energy trauma, combined with damage to the ribs, lungs, heart, blood vessels, mammary glands, fracture of the sternum, thoracic vertebrae, hemothorax and pneumothorax.
Chest contusions are more common among young people. The mortality rate is 5–6%, and is associated with the risk of disruption of the integrity and functions of internal organs located in the chest area. With timely medical care, a high percentage of favorable outcomes.
Results and discussion
The average age of the patients was 44.7 years. The ratio of men to women was 1:1.
As can be seen in Figure 1, with bruises of the upper limb, ketoprofen tablets began to show its activity already at the 10th minute, with bruises of the lower limb - somewhat later, at the 20th minute. The use of the injection form (Fig. 2) provided a pronounced analgesic effect already at the 5th minute. Both tablet and injection forms of ketoprofen demonstrated an advantage over diclofenac. By 3–4 days, in all cases it was possible to achieve complete pain relief. The duration of the analgesic effect of the drugs was not studied due to the large psycho-emotional component and the small sample of patients. A peculiarity of the assessment of pain syndrome at the initial visit was that patients with a shoulder injury rated pain 2–3 points higher than patients with a hip injury (6–8 points).
I would like to note that, despite the effectiveness of the injection form of the drug, the tablet form remained the form of choice for patients with arm injuries, according to the survey. In patients with leg injuries, the injection form was preferred. Here we have to state a paradox: with a more severe pain syndrome due to a bruise of the upper limb, a more effective injection form is used much less frequently than in patients with damage to the lower limb.
Causes
Chest contusion most often occurs due to a blow with a blunt object, compression of the sternum, or a fall. The most common circumstances of damage to soft tissues in the sternum area are domestic and industrial trauma, sports activities. Less commonly, chest contusions are diagnosed as a result of fights, car accidents, natural disasters, or gunshot injuries. The number of victims among children increases during the summer holidays.
Damage to internal organs is secondary in nature and is associated with their traumatization by sharp fragments of broken ribs.
Symptoms
Immediately after the blow to the chest, the victim feels pain. Depending on the strength of the traumatic agent, the pain can be dull, sharp, and intensifies with a deep breath or during physical activity. Minor bruises sometimes remain unidentified.
Soft tissues react to injury with swelling, bruising, and the formation of hematomas of various sizes. In the first days, the hematomas are bright purple, after a week they acquire a purplish-bluish tint, and after another 7–10 days they become greenish-brown. In some cases, with extensive bruises, an increase in temperature is possible.
In case of severe traumatic impact, the traumatologist is obliged to exclude rib fractures. If the pain does not increase when squeezing the chest with two palms, the likelihood of a fracture is minimal.
A rib fracture can be assumed if the chest on the affected side lags behind when breathing, when you feel the damaged ribs, you can hear the crunching of bone fragments, the skin in the sternum area is pale, bluish, and shallow breathing.
A fracture of the sternum is manifested by intense pain, which intensifies with pressure and breathing, coughing, swelling, hemorrhage, and painful palpation. Signs of chest compression are suffocation, shallow breathing, blue skin in the head, neck, and upper chest. In some cases, loss of consciousness and a temporary decrease in visual acuity and hearing are observed.
Displaced fragments of the ribs and sternum can disrupt the integrity of the internal organs. As a result of damage to the pleura and lungs, hemothorax (collection of blood) and pneumothorax (accumulation of air) develop.
Symptoms of hemothorax:
- respiratory failure,
- dyspnea,
- pain when breathing,
- hemoptysis,
- cardiopalmus..
When blood accumulates in the chest of 500 ml or more, the patient’s condition worsens, the pulse quickens, breathing is shallow, the skin becomes bluish. The patient takes a forced sitting position with support on his hands.
The clinical picture of pneumothorax is a dry cough, weakened breathing, pain during deep inspiration, shortness of breath, suffocation, cyanosis of the skin and mucous membranes.
Introduction
Damage to soft tissues accompanies human life.
A bruise is a closed mechanical damage to soft tissues caused by short-term exposure to a damaging factor, which is not accompanied by the formation of wounds. When a bruise occurs, small vessels always rupture, followed by hemorrhage, the severity of which can vary. Damage to soft tissues, regardless of the cause that caused them, constitutes the majority of visits to primary health care institutions. Bruises usually occur when falling or hitting hard objects. In children of the first years of life, household and play injuries, bruises of the soft tissues of the face and neck predominate. At older ages, the main types of injuries are transport, sports, and street injuries [1]. Damage to superficial soft tissues is always accompanied by swelling of the injury site as a result of the skin being soaked in lymph, blood and local aseptic inflammation. The amount of swelling depends on the area of damage to the subcutaneous tissue at the site of the injury. For example, in the area of the cranial vault, due to the thin layer of subcutaneous fat, edema is insignificant, while even mild bruises of the face are accompanied by the development of pronounced edema [2]. Bleeding that continues deep into the tissue often leads to additional trauma to adjacent tissues as a result of their compression, which is accompanied by a gradual increase in pain and dysfunction. A bruise sometimes accompanies other injuries (fracture, etc.), so you should always exclude more complex injuries and evaluate the consequences of injuries [2, 3]. Soft tissue injuries are accompanied by pain of varying intensity. Thus, with bruises of large nerves and their endings, the pain is always sharp, shooting. With bruises of the torso and limbs (shoulder, thigh), tense hematomas can form, with bursting pain, sometimes with superficial numbness.
