Stress fracture of the ribs in female rowers

Abstract

Stress fractures of the lower ribs related to sports are rare. Fractures of the ribs related to rowing sports have not been reported. We have documented seven cases of stress fractures of the lower ribs in female athletes; four were elite rowers and three were engaged in tennis, golf, and gymnastics. Each athlete was initially seen and treated elsewhere for muscular strain. All athletes presented with pain in the posterolateral thorax in and around the scapula. The time from onset of symptoms to diagnosis ranged from 2 to 6 months. Bone scans were used to document the fractures when roentgenograms were equivocal. Each athlete responded to a 4 to 8 week period of rest or training modification. Biomechanical analysis of the forces across the ribs demonstrates that these fractures tend to occur along the posterolateral segment where the bending stresses on the rib are greatest. The predominant muscle forces are generated by the forced couple of scapular retraction and protraction acting through the serratus anterior. We postulate that inadequate strength and resistance training background in women is the cause for the apparent increased susceptibility of women to these skeletal injuries.

Rowing Injuries and Related Factors in Competitive Rowing

“…Similarly, Howell's revealed an 82.2% incidence of low back pain among elite lightweight female rowers compared with an age-and sex-matched general population which was 20% to 30% [20]. In the present study both sculling and sweep rowing techniques significantly correlated with low back pain in both male and female rowers.…”

Traumatic and Overuse Injuries Among International Elite Junior Rowers

“…The risk of injury among rowers has been shown to be relatively low, 3,6,9,11,16,20,27 but there are studies that report an increasing incidence of rowing-specific injuries among senior rowers, such as low back pain 12,22,23 and rib stress fractures. 4,10,26 The purpose of this study was to perform an epidemiological study describing the variety of musculoskeletal problems in international elite-level junior rowers. The second goal was to examine the association of rowing performance, rowing achievement, training practices, and gender with the occurrence of reported injuries.…”

Costochondral calcification, osteophytic degeneration, and occult first rib fractures in patients with venous thoracic outlet syndrome

“…[21][22][23] Most stress fractures of the first rib are related to vigorous repetitive upper extremity motion, as seen in baseball players and other athletes, [24][25][26][27] and may arise in a manner similar to stress fractures of other ribs, as observed in rowing athletes. [28][29][30][31] The groove for the subclavian artery in the lateral portion of the bone is the most common location for first rib stress fractures, and these lesions can be extremely difficult to detect, requiring thin-slice computed tomography imaging and radionuclide bone scans. 32 In this study, we found that a high proportion (43%) of patients with venous TOS exhibited CC, OD, and a previously undetected FRFx, including 76% of those over the age of 30.…”