Case report
Stress fracture of the first rib from serratus anterior tension: An unusual mechanism of injury

https://doi.org/10.1016/S0196-0644(05)82349-2Get rights and content

Fracture of the first rib usually results from high-impact, direct trauma. Stress fractures are less common and are associated with minimal morbidity. The case of a patient with a stress fracture resulting from the use of an exercise machine is reported. Previous reports have attributed stress and fatigue fractures of the first rib to the forces exerted by the scalene muscles. A new pathophysiologic mechanism involving the serratus anterior muscle is introduced and is supported by T2 relaxation times from magnetic resonance imaging. Stress and fatigue fractures of the first rib have minimal complications. An aggressive diagnostic evaluation of first rib fractures occurring by this mechanism is not warranted.

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  • Cited by (35)

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      The resulting stress fracture occurs at the level of the groove for the subclavian artery—the site of maximum shear forces (Fig. 3). Notably, in throwers, these fractures tend to involve the first rib on the side of the nondominant arm [33]. Also known as “Little Leaguer's shoulder,” this is a stress reaction of the unfused proximal humeral physis that is usually seen in young, skeletally immature throwers.

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      Ochi et al10 and Sacchetti et al12 reported cases of an active volleyball player and a basketball player, respectively. In addition, Mikawa and Kobori8 reported a case of a weight lifter, and a case resulting from the use of an exercise machine for the upper limb was reported by Mints et al.9 In all of the previously reported cases, stress fractures were caused by repetitive muscle action of the upper extremities. Our case, however, is in a soccer player who did not use his upper limbs very often.

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