Non-Traumatic First Rib Fractures Secondary to Opposing Muscle Contractions: A Case Series

Weis Jamie L

doi:10.23937/2469-5718/1510113

Abstract

While first rib fractures typically occur from direct, traumatic injuries and have high rates of serious complication, less commonly, non-traumatic first rib fractures are encountered in young athletes. This paper presents the cases of a teenage basketball player with a first rib fracture after stretching, and that of a teenage cheerleader with a first rib fracture from straining to lift another cheerleader. Both patients became asymptomatic following conservative treatment and returned to sports. These cases were then evaluated next to the existing literature. The mechanism for these non-traumatic fractures is thought to be due to sudden contractions of opposing muscle forces on developing bone. Because of the biomechanics of the first rib's opposing muscle attachments, first rib fractures should be considered in patients who report pain deep to the medial clavicle, even without a history of direct, severe trauma.

Highlights

The first rib, a well-protected bone fully surrounded by other bony and muscular structures is not commonly fractured except in cases of direct, severe trauma, which carries a risk of serious visceral, vascular, or neurologic associated injuries
While first rib fractures typically occur from direct, traumatic injuries and have high rates of serious complication, less commonly, non-traumatic first rib fractures are encountered in young athletes
This paper presents the cases of a teenage basketball player with a first rib fracture after stretching, and that of a teenage cheerleader with a first rib fracture from straining to lift another cheerleader

Summary

Introduction

The first rib, a well-protected bone fully surrounded by other bony and muscular structures is not commonly fractured except in cases of direct, severe trauma, which carries a risk of serious visceral, vascular, or neurologic associated injuries. A 16-year-old female basketball player presented to the emergency department with acute upper trapezius pain She had been having some soreness in the area for approximately two weeks. Her acute-on-chronic pain did not radiate, was not associated with numbness, and was not associated with any pulmonary symptoms She was taken to the emergency department immediately where a shoulder x-ray revealed an acute, non-displaced fracture of the posterolateral aspect of the first rib (Figure 1). She presented to orthopedics four days later in a sling. She started physical therapy for strengthening and returned to cheerleading

Discussion

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Literature and evaluation

Conclusion