The human body has twelve pairs of ribs; ten pairs attach to the
spine and wrap around to attach to the sternum in the front of
the chest, and the two lower pairs only attach to the spine in
the back. The ribs serve to protect the internal organs, lungs,
heart, liver, kidneys, spleen, from injury. The bones have a lot
of nerve endings so when damage occurs, pain is significant. A
patient with an isolated rib fracture or a minor costochondral
separation usually has a history of falling on the side of the
chest, being struck by a blunt object, coughing violently or
leaning over a rigid edge. The initial chest pain may subside,
but over the next few hours or days pain increases with
movement, interfering with sleep and activity and becoming
severe with coughing or deep inspiration. The patient is often
worried about having a broken rib, and may have a sensation of
bony crepitus or abnormal rib movement. Breath sounds
bilaterally should be normal unless there is substantial
splinting or a pneumothorax or hemothor