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Bony Thorax Case 1 History/Physical Exam

Many patients with rib fractures will present after a fall, MVC, or other blunt trauma with chest wall pain that is typically pleuritic and worse with movement.

On physical exam, respirations may be splinted if pain is severe. There will be focal tenderness at the site of fracture and possibly bony crepitus as the bone edges slide against one another. Bruising or other visible signs of trauma may or may not be present.

Other physical exam signs such as decreased breath sounds (pneumothorax) or dullness to percussion (hemothorax) suggest injuries more extensive than just rib fractures. Tenderness along the costal margin can also be from liver or spleen injury, so be careful attributing costal margin tenderness solely to rib fractures.