Fractured Ribs

I'm not a doctor but… 
Cycling injury, recovery and health issues.
Forum rules
The information / discussion in the Cycling Health Forum is not qualified medical advice. Please consult your doctor.

Re: Fractured Ribs

Postby sogood » Tue Jul 22, 2014 3:14 pm

Correct. The neuro vascular bundle travels just below each rib. Following a fracture, not only are the nerves stimulated acutely, they'll get tangled and stretched throughout the healing process with each chest wall movement as well as the being squeezed by the exuberant callous formation around the fracture. Let alone the localised pleurisy and muscle bruising. They hurt!
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

by BNA » Tue Jul 22, 2014 5:16 pm

BNA
 

Re: Fractured Ribs

Postby Parker » Tue Jul 22, 2014 5:16 pm

I've been told I can't start physio after two weeks
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby Parker » Tue Jul 22, 2014 5:17 pm

Can start
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby sogood » Tue Jul 22, 2014 5:22 pm

If you breath, you've already started the physio. No physio means no breathing. LOL
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

Re: Fractured Ribs

Postby Parker » Tue Jul 22, 2014 5:25 pm

Cool. Good to know. And I've been told to do this other thing. Basically just turn to the left and the right
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby sogood » Tue Jul 22, 2014 6:25 pm

There are only so many movements one can make with those chest muscles. Not sure I'd pay money for a physio for a bit if chest wall exercises unless I am really old and decrepit.
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

Re: Fractured Ribs

Postby Mulger bill » Tue Jul 22, 2014 7:36 pm

Parker wrote:Cool. Good to know. And I've been told to do this other thing. Basically just turn to the left and the right

That's what I was told. Don't want to repeat the exercise tho'.
...whatever the road rules, self-preservation is the absolute priority for a cyclist when mixing it with motorised traffic.
London Boy 29/12/2011
User avatar
Mulger bill
Super Mod
Super Mod
 
Posts: 26009
Joined: Sun Sep 24, 2006 2:41 pm
Location: Sunbury Vic

Re: Fractured Ribs

Postby anthcon » Tue Jul 22, 2014 9:12 pm

Pooing, Spewing ..... all things that hurt with Fractured ribs.. That does explain some of the other referred pain I have been concerned about though.

On my 2nd night home after hospital my wife got the worst case of gastro I have seen..... She was that bad on the bathroom floor all I could think about was how the **** would I be able to handle that in my condition. I couldn't even help her off the floor I was in so much pain....... I did the next best thing and call an ambulance to take her away!. Sad, but true.
anthcon
 
Posts: 16
Joined: Sat Jul 12, 2014 4:05 pm

Re: Fractured Ribs

Postby chriscole » Tue Jul 22, 2014 9:47 pm

sogood wrote:
Parker wrote:Topic is ribs

Given that you've declared that your ribs weren't fractured and it was just muscle and soft tissue bruising, the initial topic has expired and thread drift followed naturally to related health issues.

If you care to bring it back to topic, here are two relevant images.
Image

Image



Ahh, if only the costal / intercostal vessels were actually routinely located where the textbooks tell us they are... :-)
chriscole
 
Posts: 127
Joined: Mon Mar 21, 2011 1:35 pm

Re: Fractured Ribs

Postby sogood » Tue Jul 22, 2014 9:57 pm

chriscole wrote:Ahh, if only the costal / intercostal vessels were actually routinely located where the textbooks tell us they are... :-)

Have you been routinely puncturing them?
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

Re: Fractured Ribs

Postby Parker » Wed Jul 23, 2014 8:54 am

sogood wrote:There are only so many movements one can make with those chest muscles. Not sure I'd pay money for a physio for a bit if chest wall exercises unless I am really old and decrepit.

