Emergency and Urgent Care - Chest Wall Injury Advice

What is a Chest wall injury?

This leaflet will give you advice on Chest Wall injuries, these include:

• Rib Fractures
• Chest Wall Bruising
• Sternum Fractures

A rib fracture is when one or more of the bones in the rib cage break or crack. They are one of the most common injuries to the chest and can be as a result of injury, such as a road traffic collision or sports injury. Occasionally they occur due to overuse of the muscles that surround the ribs in sports with repetitive actions or from a long-term cough.

A sternum fracture is when there is a break or crack in the breastbone of the chest, usually due to a significant impact during injury such as a road traffic collision.

Chest wall bruising is a contusion to the chest wall, but no fracture is suspected to the ribs, usually sustained through blunt force impact from an injury such as contact sports or a road traffic collision.

Signs and Symptoms

Pain is one of the main problems experienced with chest injuries; and can be made worse by laughing, coughing and deep breathing. Injuries to the chest can be very painful. Unlike other parts of the body, we cannot rest the chest wall as we use the chest to breathe, and it supports you when you sit up and lie down. The amount of pain you have and how long it will last for will depend on the type of injury you have. Most fractures take approximately 4-6 weeks to heal, whilst bruising can take 2-4 weeks to heal; however, it can take longer to become pain-free.

How is a Chest Wall injury diagnosed?

Rib fractures do not always show on a chest x-ray; therefore, it may not always be necessary to have an x-ray. They are suspected in a chest injury, or when someone with weak bones is unable to take a deep breath or cough. If we think that you have a rib fracture, this will be explained to you by the Clinician treating you.

If a sternum fracture is suspected, you may need an x-ray to diagnose this. If we think you have a sternum fracture, this will be explained to you by the Clinician treating you.

Treatment of a Chest wall injury

There are no specific treatments for chest wall injuries. The most important thing you can do is avoid developing a chest infection whilst your chest wall injury heals. There are things you can do at home when you have been discharged from hospital to prevent this from happening.

Do:

• Take regular pain relief – this will help you to take deep breaths and cough
• Keep mobile – moving about is the most effective way of being able to breathe deeply and clear any sputum. It may be useful to take deep breaths when you are sitting up or moving around
• Cough when you need to and support your chest when coughing- you can support the painful area with a pillow, towel or your hand
• Avoid smoking – smokers have a higher risk of developing a chest infection after chest wall injuries; seek help to stop smoking – speak to your GP or visit www.nhshealth.org.uk/stopsmoking

Don't:

• Stay lying down or still for long periods of time
• Push, pull or lift anything heavy
• Strap your chest – this will stop the lungs from expanding
• Avoid coughing

Returning to work/normal activity:

Depending on your job and injury severity, you may need to take some time off work whilst your injury heals. You can self-certify sickness for the first 7 days, and if you need any longer than this off work, you can obtain a sick note form your GP.

Lifting should be avoided for 3-4 week minimum; after this you may take part in light exercise as your pain allows.

Contact sports should be avoided for at least 6 weeks to avoid fractures failing to heal and delaying recovery.

Pain relief:

Good pain relief is the best treatment for chest wall injuries, as it will allow you to move more easily and reduces the risk of chest infection by allowing you to breathe deeply and cough effectively.

• Paracetamol – can be taken safely by most people. It can be combines with other painkillers, but you must ensure that the other painkillers do not already contain paracetamol
• Codeine phosphate – can cause drowsiness or constipation. If you are feeling drowsy, the dose may need to be reduced, seek advice from your GP. Do not drive, use machinery or sign legal documents if you are drowsy. If you are constipated, seek advice from a pharmacist regarding treatment options; drinking plenty of water, and eating fresh fruit and vegetables high in fibre will help prevent constipation
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) – Ibuprofen, Naproxen and Diclofenac – these should be taken for a short period of time only (2-3 weeks). DO NOT take NSAIDS if you have any of the following conditions:

○    Stomach ulcers
○    Kidney problems such as Renal Failure
○    If you take anticoagulants such as warfarin, apixiban or aspirin, or you have a bleeding disorder
○    Heart problems
○    Asthma

Initially you will need to take pain relief regularly to enable you to breathe deeply and cough effectively. As your pain eases, you will be able to reduce the frequency of pain relief you take regularly. For further advice speak to a pharmacist or your GP.
 
It is important that you follow the instructions on the packet for the pain relief to be most effective. DO NOT take more that the recommended amount stated on the packet.

Breathing Exercises:

Sit in a comfortable position, with your head, neck and arms supported, and your shoulders relaxed.

• Rest one hand on your stomach, keep your shoulders and upper chest relaxed and allow your hand to rise gently as you breathe in and then sigh out through your mouth
• Take a long, slow, deep breath in through your nose, once your lungs are full, hold your breath for 2-3 seconds, then let the air out gently through your mouth
• Repeat the deep breath 3-4 times
• Take a deep breath in, and then with your mouth wide open, breathe the air forcefully out of your lungs as if you are steaming up a mirror before cleaning it. This must be long and strong enough to move phlegm from the bottom of your lungs
• Follow this with a cough, and then relaxed breathing until you get your breath back

Completing the above exercise is important, as pain from chest wall injuries can make it difficult to take deep breaths and cough; this can make it hard to clear the chest of any phlegm, which increases your risk of developing a chest infection or pneumonia.

Complications

Even after following the above advice, some people develop complications from a chest wall injury.

• Chest infections are one the most common complications of a chest wall injury. Because you are in pain, this may mean you are uncomfortable when taking a deep breath or coughing; combines with the fact that you may not be moving around as much as usual; this can mean you are more likely to develop a chest infection
• Less common complications include:
  ○    Pneumothorax – air in the space surrounding the lung, causing shortness of breath, increasing chest pain, or pain that is not near the injury site
  ○    Haemothorax – blood in the space surrounding the lung, causing shortness of breath and pain in the lower part of the chest
  ○    Surgical Emphysema – air trapped under the skin, can cause a bubbly, swollen are on the chest wall, and may be linked to a pneumothorax
  ○    Abdominal injuries – liver or spleen damage, which may cause pain in your abdomen or back

Signs and Symptoms:

See you GP or return to the UCC if you develop any of the following symptoms:

• If you develop a fever
• If your sputum becomes thick and discoloured – yellow/green
• If you develop an uncontrollable cough
• If your pain is uncontrolled

If you develop any of the following symptoms, then go to an Emergency Department or ring 999:

• You start coughing up blood
• The pain is so severe, it stops you from coughing or taking a deep breath
• If your breathing becomes more difficult, you have increasing shortness of breath or chest tightness
• You develop abdominal pain

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form, follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.

If you require any further advice or information, please contact NHS 111 via telephone or on their website, or you can contact Rochdale Urgent Treatment - 01706 517023.