Musculoskeletal Injury- Football

Abstract

HISTORY A college football quarterback sustained a chest wall injury during a hit that occurred while he scrambled with the ball. During the second quarter of an early season game, he was hit on his right shoulder/neck region with his head laterally bent to the left. He did not present to the trainers with an injury or pain during the game. The next morning he presented at the training room with a chief complaint of right anterosuperior chest wall pain. Pain was worse with inspiration, right arm cocking, anterosuperior chest wall pressure, and left lateral bending. He denied any numbness, tingling, loss of sensation, radiation of pain, weakness, or change in upper extremity temperature or color. There was no neck pain but he did have some mild right trapezius pain. PHYSICAL EXAMINATION He appeared comfortable and in no acute distress. Upper extremity appeared symmetric bilaterally with no evidence of swelling or discoloration. On palpation, he had right-sided chest wall tenderness just inferior to the clavicle. Pain was exacerbated with AP compression of the chest. There was no tenderness over the clavicle or AC joint. Shoulder and arm had full range of motion. He had mild pain with the right arm abducted at 90 degrees and fully externally rotated. His strength was 5/5 and symmetric bilaterally with testing of upper extremity. His light touch sensation was intact in all dermatomes and his radial pulses were 2+ and symmetric. Neck exam revealed no tenderness and full range of motion. Pain increased with left lateral bending and left rotation of the neck. Auscultation of the lungs revealed clear breath sounds which were equal and normal sounding bilaterally. DIFFERENTIAL DIAGNOSIS Chest wall contusion Rib fracture Rib synchondrosis injury Pulmonary contusion Clavicle fracture Sternoclavicular dislocation TESTS AND RESULTS Right rib series radiographs: non-displaced right first rib fracture no clavicle fracture or other bony abnormality Posterior to anterior and lateral chest radiographs: non-displaced right first rib fracture clear lung fields normal cardiac silhouette midline trachea Chest CT scan with three dimensional reformatted images from helical CT scanner unicortical first rib fracture FINAL/WORKING DIAGNOSIS Traumatic isolated unicortical right first rib fracture TREATMENT AND OUTCOMES No contact in practice. Protective equipment modified to increase protection of first rib. Shoulder and neck range of motion and strength exercises. Discussed risks regarding close proximity of important structures. Returned to full contact and was able to start game one week after the initial injury almost completely symptom free.