I've got mandurah ironman in November which I'm really motivated for and mentally I want my prep to be spot on, so the physio is a need for me. Plus I love going and getting poked and prodded and laughing and crying at the same time
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby chriscole » Wed Jul 23, 2014 11:30 am

sogood wrote:
chriscole wrote:Ahh, if only the costal / intercostal vessels were actually routinely located where the textbooks tell us they are... :-)

Have you been routinely puncturing them?



LOL. Thankfully no, not usually. But there is significant/common anatomic variation in real life, which is not usually conveyed by general textbooks. E.g. there is often a decent sized vessel running along the _superior_ margins of the ribs as well as the as-advertised inferiorly located neurovascular bundle. The old "aim just over the rib below" is a bit of a furphy.
chriscole
 
Posts: 127
Joined: Mon Mar 21, 2011 1:35 pm

Re: Fractured Ribs

Postby sogood » Wed Jul 23, 2014 11:37 am

chriscole wrote:LOL. Thankfully no, not usually. But there is significant/common anatomic variation in real life, which is not usually conveyed by general textbooks. E.g. there is often a decent sized vessel running along the _superior_ margins of the ribs as well as the as-advertised inferiorly located neurovascular bundle. The old "aim just over the rib below" is a bit of a furphy.

There are variations in every part of the body. In practice, access via the superior margin of the rib works, especially if the periosteum is lifted. There's nothing old with that instruction.
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

Re: Fractured Ribs

Postby Dr_Mutley » Wed Jul 23, 2014 12:44 pm

chriscole wrote:
sogood wrote:
chriscole wrote:Ahh, if only the costal / intercostal vessels were actually routinely located where the textbooks tell us they are... :-)

Have you been routinely puncturing them?



LOL. Thankfully no, not usually. But there is significant/common anatomic variation in real life, which is not usually conveyed by general textbooks. E.g. there is often a decent sized vessel running along the _superior_ margins of the ribs as well as the as-advertised inferiorly located neurovascular bundle. The old "aim just over the rib below" is a bit of a furphy.


Really? How often does this occur? How have u established this?
Image
Dr_Mutley
 
Posts: 2211
Joined: Fri Jan 11, 2008 1:28 pm
Location: Flagstaff Hill, Adelaide SA 5159

Re: Fractured Ribs

Postby Parker » Tue Jul 29, 2014 4:51 pm

Update:

I went to physio today, FINALLY. Physio thinks they're probably more bruised than fractured.

I am allowed to:

Spin on the bike
kick in the pool
weight work that is from a seated position

Re-evaluate in 1 week!
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby wombatK » Tue Jul 29, 2014 6:32 pm

Parker wrote:I can't keep any liquids down today, I went to work yesterday and was fine.

I have thrown up breakfast, coffee, but I did finally poo...

I'm starting to sip small amounts of water to see what happens, I'm keeping an eye on myself and will go to the doctor if the vomiting persists. So tired.

So did anyone tell you about side effects of pain killers. Some are well known to cause constipation and associated vomiting. while hydration might help, you could need something stronger. Check in with GP.
WombatK

Somebody has to do something, and it's just incredibly pathetic that it has to be us -Jerry Garcia
User avatar
wombatK
 
Posts: 5248
Joined: Thu Jul 10, 2008 9:08 pm
Location: Yagoona, AU

Re: Fractured Ribs

Postby Parker » Tue Jul 29, 2014 9:13 pm

wombatK wrote:
Parker wrote:I can't keep any liquids down today, I went to work yesterday and was fine.

I have thrown up breakfast, coffee, but I did finally poo...

I'm starting to sip small amounts of water to see what happens, I'm keeping an eye on myself and will go to the doctor if the vomiting persists. So tired.

So did anyone tell you about side effects of pain killers. Some are well known to cause constipation and associated vomiting. while hydration might help, you could need something stronger. Check in with GP.

Oh wow... I had no idea
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby petie » Wed Jul 30, 2014 9:01 pm

Parker wrote:
wombatK wrote:
Parker wrote:I can't keep any liquids down today, I went to work yesterday and was fine.

