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.
AlkhamisiALiBHWilliamsEAMcCombBPujalteGGA. Stress rib fracture in an amateur golfer. Curr Orthop Pract. 2017;28(6):586-587.
2.
BaliusRPedretCEstruchAHernándezGRuiz-CotorroÁMotaJ. Stress fractures of the metacarpal bones in adolescent tennis players: a case series. Am J Sports Med. 2010;38(6):1215-1220.
3.
BarrettGRSheltonWRMilesJW. First rib fractures in football players. A case report and literature review. Am J Sports Med. 1988;16(6):674-676.
4.
BennellKMathesonGMeeuwisseWBruknerP. Risk factors for stress fractures. Sports Med. 1999;28(2):91-122.
5.
BodenBPOsbahrDC. High-risk stress fractures. J Am Acad Orthop Surg. 2000;8(6):344-353.
6.
BodenBPOsbahrDCJimenezC. Low-risk stress fractures. Am J Sports Med. 2001;29(1):100-111.
7.
BojanićIDesnicaN. Stress fracture of the sixth rib in an elite athlete. Croat Med J. 1998;39(4):458-460.
8.
BreithauptJ. Zur pathologie des mensclichen fusses. Med Z Berl. 1855;36:169-171, 37:175-177.
9.
BruknerPKhanK. Stress fracture of the neck of the seventh and eighth ribs: a case report. Clin J Sports Med. 1996;6(3):204-206.
10.
BugbeeS. Rib stress fracture in a golfer. Curr Sports Med Rep. 2010;9(1):40-42.
11.
ChaudhurySHobartSJRodeoSA. Bilateral first rib stress fractures in a female swimmer: a case report. J Shoulder Elbow Surg. 2012;21(3):e6-e10.
12.
CorisEEHigginsHWII. First rib stress fractures in throwing athletes. Am J Sports Med. 2005;33(9):1400-1404.
13.
CurranJPKellyDA. Stress fracture of the first rib. Am J Orthop. 1966;8(1):16-18.
14.
de MoyaMNirulaRBifflW. Rib fixation: who, what, when?Trauma Surg Acute Care Open. 2017;2(1):e000059.
15.
EdwardsTBMurphyC. Nonunion of a dominant side first rib stress fracture in a baseball pitcher. Orthopedics. 2001;24(6):599-600.
16.
FujiokaHKokubuTMakinoT, et al. Stress fracture of the first rib in a high school weight lifter. J Sports Sci Med. 2009;8(2):308-310.
17.
FunakoshiTFurushimaKKusanoH, et al. First-rib stress fracture in overhead throwing athletes. J Bone Joint Surg Am. 2019;101(10):896-903.
GowerKColbergR. A subluxed rib popped with an adjustment. Clin J Sport Med. 2020;30(2):e58.
20.
GurtlerRPavlovHTorgJS. Stress fracture of the ipsilateral first rib in a pitcher. Am J Sports Med. 1985;13(4):277-279.
21.
HeincelmanCBrownSEnglandEMehtaKWissmanRD. Stress injury of the rib in a swimmer. Skelet Radiol. 2014;43(9):1297-1299.
22.
HickeyGJFrickerPAMcDonaldWA. Injuries to elite rowers over a 10-yr period. Med Sci Sport Exer. 1997;29(12):1567-1572.
23.
HoldenDLJacksonDW. Stress fracture of the ribs in female rowers. Am J Sports Med. 1985;13(5):342-348.
24.
IwamotoJTakedaT. Stress fractures in athletes: review of 196 cases. J Orthop Sci. 2003;8(3):273.
25.
JohnsonJHoseyRMairS. Bilateral nontraumatic first rib stress fractures in a collegiate basketball player. Clin J Sport Med. 2013;23(2):e5.
26.
KarlsonKA. Rib stress fractures in elite rowers. Am J Sports Med. 1998;26(4):516-519.
27.
KawashimaKTerabayashiNMiyagawaT, et al. Stress fractures of the first rib related to swinging of a baseball bat: two case reports. Clin J Sport Med. 2016;26(6):e108-e110.
LankennerPAJrMicheliLJ. Stress fracture of the first rib. A case report. J Bone Joint Surg Am. 1985;67(1):159-160.
30.
LeeSJYieKChonSB. Juvenile first rib fracture caused by morning stretching. J Emerg Med. 2012;43(2):e119-e121.
31.
LordMJHaKISongKS. Stress fractures of the ribs in golfers. Am J Sports Med. 1996;24(1):118-122.
32.
LowSKernMAtandaA. First-rib stress fracture in two adolescent swimmers: a case report. J Sports Sci. 2016;34(13):1266-1270.
33.
MaffulliNPintoreE. Stress fracture of the sixth rib in a canoeist. Br J Sports Med. 1990;24(4):247.