Treatment of soft tissue bruises is traditionally aimed at eliminating the above symptoms and excluding more severe pathology [4]. Currently, there are treatment standards - clinical guidelines for the provision of emergency medical care for soft tissue injuries, where a special place is given to the issues of immobilization, wound care and pain relief [5]. The administration of opioid and non-opioid analgesics is recommended in combination with antihistamines (metamizole sodium, trimeperidine, diphenhydramine). It is necessary to perform immobilization as soon as possible. Even with minor injuries, it is better to apply a tight bandage to the bruised area or immobilize with an orthosis. This will ensure peace of the bruised segment, normalize microcirculation, and reduce motor activity. Some orthotic products have a micromassage effect, which also has a beneficial effect on reparative processes. Along with this, analgesic therapy is carried out. These activities must be performed within the first 3 days. Then it is possible to use warming procedures and physiotherapeutic measures. Local therapy with ointments and gels can be used from the 1st day if they do not have a warming effect and do not increase vascular permeability.
Soft tissue bruises, and therefore pain, are inherently interconnected. Pain is a unique psychophysiological state of a person that occurs as a result of exposure to super-strong or destructive stimuli and causes functional or organic disorders in the body. Moreover, pain is subjective in nature, its perception is based on personal experience associated with damage in the early period of life. Its perception is determined not only by the source of pain, but also by such, at first glance, non-obvious factors as the psychophysical and emotional characteristics of the individual, his cultural level, family training and many others. Most often it is characterized as a psychophysical state of a person, which is a characteristic reaction to various organic and functional disorders caused by the action of various stimuli. Pain is both a physical sensation and an emotional reaction to it. Pain expert Margot McCaffrey's pithy definition is "anything that a patient says hurts them."
The functioning of the nociceptive system is mediated by neurochemical mechanisms realized by endogenous peptides and mediators, including histamine, substance P, kinins, prostaglandins, leukotrienes, potassium and hydrogen ions [4–6]. When pain occurs, the processes of hypercoagulation and lipid peroxidation are activated, the content of proteolytic enzymes increases, which causes tissue destruction. Pain contributes to the development of tissue hypoxia, degenerative processes and disruption of microcirculation in tissues. This, in turn, increases the alteration of injured tissues [7].
Thus, pain is a complex psychophysiological phenomenon, which, both from an ethical and legal standpoint, requires treatment aimed at relieving pain [8]. Understanding the complexity of its nature, mechanisms of development and regulation allows us to take a differentiated approach to the issue of choosing analgesic therapy.
One of the most effective means of protecting peripheral nociceptors that does not cause depression of vital functions are non-steroidal anti-inflammatory drugs (NSAIDs). The modern concept of effective pain relief for bruises and other types of injuries involves a multimodal approach - influencing various parts of the pain impulse. In this regard, it is advisable to combine the administration of NSAIDs with opiates or opioids for severe pain syndrome, for example, in case of shockogenic traumatic injuries.
Nonsteroidal anti-inflammatory drugs are the drugs of choice for the treatment of mild to moderate pain. Their anti-inflammatory effect is based on inhibition of cyclooxygenase (COX). One of the representatives of NSAIDs is ketoprofen, produced in various forms (tablets, injections, external ones). The triple effect - anti-inflammatory, analgesic and antipyretic - is due to blocking the enzymes COX-1 and COX-2 and, partially, lipoxygenase, which leads to suppression of the synthesis of prostaglandins (including in the central nervous system, most likely in the hypothalamus) and thromboxanes. Ketoprofen stabilizes in vitro
and
in vivo
liposomal membranes, at high concentrations
in vitro
suppresses the synthesis of bradykinin and leukotrienes. It does not have a negative effect on the condition of articular cartilage [9].
From the point of view of the ratio of anti-inflammatory and analgesic activity, ketoprofen seems to be the optimal molecule. Thus, according to an experimental study using a model of toothache, ketoprofen has the most pronounced anti-inflammatory effect compared to many NSAIDs, while the clinical effectiveness indicator (total reduction in pain after 4 hours) is the greatest for ketoprofen [10]. It is important to note that these experimental data were confirmed by data from a meta-analysis of 13 RCTs: with regard to the relief of moderate and severe pain, ketoprofen is significantly superior to diclofenac and ibuprofen [11].
