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Costochondral Separation

What is costochondral separation?

The costochondral separation is a medical condition, in which one of the ribs becomes separated from the sternum. This condition usually appears after a direct impact with a blunt force.

The ribs are connected to the sternum through the costochondral joints. In the situation of costochondral separation, what happens is that the bone becomes separated from the cartilage. In the medical field, this condition is also presented as a separated rib. If someone falls on his/her side or he/she is hit, there is a very high chance that the costochondral separation is going to occur.

Symptoms

These are the most common symptoms that appear with costochondral separation:

  • Pain with sudden onset – specific location: the point where the rib connects with the sternum (costochondral joint)
  • The patient might also declare to having experience a popping sensation
  • Due to the adrenalin rush (common in accidents resulting in impact), the pain might subside initially; however, it will become worse, as the adrenaline levels are brought down to normal
  • The pain is aggravated by movement, affecting the quality of the sleep and reducing the level of activity for the patient
  • Coughing or taking deep breaths can also aggravate the pain experienced by the patient
  • Apart from the acute pain, the patient might experience difficult breathing
  • Coughing and sneezing can also be present among the symptoms

Causes

In general, a forceful impact can lead to the costochondral separation. This condition can also occur on individuals who have fallen on their side or in those who suffer from a violent attack. In case of twisting movements that are highly violent, there is an increased risk for this problem to appear. In some individuals, a violent cough is enough to cause the costochondral separation.

Patients who have been struck with a blunt object or those who have leaned over a rigid ledge can also suffer from costochondral separation.

Diagnosis

These are the most common methods used for the diagnosis of the costochondral separation:

  • Physical examination
    • Identification of potential injuries
    • Abdominal examination – injury at the level of the liver or the spleen
  • Compression of the rib – performed if there is also a suspicion of fracture; if pain occurs with this maneuver, the patient might be suffering from costochondral separation
  • Medical history
    • Pre-existing illnesses – chronic lung problems
    • Heavy smoking
    • Exposure to toxic environment or substances (occupational hazard)
  • X-rays
    • The X-ray is recommended in order to rule out other medical problems, such as the pneumothorax, hemothorax or pulmonary contusion
    • Both frontal and lateral views are recommended, especially in elderly patients and when there is the suspicion of multiple rib fractures

Treatment for Costochondral Separation

The best way to recover from the costochondral separation is to take a break from the physical activity and get plenty of rest. The treatment might be necessary, in order to prevent the complications that can occur due to the fracturing of the dislocated rib or the appearance of the pneumothorax. Anti-inflammatory medication and analgesics might be useful in bringing the necessary pain relief. The drugs recommended above are also going to allow the patient to breathe more easily.

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Ice applications might also help with the symptoms during the acute painful period. Wrap the ice in a cloth or use cold compresses in order to obtain relief from the pain. The cold applications should be maintained at the site on the injury for approximately 20 or 30 minutes, during the first two or three days after the injury. Make sure that you do not apply the ice directly to the skin, as this often leads to circulatory problems. The symptoms of costochondral separation can also be improved with the help of high volt electro stimulation and ultrasound therapy. These methods are known to reduce the intensity of the pain experienced by the patient but also to promote a faster and a more efficient healing process.

The patient might also be instructed to wear an elastic rib belt, in order to reduce the pain experienced and promote the faster healing. The rib belt should be worn between one and four days, being removed after the acute painful period has passed. The patients should be encouraged to cough and take deep breaths, despite the pain that might be elicited by such actions. The active coughing and the deep breaths can prevent the complications of costochondral separation, such as pneumonia. Hospitalization is required in patients who are older or suffer from pre-existent conditions, so as to reduce the risk of complications.

Prevention

The prevention of the costochondral separation is quite difficult, as this problem is often caused by blunt force. However, you can prevent this condition by avoiding sleeping on your stomach. You also need to avoid the activities that will cause the hyper-extension of the lumbar area. Also, avoid maintaining the same position for prolonged periods of time. Interrupt the long periods of sitting and try to stand or stretch as much as you possibly can.

Recovery time

The recovery time depends on the exact cause that has led to the costochondral separation and whether the patient follows the indications regarding the rest or not. In general, provided there are no other complications (fractured rib, pneumothorax), the patients is fully healed in approximately two or three months. Strenuous physical effort should be avoided for at least eight weeks after the injury.

In conclusion, it is important that the diagnosis of costochondral separation is correctly made. It is just as essential to identify if there are other injuries present, especially if they may cause life-threatening complications. If the patient is older or presents pre-existing conditions, the recovery time might be longer and more difficult. Regardless of the age, the patient has to follow the recommendations of the doctor, in regard to the rest and avoidance of physical activity. Otherwise, the recovery period might be even more prolonged or serious complications can arise. Wearing the elastic belt is also recommended during the recovery period, allowing for the injured areas to heal in a proper manner.


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