Dominant-Sided First-Rib Stress Fracture in a Collegiate Baseball Pitcher: A Case Report.

Abstract

The incidence of asymptomatic fatigue fractures of the first rib in the young, active male population is very low; these fractures were observed in only 0.001% of retrospectively reviewed chest radiographs in one series1. First-rib fractures have been postulated to result from several primary mechanisms: high-energy direct impact such as a motor vehicle collision2, indirect trauma such as a fall on an outstretched arm3, fatigue fractures from repeated muscular contracture4, or sudden, violent muscular forces resulting in stress fractures5. Although the exact incidence of first-rib stress fracture caused by sudden muscular contracture is not known, many repetitive activities, including gymnastics, tennis, basketball, weightlifting, and even coughing or sneezing, have been associated with this mechanism6. We present the case of a first-rib stress fracture in a collegiate baseball pitcher and discuss the relevant literature. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A nineteen-year-old right-hand-dominant male collegiate baseball pitcher presented to the office with the symptom of right shoulder pain. He denied any history of trauma but stated that he had felt a popping sensation in the shoulder while pitching several days prior to presentation, and he had had pain since that time with both pitching and activities of daily living. He denied any change in the pitching mechanics or increase in the number of pitches in the preceding several weeks. He had no prior history of trauma to the spine or thorax. The pain was aggravated by the late-cocking phase of throwing. He also admitted to difficulty with deep inspiration because of the pain at the base of the neck, but had no dyspnea at rest. On examination, he was 6′8″ (203.2 cm) tall and weighed 193 lb …