Rib Stress Fractures Research Articles

Rib Stress Fractures and a Novel Muscle-Sparing Rib Fixation Plating in an Elite Tennis Player: A Systematic Review of the Literature and Case Report.

A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during a routine overhead movement. The patient was eventually diagnosed with 2 lower rib stress fractures. After unsuccessful conservative management, the player underwent an open reduction and internal fixation and autologous bone grafting of the sixth and seventh ribs with a muscle-sparing approach and was able to return to full competition. We present this case along with a systematic review of the literature regarding rib stress fractures, which included 6 separate online data sources (PubMed, EMBASE, Cochrane, CINAHL, SportDiscus, and Medline). The successful surgical intervention demonstrates a significant option for elite athletes who wish to return to competition but have been unable to with standard of care conservative management of rib stress fractures.

Ultrasound Identifies First Rib Stress Fractures: A Case Series in National Collegiate Athletic Association Division I Athletes.

Isolated first rib stress fractures in athletes are thought to be rare. In this case series, 3 National Collegiate Athletic Association Division I athletes developed isolated first rib stress fractures over the span of 1 year, indicating that these injuries may occur more often than previously understood. These fractures can be easily missed because of the low incidence, lack of clinical suspicion, and vague presentation. Further, radiographs can fail to reveal such fractures. To our knowledge, this is the largest case series of athletes with first rib stress fractures presenting with vague rhomboid interscapular pain. We also demonstrated that ultrasound successfully visualized these injuries; in the hands of an ultrasonographer or clinical provider trained in musculoskeletal ultrasound, this technique offers an advantageous point-of-care screening imaging modality.

Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management.

Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.

Unilateral Seventh Rib Posterior Stress Fracture in a High School Baseball Pitcher

Posterior rib stress fractures may infrequently occur in baseball pitchers at the first or second rib. Lower thoracic rib stress fractures, however, are a rare phenomenon with only a few cases described at the collegiate or professional level.

Clinical experience of first rib stress fractures

Clinical experience of first rib stress fractures

Classification of stress fractures of the first rib in adolescent athletes.

Stress fractures of the first rib occur infrequently in adolescent athletes; therefore, there have been few case reports. Initial radiographs do not always lead to the diagnosis of first rib stress fractures. This study proposed a classification system and a possible mechanism for stress fractures of the first rib using three-dimensional computed tomography (3D-CT). The data of 10 stress fractures of the first rib in adolescent athletes obtained using 3D-CT between 2007 and 2018 were reviewed. Fractures of the first rib were classified according to the location and type of the fracture line. Stress fractures of the first rib were classified into three types: type 1, center-transverse fracture; type 2, center to posterior-oblique fracture; and type 3, posterior-transverse fracture. There were three type 1 fractures, five type 2 fractures, and two type 3 fractures. The fracture lines of types 1 and 2 were on the deep groove of the subclavian artery between the anterior and middle scalene muscle attachments, which is the thinnest and weakest portion of the first rib. However, the fracture line of type 3 was across the posterior part of the first rib and located slightly away from the deep groove of the subclavian artery. A 3D-CT classification of stress fractures of the first rib in adolescent athletes was proposed. Our results suggested that there are three types of the fracture and different mechanisms that cause this type of injury. This classification system helped to implement adequate conservative therapeutic plans based on the proposed mechanism.

First Rib Stress Fracture in Overhead Throwing Athletes

Objectives:First-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent athletes. However, etiology on throwing athletes with first rib fracture have not been still unknown. The purpose of this retrospective study was to investigate characteristic clinical features and radiographic findings of patients with the first rib fracture in overhead throwing athletes.Methods:Twenty-four cases of first rib stress fracture in 23 players were studied retrospectively. We reviewed clinical features, including age, initial symptom, sports, activity related to pain, method of diagnose, method of treatment, and final follow-up.Results:We found characteristic clinical features as follows; 16.8 years (13-25), 19 dominant side injury and 5 non-dominant injury, an acute increase in pain while swinging the bat (9 cases) or pitching the ball (6 cases). Sixteen cases presented with posterior shoulder, inferior or medial border of the scapula, upper thoracic back pain. The current study showed 17 healing on average 3.8 month after conservative treatment and 7 nonunion of throwing athlete with the first rib stress fracture, (69.6%, 30.4%, respectively). Analysis on radiographs and CT revealed that the first rib stress fractures were classified into 3 types depends on direction and portion of fracture lines: Groove type, fracture line along with the subclavian artery groove; Intrascalene type, fracture line inside the middle scalene muscle insertion; and Posterior type, fracture beside to the costovertebral articulation (Figure 1 a-c). A 3-dimensional CT angiography showed that fracture line in the Groove type was consistent with the subclavian artery and fracture line in the Intrascalene type was different to the subclavian artery (Figure 2 a-f).We found 2 symptomatic cases and they had the first rib resection cause of thoracic outlet syndrome. We calculated percent availability of the first rib based on the measurements of 2 different observers. Percent availability of the shoulder and cervical spine radiographs were 46% and 97%, respectively. The Cohen’s kappa coefficient and percent agreement of the shoulder and cervical spine were 0.87, 89.4% and 0.80, 99.0%, respectively.Conclusion:We should consider the first rib stress fracture when teenage overhead athletes have posterior shoulder pain and acute onset while swinging the bat or pitching the ball. An anteroposterior radiograph of the cervical spine was available for initial diagnose. Although 70% of the patients would heal in 3 months with conservative treatments, some patients may have a symptom like thoracic outlet syndrome.

