Costillas rotas o magulladas

¿Qué son las lesiones de costillas?

Rib injuries include bruising a rib or the muscles surrounding or between the ribs. They also include rib fractures- a break in one or more of the rib bones.

Children and babies are less likely to break ribs because their bones are more elastic. So, if a young child or baby has a rib fracture, it is very important to know what caused the injury. If there is no clear cause, the possibility of child abuse should be considered.

Broken (fractured) or bruised ribs often heal in about six weeks. However, the recovery time may be longer, especially for displaced fractures (when the broken ends of the rib no longer line up with one another). It is unusual to have pain persisting beyond 3 months and medical advice should be sought in this case.

Ribs that are broken (fractured ribs) are usually:

• Painful, particularly with movement, deep breaths, or coughing.

• Tender when pressed.

Las lesiones en las costillas generalmente se curan solas en unas pocas semanas

Usually, a broken or bruised rib diagnosis is made from the details given to a doctor (history) plus an examination. The chest wall will usually be inspected for swelling, redness or bruising, examined for tenderness and the chest listened to with a stethoscope The diagnosis usually based on this. A radiografía de tórax is not required unless there are suspected complications (detailed below).

Si se sospecha de una costilla rota, el objetivo principal de una radiografía de tórax es buscar complicaciones en lugar de diagnosticar la fractura en sí. Las radiografías no se utilizan a menos que sea necesario debido a la radiación involucrada y porque el tratamiento es el mismo tanto para costillas rotas como magulladas. Esto se aplica especialmente a las mujeres que están, o que pueden estar, embarazadas.

The most important treatment is to have good pain relief

Good pain relief for broken or bruised ribs is important as it helps to enable normal breathing and coughing. Simply putting up with the pain is not a good idea, as it can lead to taking shallow breaths which increases the risk of developing chest infections. (See the 'Complications' section below) . Painkillers help to prevent these problems.

Effective and safe pain relief is especially important for people who are more prone to chest infections. This includes, for example, smokers and people with persistent (chronic) chest conditions such as enfermedad pulmonar obstructiva crónica (EPOC) o insuficiencia cardíaca.

What pain relief should I use?

Three types of analgésicos can be used:

• Paracetamol.

• Antiinflamatorios no esteroideos (AINEs), such as naproxeno, diclofenaco, ibuprofeno o aspirina.

• Analgésicos fuertes containing codeína o dihidrocodeína.

How should I take the painkillers?

For painful rib injuries, it is best to take painkillers regularly without waiting until the pain becomes severe. As the ribs heal, the dose of the painkillers should be reduced. General advice is:

• For mild-to-moderate pain, take paracetamol.

• For moderate-to-severe pain, take paracetamol OR codeine OR paracetamol plus an anti-inflammatory painkiller. You can take paracetamol and codeine together, but studies suggest the resulting pain relief is not much better than taking one or other alone.

Siga siempre las instrucciones de dosificación en el paquete y no tome más de la dosis recomendada en el paquete.

¿Existen efectos secundarios de los analgésicos?

Es poco probable que el paracetamol cause efectos secundarios. La codeína y la dihidrocodeína pueden causar somnolencia o estreñimiento.

Para el estreñimiento, se pueden usar laxantes estándar (comprados sin receta) como:

• Tabletas de sen.

• Lactulosa.

• Fibrogel.

Los cambios en la dieta y el estilo de vida, junto con cualquier medicación, pueden ayudar. Estos incluyen:

• Increasing fruit intake.

• Increasing fibre.

• Aumentar la cantidad de agua consumida.

• Increasing the amount of exercise - even just walking.

It is important to treat constipation promptly because straining worsens rib pain. Codeine can be continued, together with enough laxative to relieve the constipation. Codeine can cause drowsiness in some people - driving should be avoided if affected and the dose reduced.

Anti-inflammatory painkillers (such as naproxen or ibuprofen) can cause stomach ulcers or stomach inflammation (gastritis). Many people can take them without problems, but some people need to be very careful about taking anti-inflammatory painkillers.

• DO NOT take anti-inflammatory painkillers if also taking anti-clotting medicines such as warfarin, heparin or similar medication.

Antes de tomar analgésicos antiinflamatorios, consulte a un farmacéutico u otro profesional de la salud si:

• Tienes más de 60 años.

• You have a history of úlcera de estómago or stomach bleeding.

• Tienes antecedentes de enfermedad cardíaca, accidente cerebrovascular o enfermedad arterial periférica.

• You have asthma, high blood pressure, kidney disease or may be pregnant.

• You are already taking aspirina (including aspirina de baja dosis) or clopidogrel.

• Estás tomando estos analgésicos por períodos prolongados, digamos, por más de dos semanas de forma continua.

