Journal List > Korean J Sports Med > v.35(2) > 1054587

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

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.

Figures and Tables

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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Notes

Conflict of Interest No potential conflict of interest relevant to this article was reported.

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