Costochondral Separation

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A costochondral separation (rib separation) is a severe injury that could result in damage to the body’s vital organs. If the patient is involved in a vehicle accident, it can result in a blow to the chest; this may come from a collision with a steering wheel, dashboard, or center console etc.

The ribs are a set of bones that course from your spinal column, around your body and attach to your sternum or breastbone. These bones serve to protect the contents of your thoracic cavity. They also serve as an attachment point for many muscles and are active during respiration. Overall, you have a total of 24 ribs, which are 12 on each side of your body. The most typical ribs are the third to the ninth and are alike in structure and function. Each rib arises from the thoracic vertebra for which it’s named:

  • Rib number three arises from your third thoracic vertebrae.
  • Rib number seven arises from your seventh thoracic vertebrae.

Generally, there are three parts of each rib, which are the head, the neck, and the shaft, or body, of the rib. The head of your ribs is shaped like a wedge and has two very specific areas called facets. These facets articulate with your spinal vertebrae.

Ribs are difficult to break. They are a bony framework that protects the vital organs located within the chest cavity. They are also surrounded by strong muscles and typically can take a lot of abuse before they crack.

While many people have heard of costochondral fractures, a costochondral separation might sound like an unusual injury. This injury occurs when the ribs become detached from the sternum. The ribs are joined to the sternum at the costochondral joint. This is a layer of cartilage that connects the ribs to the sternum, therefore, if this joint becomes damaged, it could lead to separation between the rib and the sternum. This typically occurs following a blow to the chest, such as in a car accident or in contact sports.

Like other injuries, some rib separations are much more severe than others. There could even be other associated injuries to the organs inside of the rib cage.

Causes & Symptoms of a Costochondral Separation

Generally, the costal cartilage between your ribs and sternum gives your rib cage more flexibility and the ability to expand when you breathe. A sudden separation of one of the costochondral joints normally occurs after an impact, for instance, falling onto the side of your body or being hit by something.

Also, violent twisting movements can also result in a costochondral separation as can coughing violently. In some cases, when a person has costochondral separation, it can make you susceptible to costochondritis.

This medical condition is characterized by inflammation at the junction of the costal cartilage and the rib. Some people feel that when they experience the pain on the left side of their chest that this condition causes is a sign of a heart attack.

While the more immobile first and second ribs seem to be more prone to costochondral separation from twisting injuries, the lower ribs can suffer costal cartilage fracturing more easily and are more likely to direct trauma. Costal cartilages can fracture due to blunt trauma sustained in high-energy trauma or a fall.

One of the most common symptoms of a costochondral separation is chest pain when you take a deep breath. Inhaling deeply may impact your ribs even more. Laughing, coughing, or sneezing can also send sharp pains shooting from the site of the break.

In some cases, you might also see swelling and bruising on the skin near the separated ribs. Depending on the location of the separation, bending over or twisting your upper body may also trigger sudden pain.

Striking or pressing on the fracture will cause pain for at least several weeks. Another symptom linked to costochondral separation is restlessness. You may find it difficult to find a better position to sleep due to the damaged rib causing pain in your chest while sleeping face-up or even on your side, thus leading to a lack of rest.

Other symptoms that are known to present while experiencing a rib separation include:

  • Headaches
  • Dizziness, tired, or sleepy
  • Fear and anxious
  • Pain that comes and goes
  • A popping sensation when the injury occurs

Who gets Costochondral Separation?

There are several risk factors that can increase the risk of developing a costochondral separation, such as:

  • Exercise injuries – Athletes who engage in extreme exercises such as weight lifting can lead to rib separations, especially if you attempt more strenuous exercise than your abdominal and back muscles are currently in shape to handle.
  • Occupational injuries – Certain occupational activities, such as construction and carpentry, have an increased chance of separating your ribs if you fall or slip from a great height.
  • Sports injuries – Sports such as boxing or wrestling have a likelihood of experiencing separated costal cartilage because of the repetitive chest and ribcage impact that are presented in the chosen sport. Some of these sports include boxing, wrestling, and basketball.
  • Age – Patients who are older than 50 and living with osteoporosis have an increased risk of separating their ribs due to the thinning and weakening of the bones.

How Does Costochondral Separation Affect You? How Serious is it?

Severe cases of separation of the costal cartilage (or dislocations, fractures, and subluxations) can cause serious or life-threatening complications. Some of these complications include:


Collapsed lung

Also known as pneumothorax, collapsed lung is a rare condition that may cause chest pain and make it difficult to breathe. One of the causes that can result in a collapsed lung is being punctured from a fractured rib.