A different painkiller may be suggested or a medicine to protect the stomach (for example, omeprazol). Stomach inflammation or ulcers can cause pain in the upper part of the tummy (abdomen). If this occurs then anti-inflammatory tablets should be stopped and medical advice sought.

Black tarry stools, blood in vomit or vomit that looks like coffee grounds could be signs of bleeding from an ulcer. Anyone with these symptoms should attend the Emergency Department at their nearest hospital.

¿Existen otros tratamientos?

For severe pain, another option is a nerve block with local anaesthetic near to the injury. This is rarely necessary and is not usually available.

Surgery may be offered if there are multiple rib fractures following major trauma. This may be required if the damage to the chest wall is so severe that the muscles are unable to support the movements of the lungs. It is not usually offered in other circumstances and current evidence suggests that it does not help speed the healing process.

Nota:

It is important NOT to wrap a bandage tightly round the chest to support it. Although this may help the pain, it stops the lungs from expanding fully and can lead to pneumonia. It is important that the ribs and muscles are allowed to move normally which is why pain relief is necessary.

Most rib injuries heal well with no ongoing problems. Complications can occur if internal organs are damaged by the sharp end of a broken rib.

Neumotórax

Pneumothorax occurs if the membrane around the lung is damaged. Air enters and forms a pocket of trapped air around the lung, which squashes the lung. The word pneumothorax means air in the thorax. Symptoms include shortness of breath or pain on breathing - sometimes pain near the shoulder. A pneumothorax can be suspected from listening to the chest with a stethoscope and can show on a chest X-ray. It may need treatment under local anaesthetic to remove the trapped air.

A pneumothorax is usually noticed soon after the injury. However, it can occasionally occur later, even several days afterwards. It is important to be alert for symptoms such as shortness of breath, increasing chest pain, or pain that is not near the break (fracture) and urgent medical advice should be sought for these symptoms.

Rarely, a dangerous pneumothorax can occur where air is trapped under pressure. It compresses the lungs and causes increasing difficulty breathing. This is called a tension pneumothorax and is a medical emergency.

Nota: cualquier persona que tenga dolor en el pecho asociado con dificultad para respirar o que se sienta más sin aliento de lo habitual necesita ayuda médica inmediata - llame a una ambulancia de emergencia de inmediato - 999 en el Reino Unido - o acuda al Departamento de Emergencias local.

Surgical emphysema

A sharp fractured rib can let air from the lung get in underneath the skin. This causes a swollen or bubbly area which may crackle when pressed. It is called surgical emphysema. It will clear up gradually. Surgical emphysema can sometimes be linked to a pneumothorax (see above) and the pneumothorax may need treatment.

Haemothorax

This is similar to a pneumothorax except that there is blood, not air, trapped around the lung. The blood collects at the base of the lung, so may cause shortness of breath or pain in the lower part of the chest. It is treated by draining off the trapped blood.

Lesiones en el abdomen (abdominales)

The lower part of the rib cage is near the liver, spleen and kidneys. Rib fractures can cause internal damage to these organs. Symptoms are tummy or back pain (rarely, pain may travel to the shoulder). If there is internal bleeding, this can cause faintness or a feeling of being very unwell. Urgent surgery may be needed.

Chest infections

Rib fractures or bruising often make it difficult to breathe deeply or cough properly due to pain. This can make it difficult to clear mucus in the chest, leading to chest infections. Good pain relief helps to prevent chest infections. (See 'How to treat a rib injury', above.)

Incluso con buenos analgésicos, algunas personas pueden desarrollar una infección en el pecho. Se debe buscar consejo médico si se presentan síntomas como tos, fiebre, dolor en el pecho, dificultad para respirar o aumento de flema (esputo) después de una lesión en las costillas.

Complications are more likely if the injury involved a large force and if the injured person is frail or has other medical problems. If a complication is suspected, medical advice should be sought.

There are some common questions about broken and bruised ribs people may ask from a GP or search online.

How long should I be off work with a broken rib?

Most people will not need any significant amount of time off work following a simple rib injury. Depending on the nature of the work, some people may need some time off, particularly if the work involves lifting or moving around a lot. If there are multiple rib fractures from a severe injury such as a car accident or fall from a height, then this may require a significant amount of time off work.

Why does the pain from a broken rib get worse after the first week?

Sometimes it can feel that pain gets worse before it gets better. The initial pain is often due to the injury itself whereas, as the injured area starts to heal, it becomes inflamed as part of the healing process. This can feel more painful than the injury itself did.

Pain can also feel worse because people are trying to get back to normal activities too soon or because they have reduced their painkillers too soon and need to restart them.

¿Puedes romperte una costilla al toser?

Rib injuries can occasionally be caused by coughing or straining. This is more likely if there is weakness of the ribs such as occurs with 'thinning of the bones' (osteoporosis) or other disease in the bone.