Stress Fractures And The Reproductive System In The Female Athlete

Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system. This review contains 6 figures, 5 tables and 49 references Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture

Swimmers Are At Risk For Stress Fractures? A Systematic Review

Background: Stress fractures occur most commonly in the weight-bearing bones of the lower extremities. Swimming, a non-weight-bearing activity, is a potential activity form which associated with stress fractures? Objective: This systematic review aims to provide an answer in the above question and also to identify the reported cases of stress fractures among swimmers. Method: A systematic and comprehensive search was conducted using PubMed and Research Gate databases before January 2017. The search process was completed using the keywords: “stress fracture”, “stress injury”, “fatigue fracture”, “swimming” and “swimmers”. Results: There have been only 10 studies describing stress fractures in swimmers. This rare type of injury is commonly diagnosed in the ribs of young competitive swimmers, irrespective of their preferred swimming stroke. The etiology is multifactorial and includes a combination of intrinsic and/or extrinsic factors. Conclusion: Although any sport activity can potential cause a stress fracture, competitive swimming seems to be relatively safe in this respect. Rib stress fractures appear as the most common stress fracture in competitive swimmers that clinicians should consider. A prompt diagnosis can shorten the time required for healing and decrease the risk of complication.

Rib Injury in a Professional Baseball Player

A 24 year old previously healthy left handed male professional baseball pitcher was warming up on the mound before a game when he suddenly felt a vague pain in his lower left anterior-lateral rib cage region but denied hearing a pop. Pain was a localized deep ache on the lower anterior rib cage. Although he felt discomfort the player was able to complete his warm up regimen and start the game. During the game he was only able to throw four pitches prior to unbearable pain during the acceleration phase of pitching causing him to be pulled from the game and seek medical attention. PHYSICAL EXAM: Normal appearance of the chest wall. Point tenderness to palpation and a 1x1cm soft tissue mass on the lower left anterior chest wall on palpation. Any active and passive motion of the torso exacerbated the pain and the mass was exquisitely tender to palpation. Bilateral shoulder exams were within normal limits and pain was not affected by inhalation or exhalation. On exam, he was neurologically and vascularly intact. There was no winging of the scapula or crepitus along the rib cage. DIFFERENTIAL DIAGNOSIS: 1. Oblique muscle strain 2. Rib stress fracture 3. Costochondral junction avulsion fracture 4. Serratus anterior avulsion fracture 5. Intercostal muscle strain TEST AND RESULTS: Thoracic MRI findings suggested either a fracture or stress injury of the costochondral cartilage along the left anterior-inferior aspect of the ribcage. There was extensive edema present along the region that measured 8x10 cm but there was no evidence of rib fractures. Chest CT without contrast revealed edema around the costochondral junction of ribs 7 and 8 on the left with anterior prominence of the cartilage but no focal displacement or rib fractures. FINAL WORKING DIAGNOSIS: Based on Imaging, injury most likely to be costochondral junction avulsion fracture of ribs 7 and 8. TREATMENT AND OUTCOMES: The player was initially treated with 6 weeks of activity restriction and rest. Surgery was not warranted due to lack of significant separation of the fragment. Repeat radiographs were obtained at 6 weeks which revealed proper healing. After 6 weeks he began a graduated pitching regimen. Pain improved throughout his rehabilitation with rest and NSAIDS once he began physical activity. He returned to full activity at 8 weeks.

Stress Fractures And The Reproductive System In The Female Athlete

Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system. This review contains 6 figures, 5 tables and 49 references Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture

Stress Fractures And The Reproductive System In The Female Athlete

Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system. This review contains 6 figures, 5 tables and 49 references Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture

A Rowing Ergometer Test to Assess the Arm Contribution in Force Production during the Rowing Stroke