I have thrown up breakfast, coffee, but I did finally poo...

I'm starting to sip small amounts of water to see what happens, I'm keeping an eye on myself and will go to the doctor if the vomiting persists. So tired.

So did anyone tell you about side effects of pain killers. Some are well known to cause constipation and associated vomiting. while hydration might help, you could need something stronger. Check in with GP.

Oh wow... I had no idea

Oh if only you had proper education around your analgesia regime when it was prescribed and then dispensed to you. Now you know!
petie
 
Posts: 520
Joined: Sun Feb 07, 2010 1:16 pm
Location: The Ice rink, bring skates

Re: Fractured Ribs

Postby chriscole » Wed Jul 30, 2014 9:15 pm

sogood wrote:
chriscole wrote:LOL. Thankfully no, not usually. But there is significant/common anatomic variation in real life, which is not usually conveyed by general textbooks. E.g. there is often a decent sized vessel running along the _superior_ margins of the ribs as well as the as-advertised inferiorly located neurovascular bundle. The old "aim just over the rib below" is a bit of a furphy.

There are variations in every part of the body. In practice, access via the superior margin of the rib works, especially if the periosteum is lifted. There's nothing old with that instruction.



True. I didn't say there _isn't_ a neurovascular bundle inferiorly, just that relying on there _only_ being an inferior significant costal vessel is often not a correct (or therefore safe) assumption. I still generally err towards the inferior aspect of the intercostal space. Hopefully during thoracostomy with blunt dissection, either to insert a drain or simply a finger, most of us are unlikely to prang an important vessel, anyway... and the majority of the time the risk of doing so is outweighed by the risk of not opening the chest in the first place.

In any case, I fear we have digressed.

Fractured ribs hurt!
Last edited by chriscole on Wed Jul 30, 2014 9:21 pm, edited 1 time in total.
chriscole
 
Posts: 127
Joined: Mon Mar 21, 2011 1:35 pm

Re: Fractured Ribs

Postby chriscole » Wed Jul 30, 2014 9:20 pm

Really? How often does this occur? How have u established this?


Fairly common normal anatomic variation. Couldn't give you a % figure, but a good surgical text or experienced thoracic surgeon could probably fill the void. My comment was based on anecdotal evidence from putting in chest drains / doing finger thoracostomies fairly frequently, watching thoracotomies and chit-chat with the friendly neighbourhood thoracic surgical folk who routinely open (and thankfully close) chests.
chriscole
 
Posts: 127
Joined: Mon Mar 21, 2011 1:35 pm

Re: Fractured Ribs

Postby sogood » Wed Jul 30, 2014 11:26 pm

chriscole wrote:Fairly common normal anatomic variation. Couldn't give you a % figure, but a good surgical text or experienced thoracic surgeon could probably fill the void. My comment was based on anecdotal evidence from putting in chest drains / doing finger thoracostomies fairly frequently, watching thoracotomies and chit-chat with the friendly neighbourhood thoracic surgical folk who routinely open (and thankfully close) chests.

I don't think A&E/ward dissection and chest drain insertions are adequate processes to properly define anatomy. You are going through muscle and muscle bleeds. No proof of hitting one of the intercostal vessels proper. More likely than not, there's not enough adrenaline in the L.A. Even when they do bleed, they bleed internally and get mixed in the chest drain fluid. Nothing proven.
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

Re: Fractured Ribs

Postby chriscole » Thu Jul 31, 2014 3:24 am

sogood wrote:
chriscole wrote:Fairly common normal anatomic variation. Couldn't give you a % figure, but a good surgical text or experienced thoracic surgeon could probably fill the void. My comment was based on anecdotal evidence from putting in chest drains / doing finger thoracostomies fairly frequently, watching thoracotomies and chit-chat with the friendly neighbourhood thoracic surgical folk who routinely open (and thankfully close) chests.

