Bruised Ribs After a Car Accident

Rib Contusion Basics

A bruised rib, also called a rib contusion, is an injury to the soft tissue over a rib with no break in the bone. MedlinePlus explains that a bruise forms when small blood vessels break and leak into the tissue under the skin, which turns the skin a darker color.

MedlinePlus lists car accidents among the common causes of bruised ribs, along with sports injuries and falls. The same blow can also fracture ribs or damage the lungs, liver, spleen, or kidney, and MedlinePlus says those added injuries are more likely after a car accident.

Chest Impact During a Car Accident

Motor vehicle accidents are the leading cause of chest trauma, according to the StatPearls chapter on thoracic trauma. The same chapter lists airbag deployment, steering-wheel damage, intrusion into the passenger space, and extensive vehicle damage as risk factors for significant injury.

The shoulder belt crosses the chest, and the StatPearls chapter on seat belt injury says it can pass significant force into the body depending on how the car accident happens. The same chapter lists sternal and rib fractures and bruised lungs among the chest injuries that seat belt force can cause. Bruising in the pattern of the belt may leave point tenderness over the ribs, according to the StatPearls thoracic trauma chapter.

Belt-related chest injuries are covered in more depth on the pages about seat belt injuries after a car accident and sternum fractures from a car accident.

Common Signs of a Rib Contusion

Pain, swelling, and skin discoloration are the main symptoms, according to MedlinePlus. The skin over the bruise may turn blue, purple, or yellow, and the area feels tender and sore.

Breathing, coughing, laughing, and sneezing can all cause or increase the pain. MedlinePlus notes that the pain may be present during movement and at rest.

MedlinePlus lists the signs below as reasons to contact a provider right away.

Bruise Versus Fracture

The MedlinePlus page on rib fractures describes a rib fracture as a crack or break in one or more rib bones, while a bruised rib is limited to the soft tissue over the rib. That page says a rib fracture hurts because the ribs move with each breath, cough, and upper-body movement.

MedlinePlus says bruised ribs recover in the same manner as rib fractures. Its rib fracture page says providers also check for other chest and organ injuries when a rib is fractured. The page on rib fractures after a car accident covers the fracture itself.

Physical Examination and Imaging

Evaluation starts with a physical exam of the chest wall and breathing. The StatPearls thoracic trauma chapter describes checking for tenderness when the chest wall is pressed and listening to breath sounds, since quieter breath sounds may point to blood or air collecting around a lung.

MedlinePlus says an x-ray, MRI, or CT scan is rarely needed to confirm a bruised rib and may be needed to check for more serious injuries, such as a rib fracture that has shifted a rib out of alignment or damage to internal organs.

For suspected rib fractures after minor blunt trauma confined to the ribs, the American College of Radiology rates a chest x-ray as usually appropriate first imaging. In that same scenario, dedicated rib x-ray views rate “may be appropriate,” and chest CT rates “usually not appropriate.”

For blunt chest trauma more broadly, the StatPearls thoracic trauma chapter describes the NEXUS chest decision tool, which uses 7 criteria to judge the likelihood of a significant chest injury on imaging. The criteria are age 60 or older, rapid deceleration such as a motor vehicle accident above 40 mph, chest pain, intoxication, altered mental status, a distracting painful injury, and chest wall tenderness.

Lung and Organ Injuries

A bruised chest wall can sit over a deeper injury. The StatPearls chapter on pulmonary contusion calls a bruised lung a common complication of rib fractures. In mild cases, symptoms may develop gradually over 24 to 48 hours, and complications can include pneumonia and respiratory failure.

The StatPearls thoracic trauma chapter also says significant chest trauma can occur without a rib fracture, and that lower rib fractures may come with injuries inside the abdomen. Lung and heart injuries from the same kind of impact are covered under chest injuries from a car accident.

Home Care and Chest Wrapping

Ice, pain medicine, and breathing exercises make up the MedlinePlus self-care instructions for a bruised rib. Those instructions describe an ice pack wrapped in cloth for 20 minutes, 2 to 3 times a day for the first 1 to 2 days, to reduce swelling and numb the area.

MedlinePlus lists store-bought pain relievers for pain that is not severe. For two of them, it cautions that people with heart disease, high blood pressure, kidney or liver disease, or a history of stomach ulcers or internal bleeding check with a provider first.

A belt or bandage around the chest is not part of that care. MedlinePlus explains that wrapping keeps the ribs from moving with each breath or cough, which may lead to pneumonia.

Deep Breathing and Coughing

Slow deep breaths and gentle coughing clear mucus from the lungs and prevent partial lung collapse, according to MedlinePlus. Rib pain can make breaths shallow, and shallow breathing for too long raises the risk of pneumonia, so providers may recommend these exercises.

A provider may also have the person blow into a spirometer, a device that measures how much air moves with each breath. Holding a pillow or blanket against the injured rib can make those breaths less painful. Resting in bed all day can cause fluid to build up in the lungs, so MedlinePlus advises against it.

Recovery Time Range

MedlinePlus puts healing for bruised ribs at about 4 to 6 weeks, and its rib fracture page gives at least 6 weeks for a rib fracture. As the pain decreases, normal daily activities can resume slowly after talking with a provider.

Heavy lifting, pushing, pulling, and movements that cause pain are on the MedlinePlus list of activities to avoid while a bruised rib heals. For the first few nights, MedlinePlus describes sleeping semi-upright with pillows under the neck and upper back, then sleeping on the uninjured side a few days after the injury. Smoking and other tobacco use are on the same list.