From the Guidelines
The management plan for a patient with a torn intercostal muscle should prioritize pain control and rest, with a focus on early mobilization and return to activity, as supported by the principles of accelerated recovery outlined in 1. The goal is to minimize surgical trauma and facilitate early recovery, which can be applied to the management of torn intercostal muscles.
- Pain management is crucial and can include the use of NSAIDs, acetaminophen, and short-term opioids as needed, similar to the approach for postoperative pain management discussed in 1.
- Local pain control measures, such as long-acting intercostal blocks with bupivacaine or liposomal bupivacaine, can be beneficial in reducing pain and facilitating early mobilization, as described in 1.
- Rest and avoidance of activities that exacerbate pain are recommended for the initial 1-2 weeks, followed by gradual return to activity and gentle stretching and breathing exercises to improve mobility and prevent complications.
- The use of ice therapy in the acute phase and heat therapy later on can help reduce inflammation and promote healing, although this is not directly mentioned in 1, it is a common practice in managing muscle injuries.
- Physical therapy may be beneficial for persistent cases, focusing on intercostal stretching, breathing exercises, and core strengthening to promote full recovery and prevent long-term complications.
- Most intercostal muscle tears heal within 3-6 weeks, though severe cases may take longer, and a comprehensive approach addressing both pain management and functional recovery is essential for optimal outcomes.
From the Research
Management Plan for Torn Intercostal Muscle
The management plan for a patient with a torn intercostal muscle involves a combination of pharmacologic and non-pharmacologic interventions.
- Pharmacologic Interventions:
- The first-line pharmacologic agent for the symptomatic treatment of mild to moderate pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) 2.
- For severe acute pain, potent opioids may be used, but with caution due to the risk of misuse and diversion of controlled substances 2.
- A study comparing diflunisal and acetaminophen with codeine for the treatment of acute mild to moderate pain from soft tissue injuries found that diflunisal was an effective analgesic with fewer side effects 3.
- Non-Pharmacologic Interventions:
- The use of intercostal muscle flap and intracostal sutures has been shown to decrease postoperative pain after thoracotomy 4.
- Multimodal analgesia, including cognitive and physical strategies, is recommended for the management of acute musculoskeletal pain 5.
- Physical strategies such as ice, elevation, and transcutaneous electrical stimulation may also be beneficial 5.
- Additional Considerations:
- Patients should be advised to properly dispose of unused medications to prevent misuse and diversion of controlled substances 2.
- Prescribing for patients on long-term opioids at presentation should be limited to one prescriber, and both pain and sedation should be assessed regularly for inpatients 5.