I don't think A&E/ward dissection and chest drain insertions are adequate processes to properly define anatomy. You are going through muscle and muscle bleeds. No proof of hitting one of the intercostal vessels proper. More likely than not, there's not enough adrenaline in the L.A. Even when they do bleed, they bleed internally and get mixed in the chest drain fluid. Nothing proven.


Phew!! Lucky I was neither trying to prove anything (I generally find that's best left to the mathematicians), nor "define anatomy"... But thanks for the epistle, anyway. ;-)

I do, however, applaud your apparent desire for a more solid evidentiary basis of argument, and with regard to the location and course of the intercostal arteries in real, live humans (as opposed to undergraduate textbook diagrams), one could do worse than to use some of the following recent radiological anatomic studies as jumping-off points:

http://www.ncbi.nlm.nih.gov/pubmed/20154433

http://www.ncbi.nlm.nih.gov/pubmed/22125216

http://www.ncbi.nlm.nih.gov/pubmed/20718909

http://www.ncbi.nlm.nih.gov/pubmed/22301442


Essentially, it runs much more inferiorly (to the extent of being closer to the rib _below_) posteromedially, there is great variability in how laterally it finally ducks for cover behind the rib above, the variability, tortuosity and length of exposure tends to be higher in older patients, and occasionally the damn thing can be exposed in the middle of the intercostal space all the way out at the axillary line(s).

This, I would suggest, might be a wee bit clinically relevant when performing thoracostomies, and even more so when performing thoracocentesis for an effusion from a posterior approach (not uncommon).

But as educational as all of this may be, my main point was not so much about the variable position/course of the intercostal artery, but the likelihood of the presence of less famous (ie unnamed) branches running more superiorly (with regard to the rib). The clinically relevant aspect is simply that one should not be blissfully confident they will not lacerate a significant vessel simply because they are being good little vegemites and staying in the inferior half of the intercostal space like we were all taught at medical school.
chriscole
 
Posts: 127
Joined: Mon Mar 21, 2011 1:35 pm

Re: Fractured Ribs

Postby Parker » Thu Jul 31, 2014 11:19 am

petie wrote:
Parker wrote:
wombatK wrote:So did anyone tell you about side effects of pain killers. Some are well known to cause constipation and associated vomiting. while hydration might help, you could need something stronger. Check in with GP.

Oh wow... I had no idea

Oh if only you had proper education around your analgesia regime when it was prescribed and then dispensed to you. Now you know!

:roll:
Parker
 
Posts: 1449
Joined: Wed Aug 04, 2010 6:25 pm

Re: Fractured Ribs

Postby sogood » Thu Jul 31, 2014 6:03 pm

chriscole wrote:This, I would suggest, might be a wee bit clinically relevant when performing thoracostomies, and even more so when performing thoracocentesis for an effusion from a posterior approach (not uncommon).

Relax, it's hardly a significant consideration with routine thoracotomy. Periosteal lift and diathermy access, it's all trivial. If you have seen enough of the inside of a thoracic cavity, you'll know the discussions are all a bit academic and a bit overblown.
Bianchi, Ridley, Montague, GT, Garmin and All things Apple :)
RK wrote:And that is Wikipedia - I can write my own definition.
User avatar
sogood
 
Posts: 17012
Joined: Thu Aug 31, 2006 7:31 am
Location: Sydney AU

Previous

Return to Cycling Health

Who is online

Users browsing this forum: No registered users



Popular Bike Shops
Torpedo 7 Torpedo7 AU
Ground Effect Ground Effect NZ
Chain Reaction Cycles CRC UK
Wiggle Wiggle UK
Ebay Ebay AU

“Bicycles BNA Twitter
“Bicycles BNA Facebook
“Google+ BNA Google+
“Bicycles BNA Newsletter

> FREE BNA Stickers
> BNA Cycling Kit