Pneumonia is a lung infection that can range from mild to severe that immediate medical attention. It occurs when an infection causes the air sacs in your lungs to fill with fluid or pus. Therefore, if you don’t breathe deeply enough, mucous and moisture can build up in the lungs and lead to an infection such as pneumonia.

Lung cancer

Lung cancer is a cancerous condition that causes a number of symptoms including ribcage pain, or chest pain that worsens upon breathing deeply, coughing, or laughing. Having broken/dislocated ribs can increase the chance of spreading lung cancer in your ribs.

If there are other severe injuries, such as a collapsed lung, surgery could be required. Surgery might also be needed if multiple ribs are separated, leading to a syndrome called flail chest. Depending on the severity of the cartilage tear, the treatment time could take two to three months.

Recommended Treatment & Rehabilitation for Costochondral Separation

During a diagnosis of a costochondral separation, your doctor will usually look for any signs of separation or bruising during a physical exam. He or she may ask you about your pain level and if it is difficult to breathe.

Additionally, your doctor may perform a specific test called a hooking maneuver to help diagnose a separated rib. The test involves your doctor hooking his / her fingers under your rib margins and moving them upward and back. If this causes discomfort, the doctor may be able to diagnose slipping ribs without any further tests.

If otherwise, your doctor may order an X-ray for further rib details. This will show clearer details on which rib has been separated. Your doctor will then be able to see any segments of floating bone on an X-ray.

If your doctor suspects that the dislocation has caused a serious lung injury, a Computed Tomography (CT) scan or ultrasound may be recommended to rule out the condition.

After a diagnosis has been completed, physiotherapy may be further advised. A physiotherapist will work with you by designing a special treatment program specific to your condition and goals. Early mobilization is first recommended to promote spinal mobility and prevent persistent rib pain.

Physiotherapy breathing exercises may be combined with a spirometer, a device that measures the volume of air you breathe in and out. This will give you a better idea of how it should feel to take a full, deep breath.

In addition, there is a technique called “the active cycle of breathing” to encourage deeper breaths and an effective cough, which is important to allow you to clear any sputum from your chest.

If you have pain or stiffness which does not fully settle with a range of movement and breathing exercises your physiotherapist may use manual therapy techniques to help relieve pain and enable you to further progress with your rehabilitation.

There are several different types of hands-on therapy and the type of treatment utilized that your therapist will work with you. Manual therapy has been shown to have a neurophysiological effect, which reduces pain.

The following exercises below will help you boost your recovery from a costochondral separation:


Deep breathing

Sit upright in a chair and place your hands over your fractured rib area. You can also hold a pillow to your chest for support. Take a deep breath, and slowly and gently fill your lungs. Hold your breath for about 10 seconds, then exhale slowly. Finally, cough gently to help loosen mucus before repeating 5 times a day.

Bucket handle breathing

Sitting upright in a chair, place your hands on your sides. This is where your lower rib cage is located. Inhale slowly, breathing so your sides push into your hands. Hold for 10 seconds and exhale slowly before repeating this exercise 5-10 times a day.

Chest stretches

Sit upright in a chair and lift your arms, bending your elbows to 90 degrees. Alternatively, you can try to raise your arms and interlock your fingers. Next, gently squeeze your shoulder blades toward one another. Hold for 5-10 seconds and release. Return your arms to their original position, then repeat this stretch 5-10 times a day.

Diaphragmatic breathing exercise

Sit upright in a chair and place one hand on your upper chest and the other on your abdomen. Then, inhale slowly and focus on pushing your stomach into your hand. Try to make sure your upper hand remains motionless. Tighten your stomach muscles as you exhale slowly, then repeat this exercise 5-10 times a day.

Alternative & Homeopathic Treatment for Costochondral Separation

Most ribcage pain usually takes up to 6 weeks to completely recover. However, in cases of a costochondral separation, it may take longer to heal. Therefore, some of these home remedies may help improve symptoms linked to the condition:

  • Diet – Certain dietary practices may help speed the healing of your painful ribs. Consuming selective fruits (such as pineapple) daily may help reduce pain. It is also recommended to avoid eating red meat, foods containing preservatives, and soft drinks with caffeine and other caffeinated beverages.
  • Rest – Take a break from sports or occupation to allow yourself to heal without re-injuring your ribs.
  • Ice application – Applying ice to the affected area may increase your recovery process by reducing swelling and inflammation.
  • Non-steroidal anti-inflammatory medications (NSAIDs) – such as acetaminophen or ibuprofen will support you in reducing further swelling and inflammation located in your affected rib. A pain-reliever cream may also be used to heal the area if you avoid taking oral medications.

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