Chest, or thoracic, trauma is no laughing matter. Chest pain and soft tissue injuries associated with accidents (home, recreational or vehicular) accounts for over $600 billion dollars a year! In fact, almost one-third of patients admitted to trauma centers in the United States sustain serious injuries to the chest. Injuries can range anywhere from damage to the lungs, broken or cracked ribs, soft tissue damage, internal bleeding, and most dire – injuries to the heart.
Though our practice isn’t equipped to handle the immediate post-trauma care, we take a non-surgical and non-invasive approach to diagnosing, treating and caring for chest injuries with a non-surgical approach. Medications, therapy, specific injections and alternative treatments will be discussed with each patient. But first let’s take a look at the most common injuries.
Stress fracture is most likely to occur in the first rib. Overhead athletes such as basketball or tennis players are typically at risk here: repeated contraction of the anterior scalene (deep neck) muscle exerts bending stresses on the subclavian sulcus, a small recess in the rib bone and the most common site of fracture. Acute rib fractures, on the other hand, are the result of direct injury. Fractures of the first and second ribs suggest a very significant transfer of energy and can be associated with underlying injuries to the thoracic aorta, brachial plexus or subclavian vein.
Fractures of the breastbone tend to be the result of direct high-energy trauma. The vast majority result from road traffic accidents, with the steering wheel striking the sternum, but a small number may arise from direct blows during high-impact sports activities such as those received in rugby or wrestling. Luckily, these injuries are rare – however, due to the proximity to the heart, these injuries can often be serious.
This is sometimes seen without any history of trauma, but the most common tear, a minor subluxation, usually results from a fall or blow to the front of the shoulder, or a fall on to an outstretched hand. The impact forces the inner end of the clavicle on the affected side downwards and forwards, creating a clear asymmetry of the collar bones. There is local tenderness.
The Examination and Diagnosis Process
Our team takes a very thorough approach to examining and diagnosing chest injuries. Internal bleeding and soft tissue and organ damage may be lurking under every trauma.
CT Scans: The CT scan is one of our most invaluable tools to locate the precise location of the trauma and other lesions (a scan taken ‘with contrast’ looks for hemorrhages and other hard-to-spot injuries)
Echocardiography: Detects cardiac wall motion abnormalities and valve function and presence of pericardial fluid or blood.
ECG: (referred to colloquially as the ‘E.K.G.’) Helps detect the most common abnormality in thoracic trauma are S-T and T wave changes and findings indicative of bundle branch block
Bronchoscopy: This process evaluates airway injury, haemoptysis or the removal of aspirated foreign bodies–
Time is your best friend when it comes to chest injuries. The treatment we recommend are primarily concerned with controlling pain because the structures in your chest are hardly sitting still – they expand and contract with breathing, which may aggravate your injury.
Immobilization or at least ‘taking it easy’ is a critical step in the process. A serious rib fracture may require surgery, after which you’ll wear a special type of support to keep it from moving too much until it’s healed. Most rib fractures, however, are treated non-surgically. Often splinting and rest allows for ample healing.
Follow-up medications can include NSAIDs, muscle relaxants, analgesics, neuropathic pain medications and topical applications (Icy Hot, anyone?)
About the Practice
Non-Surgical Orthopaedics, P.C. believes in a hands-on approach to patient care to ensure the proper treatment plan is implemented for the greatest level of pain relief and return to daily activities. Dr. Weil recommends non-surgical or medical solutions whenever possible. These include passive/active modalities, active exercises and rehabilitation, patient education (the practice has its own learning center) and – perhaps most important for the patient’s overall well-being – home exercises.
Arnold J. Weil, M.D. of Non-Surgical Orthopaedics, P.C. in Atlanta, Ga. specializes in spine care and pain management. His office’s approach is to identify and treat the cause of the pain, not just the symptoms. The practice has a strong emphasis on injury prevention, treatment and rehabilitation for back, neck and upper body injuries. The practice has highly skilled and trained Board Certified Physicians