An Unusual Cause of Stress Fracture of the First Rib

Abstract

An unusual case of stress fracture of the first rib that occurred in a young male as a result of the constant loading due to carrying a heavy schoolbag is reported. This case demonstrates the difficulty in diagnosis and highlights the need for awareness of this condition, thus avoiding invasive investigation.

Bilateral First Rib Fracture in a Dive With Life Vest

“…There is even a preferential site for such fractures: the subclavian groove. The cases of sports-related fractures described in the literature have occurred in American football, soccer, baseball, basketball, tennis, rugby, surfing, weightlifting and rhythmic dancing 8 , 12 , 18 , 28 .…”

“…However, attention is drawn to a case of spontaneous fracturing caused by coughing mechanisms in a patient with pertussis, another case of spontaneous fracture with a condition of acute torticollis in an eight-year-old boy with a history of carrying a heavy schoolbag by means of a strap across his shoulder, and a further report with the same history in an 17-yearold boy. Even though the reports presented have been anecdotal, they carry a relevant message: in cases of painful symptoms in the shoulder and scapular regions, it is important to investigate the first rib 9 , 12 , 18 , 20 , 32 , 33 . Such pain is sometimes nonspecific and even not correlated by patients with the type of trauma that generally triggers it.…”

Fracture of the first rib as a consequence of pertussis infection

“…Fractures of the first rib can be classified by cause into four categories: (i) traumatic; (ii) pathological; (iii) stress; and (iv) cough fractures. Fractures of the first rib are uncommon and are usually associated with severe direct trauma 3 . Because the first rib is well protected by the muscles of the shoulder girdle, a high impact injury is necessary to cause a fracture (such as that caused by a high speed motor vehicle accident) 4,5 .…”

“…They usually occur over a period of days or weeks 6 . There are a number of case reports documenting stress fractures of the first rib secondary to a variety of activities, for example jive dancing, 7 carrying a school bag, 3 excessive nautilus machine workout, 8 throwing a basketball, 9 lifting of objects whilst working in a factory, 10 snow shovelling, 11 and weightlifting 12 Figure 2b. summarizes the different muscle groups having attachments to the first rib, that may be contracting simultaneously, resulting in opposing forces acting across a fulcrum in the area of the subclavian groove (the thinnest and weakest part of the first rib).…”

Acute Torticollis After Isolated Stress Fracture of the First Rib in a Child: A Case Report

“…solated stress fractures of the first rib have previously been reported in adults and adolescents who participate in sports such as rugby 1 , baseball 2 , weight-lifting 3 , basketball 4 , and tennis 5 as well as in individuals who carry a heavy schoolbag 6 . Stress fractures of the first rib in children are rare, and only five fractures in four patients have been reported (Table I) 1,[7][8][9] .…”