Korean J Sports Med.  2017 Sep;35(2):121-124. 10.5763/kjsm.2017.35.2.121.

Bilateral First Rib Stress Fractures with Pseudoarthrosis in a Young Weightlifter: A Rare Cause of Shoulder Pain

• Kim JB
• Hong S

• KMID: 2389652
• DOI: http://doi.org/10.5763/kjsm.2017.35.2.121

Abstract

Isolated stress fracture of the first rib is quite rare cause of uncertain shoulder pain in athletes. These fractures are stress induced and precipitated by repeated traction of muscles acting on the first rib. A prompt diagnosis can shorten the time required for healing and decrease the risk of associated complication as nonunion or pseudoarthrosis. The diagnosis can be made by taking a thorough history and performing chest X-ray, computed tomography, or bone scan. Early recognition and proper management generally lead to successful outcomes and return to normal activities. Typically, they heal with conservative treatment with rest and mild analgesia. This report describes stress fractures of bilateral first rib in a weightlifter, one of which developed into a pseudoarthrosis as a result of persistent overhead activities due to missed diagnosis.

Keyword

Ribs; Stress fracture; Pseudoarthrosis; Weightlifter

MeSH Terms

Analgesia
Athletes
Diagnosis
Fractures, Stress*
Humans
Muscles
Pseudarthrosis*
Ribs*
Shoulder Pain*
Shoulder*
Thorax
Traction

Figure

• 

  Fig. 1 Chest radiograph showing acute linear fracture of right first rib and chronic fracture with hypertrophy of fracture margin of left first rib (arrows).

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  Fig. 2 (A) Right first rib stress fracture (white arrow) in axial image of computed tomography (CT) scan. (B) Left first rib fracture with nonunion. Note the fracture gap with hypertrophy of fracture margin (white arrow). Three-dimensional reconstructed CT image of (C) right and (D) left side (black arrows).

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  Fig. 3 Illustration of forces acting on the first rib. AS: anterior scalene, MS: medial scalene, SA: serratus anterior, ST: sternum, IC: intercostal muscle.

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  Fig. 4 Trapezius squeeze test.

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