Introduction: Rib stress fractures result from a nutcracker action on the ribs as the load on the blade is counteracted by the posterior scapular muscles. One of many factors is the proportion of force production from the arms in relation to the legs. If the arms give more the load on the ribs is greater.Methods: This study sought to find a simple rowing ergometer test which is functional but accurately reflects the ratio of force contribution between the arms and the rest of the body. The new test was used to establish normative data for the protocol and a re-test study was conducted to investigate the reliability of the test protocol.Results: The results were gender specific with men having a higher arm contribution percentage than women. Both groups were tested at two ratings 18 strokes/min and 26 strokes/min (s/m). Both groups had a lower arm contribution at the faster rating. At 18 strokes per min, the women averaged 21.85% of their power from their arms compared with 27.8% in the men. At 26 s/m the women averaged 18.35% and the men 23.2%. However, these figures are contrasted with an average from the cohort of normal (no history of rib issues) elite rowers who produced only 10% of their power from their arms at 18 s/m and 7.47% at the higher rating of 26 s/m. Test re-test validity showed the test is reliable to 1.8%.Conclusion: This test could be used as a training aid to modify technique and a screen to look for subjects at risk. The recommendation of the co-author and experienced coach, Rob Baker, is that using results from this test at 18 s/m; the arm contribution of non-elite rowers should aim not to exceed 20% in women and 25% in men. Elite rowers should aim for 10%.

The Cambridge protocol for the prevention and management of rib stress fractures in elite rowers

The Cambridge protocol for the prevention and management of rib stress fractures in elite rowers

Rib stress fractures in pregnancy: a case report and review of literature

Thoracic pain in pregnancy has a broad differential diagnosis. The authors report a young pregnant woman with acute pain in the thoracic region due to a rib fracture after a coughing flare. Physicians must be aware of the broad differential diagnosis (and its clinical consequences) of thoracic pain in pregnancy. Radiographic imaging is not necessary if the clinical signs are obvious. If there is no suspicion for underlying pathology other (expensive) diagnostic tests lose their value. Treatment consists of adequate analgesia and no firther measures need to be taken.

Imaging of rib stress fractures in elite rowers: the promise of ultrasound?

Stress fractures are common injuries in endurance athletes, and are due to high-intensity, repetitive training activities.1 ,2 Although these fractures occur more frequently in weight-bearing bones, the ribs are a...

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

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

Posterior Shoulder Pain in a High School Football Lineman

HISTORY: 16yo high school football lineman presented with right shoulder pain. He initially noticed moderate pain after squatting 350lbs and placing the weight back down. The pain was sharp and painful when turning his head to the left. He was evaluated at an urgent care facility and felt to have a muscular injury and placed on muscle relaxants and anti-inflammatories. His pain improved transiently. He then re-injured this area when he was in gym class running hurtles and brought his arms across his chest in the front of him. He states that he heard a pop in his shoulder and had excruciating pain, and presented to the sports medicine clinic for further evaluation. The pain was pleuritic and still localized to the posterior shoulder. PHYSICAL EXAMINATION: BMI 33.5RR 17O2 Sat 99% He appeared moderately uncomfortable. He had full motion at the neck with no tenderness of the cervical spine. Bending to the left was mildly painful. He had a negative Spurling’s maneuver. He had tenderness over the medial rhomboids, trapezius, and overlying the scapular body. He had no scapular winging. He had full range of motion at the shoulder and 5/5 rotator cuff strength. He had no AC tenderness or pain with cross arm adduction. His lung fields were clear to auscultation with good air movement throughout. DIFFERENTIAL DIAGNOSIS: 1. Strain or partial tear of scapular stabilizer 2. Snapping Scapula (scapulothoracic bursitis) 3. First Rib Fracture TEST AND RESULTS: Three views of the right shoulder (AP, scapular Y, and lateral axillary) -Nondisplaced, oblique fracture through mid-portion of the first right rib Two views of clavicles (AP and 15 degree cephalic) -Fracture confirmed; no pneumothorax is visualized FINAL WORKING DIAGNOSIS: 1st Rib Stress Fracture secondary to scalene and serratus anterior contraction TREATMENT AND OUTCOMES: 1. Patient was placed in sling and provided with narcotic analgesia; pendulum exercises were emphasized. 2. At three weeks, repeat XR showed minimal displacement of the fracture. His sling was discontinued and he was allowed to start back light weight training (30lbs max). Physical therapy was ordered. 3. At 7 weeks, he was pain free with normal strength and allowed to resume normal weight lifting. 4. At 3 month follow up, repeat XR showed some callus formation. He was allowed to resume contact sports, such as football.

Rib Stress Fracture in a Collegiate Softball Pitcher: A Case Report.

We present the case of a twenty-one-year-old right-hand-throwing, right-hand-batting female softball pitcher who presented with a three-month history of right rib pain. A bone scan showed increased uptake in the lateral aspect of the right seventh rib, consistent with a stress fracture. The patient was managed nonoperatively and made a full recovery. The forces created by the attachment of the serratus anterior during underhand throwing are the likely etiology of the injury in our patient. Physicians should maintain a high clinical index of suspicion for stress fracture in underhand athletes with lateral rib pain.

Bilateral First Rib Stress Fractures in a Basketball Player

Bilateral First Rib Stress Fractures in a Basketball Player