Korean J Sports Med.  2020 Jun;38(2):117-120. 10.5763/kjsm.2020.38.2.117.

First-Rib Fracture in a Baseball Pitcher

• Ku JH
• Cho HL
• Kim JM

• KMID: 2502524
• DOI: http://doi.org/10.5763/kjsm.2020.38.2.117

Abstract

First-rib fractures may be caused due to high energy direct trauma, violent muscle contracture, or chronic fatigue. Isolated fractures are very rarely noted and may be a potential cause of nonspecific shoulder pain in overhead athletes. Although the exact mechanism underlying first-rib fractures caused by sudden muscular contracture is still not known, many repetitive activities have been associated with with these unique fractures. We present a case of an acute first-rib fracture in a rookie professional baseball pitcher. He returned to the same level of throwing in 5 months with rest and rehabilitation.

Keyword

Baseball pitcher; First rib; Fracture

Figure

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  Fig. 1 (A) Anteroposterior chest radiograph before the injury at basic preadmission team screening examination showed no visible fracture on the right first rib. (B) Rib radiograph just after the injury demonstrated sharp linear fracture line on the first-rib (arrow). (C) Axial computed tomographic image clearly showed the complete fracture line (arrow, fracture of first-rib).

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  Fig. 2 Three-dimensional reconstruction computed tomographic image showed anterior one third location of the fracture of right first rib (arrow) and corresponding anatomical weak area of subclavian groove (arrow head G) just posterior to scalene tubercle (arrow head T) on contralateral left first rib.

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  Fig. 3 Serial follow-up rib radiographs of the presented case. (A) Fracture line was more evident in 3 weeks after the injury and (B) 6 weeks, (C) 9 weeks, (D) 12 weeks radiograph showed callus formation and marginal sclerosis of the fracture end. (E) Eighteen weeks after the injury, radiographic healing was identified and the pitching performance program was initiated. (F) Chest radiograph in regular check- up 10 months after the injury demonstrated the healing and remodeling of the fracture site. Arrows indicate the fracture of first-rib.

Reference

1. Coris EE, Higgins HW 2nd. 2005; First rib stress fractures in throwing athletes. Am J Sports Med. 33:1400–4. DOI: 10.1177/0363546505275349. PMID: 16002484.

2. Sakellaridis T, Stamatelopoulos A, Andrianopoulos E, Kormas P. 2004; Isolated first rib fracture in athletes. Br J Sports Med. 38:e5. DOI: 10.1136/bjsm.2003.009225. PMID: 15155456. PMCID: PMC1724847.

3. Lankenner PA Jr, Micheli LJ. 1985; Stress fracture of the first rib: a case report. J Bone Joint Surg Am. 67:159–60. DOI: 10.2106/00004623-198567010-00022. PMID: 3968096.

4. Matsumoto T, Fujita K, Fujioka H, et al. 2003; Stress fracture of the first rib in a soccer player: a rare etiology of shoulder pain. J Shoulder Elbow Surg. 12:197–9. DOI: 10.1067/mse.2003.22a. PMID: 12700577.

5. Kim JB, Hong S. 2017; Bilateral first rib stress fractures with pseudoarthrosis in a young weightlifter: a rare cause of shoulder pain. Korean J Sports Med. 35:121–4. DOI: 10.5763/kjsm.2017.35.2.121.

6. Lorentzen JE, Movin M. 1976; Fracture of the first rib. Acta Orthop Scand. 47:632–4. DOI: 10.3109/17453677608988750. PMID: 1015257.

7. Curran JP, Kelly DA. 1966; Stress fracture of the first rib. Am J Orthop. 8:16–8. PMID: 5903797.

8. Luceri RE, Glass NE, Bailey JA, et al. 2018; First rib fracture: A harbinger of severe trauma? Am J Surg. 216:740–4. DOI: 10.1016/j.amjsurg.2018.07.034. PMID: 30060914.

9. Funakoshi T, Furushima K, Kusano H, et al. 2019; First-rib stress fracture in overhead throwing athletes. J Bone Joint Surg Am. 101:896–903. DOI: 10.2106/JBJS.18.01375. PMID: 31094981.

10. Young BL, Watson SL, Meyer RD, Ponce BA. 2016; Nonunion of first rib fracture in a softball player: case report of a rare cause of thoracic outlet syndrome. J Shoulder Elbow Surg. 25:e353–7. DOI: 10.1016/j.jse.2016.07.025. PMID: 27742249.