Despite the fact that ketoprofen is a “traditional” non-selective NSAID, it is less capable of causing NSAID-associated gastrointestinal and cardiovascular complications - data from a Finnish population-based study assessing the causes of 9191 events in the upper gastrointestinal tract ( including cases of bleeding, ulcers and perforation). According to the results obtained, the likelihood of developing serious gastrointestinal complications when using ketoprofen was lower compared to other NSAIDs, such as diclofenac. Ketoprofen demonstrated a similar or even lower risk of developing gastrointestinal pathology than a number of selective NSAIDs [9–11]. The minimal negative effect of ketoprofen on the cardiovascular system has been demonstrated in a number of large-scale epidemiological studies.
In a study of the analgesic effect of ketoprofen in the acute period of injury in victims with various skeletal injuries, the onset of analgesic effect was noted within 12.2 ± 2.6 minutes after intramuscular application of 100 mg of ketoprofen. The use of 200 mg reduced the wait for the development of analgesia to 8.2±2.2 minutes. At the same time, in patients with severe musculoskeletal injury, ketonal was used at a dose of 200 mg in combination with intravenous tramadol (100 mg), and the analgesic effect was realized in 5.8 ± 0.9 minutes, which was faster compared to tramadol monotherapy at the same dosage (6.0±1.2 min) [12].
Purpose of the study:
determine the effectiveness of analgesic therapy for bruises of the upper and lower extremities.
Degrees of bruises
The severity of the bruise is determined by the strength of the traumatic factor - speed, weight, nature of the surface, and bone density, the state of the blood coagulation system.
Taking into account the mechanism of injury, damage to soft tissues and organs, four degrees of chest contusion are distinguished:
- I degree
- characterized by injury to muscles and fatty tissue. Manifested by swelling and slight pain. External signs disappear on their own within 3–7 days. - II degree
- damage to muscles and blood vessels is accompanied by swelling and the formation of hematomas. The recovery period varies between 10–14 days. - III degree
- soft tissue injury is complicated by damage to internal organs. Symptoms depend on which organ or bone was affected. The recovery period is from two weeks to a month or longer. - IV degree
- diagnosed when the integrity and functions of internal organs are violated. Such injuries threaten the life and health of the patient and require urgent hospitalization. The duration of the rehabilitation period depends on the severity of the injury.
Classification
It should be noted that the symptoms and treatment of bruised ribs are closely interrelated. There are 3 degrees of rib bruises:
- 1st degree – the pain is slight, may intensify with sharp bends, turns and other movements, during palpation, but is absent at rest. Treatment in such cases is not required, and everything goes away on its own within a week. The absence of a bruise is also an indicator of 1st degree injury.
- 2nd degree – there is a hematoma; As a rule, the pain is constant and intensifies with the slightest physical effort. Differential diagnosis is mandatory. Treatment is medicinal to eliminate swelling.
- 3rd degree occurs when falling from a height, the symptoms are combined. Accompanied by compression of the lungs. The pain is so acute that it is difficult to breathe.
First aid
At the stage of first aid, it is necessary to provide the victim with rest, give an analgesic, and apply cold to the site of the injury to reduce swelling, pain and bruising. This could be a heating pad with cold water or an ice pack. If you are in an emotionally unstable state, offer water, sedatives, and provide a flow of fresh air.
Important!
In the first 3–4 days after injury, it is forbidden to take a hot bath, visit a sauna, or bathhouse, as heat increases swelling and the risk of developing hemarthrosis.
Even with a minor injury and satisfactory condition, the patient needs an urgent examination by a traumatologist, since damage to internal organs at the initial stage can be asymptomatic. It is better to transport the victim in a sitting or semi-sitting position.
A chest contusion is diagnosed based on external signs and subjective sensations of the patient. To exclude injury to internal organs, a chest x-ray is required. The study allows you to assess the condition of bone structures, determine the location of fractures, and identify the level of fluid and gas in the pleural cavity and lung tissue.
Rehabilitation period
It becomes necessary because bed rest should be replaced by restoration of rib mobility. To do this, you can do exercise therapy under the supervision of an instructor and perform breathing exercises. Swimming becomes very useful, as it strengthens the muscles of the back and chest very well.
How long do ribs hurt after a bruise combined with a fracture? If the injury resulted in a fracture, the doctor will have to treat 2 types of injuries simultaneously. The healing of bone tissue during fractures also depends largely on the body and its capabilities. The process will take more than six months.
How long does a rib bruise hurt? Based on reviews, one can draw a conclusion about the individuality of the organism in each specific case. Often the consequences of a bruise can last for several years. When using Ibuprofen and analgesics and staying in bed, it takes several months to complete the process.
For some people, the bruise may remain painful for up to a year. There are cases when, even after 10-12 years, a reaction to the weather remains - when it changes, aching pain is noted in the ribs.