34.
MamaneePWeinbergJCurlLAMcFarlandEG. Bilateral first rib and unilateral second rib stress fractures in a female athlete. Clin J Sport Med. 1999;9(3):177-183.
35.
MarcanoAISamitierGWrightTWFarmerKW. Stress fracture of second rib and scapular spine in a female softball player. Curr Sports Med Rep. 2014;13(5):314-318.
36.
MatsumotoTFujitaKFujiokaH, et al. Stress fracture of the first rib in a soccer player: a rare etiology of shoulder pain. J Shoulder Elbow Surg. 2003;12(2):197-199.
37.
MaquirriainJGhisiJP. The incidence and distribution of stress fractures in elite tennis players. Br J Sports Med. 2006;40(5):454-459.
38.
McKenzieDC. Stress fracture of the rib in an elite oarsman. Int J Sports Med. 1989;10(3):220-222.
39.
MikawaYKoboriM. Stress fracture of the first rib in a weightlifter. Arch Orthop Trauma Surg. 1991;110(2):121-122.
40.
MillerTLHarrisJDKaedingCC. Stress fractures of the ribs and upper extremities: causation, evaluation, and management. Am J Sports Med. 2013;43(8):665-674.
41.
MithöferKGizaE. Pseudarthrosis of the first rib in the overhead athlete. Br J Sports Med. 2004;38(2):221-222.
42.
NoonanTJSakrydGEspinozaLMPackerD. Posterior rib stress fracture in professional baseball pitchers. Am J Sports Med. 2007;35(4):654-658.
43.
O’NealMGaneyTMOgdenJA. First rib stress fracture and pseudarthrosis in the adolescent athlete: the role of costosternal anatomy. Clin J Sport Med. 2009;19(1):65-67.
44.
OchiMSasashigeYMurakamiTIkutaY. Brachial plexus palsy secondary to stress fracture of the first rib: case report. J Trauma. 1994;36(1):128-130.
45.
OravaSJaakkolaLKujalaUM. Stress fracture of the seventh rib in a squash player. Scand J Med Sci Sport. 1991;1(4):247-248.
46.
PfefferleKJBoydJAAcusRWIII. Rib stress fracture in a collegiate softball pitcher. JBJS Case Connect. 2016;6(1):e16.
47.
PriskVAHamiltonWG. Stress fracture of the first rib in weight-trained dancers. Am J Sports Med. 2008;36(12):2444-2447.
48.
ReadMTF. Case report-stress fracture of the rib in a golfer. Br J Sports Med. 1994;28(2):206-207.
49.
SacchettiADBeswickDRMorseSD. Rebound rib: stress-induced first rib fracture. Ann Emerg Med. 1983;12(3):177-179.
50.
SakataTKimuraYHidaT. First rib stress fracture in a sidearm baseball pitcher: a case report. J Sports Sci Med. 2005;4(2):201-207.
51.
SakellaridisTStamatelopoulosAAndrianopoulosEKormasP. Isolated first rib fracture in athletes. Br J Sports Med. 2004;38(3):e5.
52.
SinhaAKKaedingCCWadleyGM. Upper extremity stress fractures in athletes: clinical features of 44 cases. Clin J Sport Med. 1999;9(4):199-202.
53.
SmoljanovicTBojanicIPollockCLRadonicR. Rib stress fracture in a male adaptive rower from the arms and shoulders sport class: case report. Croat Med J. 2011;52(5):644-647.
54.
SueharaYImashimizuKMiyamotoN, et al. Arterial thoracic outlet syndrome and cerebellar infarction following a stress fracture of the first rib and extensive callus formation: a case report. JBJS Case Connect. 2017;7(3):e64.
55.
TaimelaSKujalaUMOravaS. Two consecutive rib stress fractures in a female competitive swimmer. Clin J Sport Med. 1995;5(4):254-256.
56.
TriebKHuberWKainbergerF. A rare reason for the end of a career in competitive tennis. J Sports Med Phys Fitness. 2008;48(1):120-122.
57.
TrinhCBarrettJColemanB. Rib injury in a professional baseball player. Clin J Sport Med. 2018;28(2):e14-e15.
58.
VikramadityaPrittyP. Two cases of isolated first rib fracture. Emerg Med J. 2001;18(6):498-499.
59.
WildATBeglyJPGarzon-MuvdiJDesaiPMcFarlandEG. First-rib stress fracture in a high-school lacrosse player: a case report and short clinical review. Sports Health. 2011;3(6):547-549.
60.
YoungBLWatsonSLMeyerRDPonceBA. Nonunion of first rib fracture in a softball player: case report of a rare cause of thoracic outlet syndrome. J Shoulder Elbow Surg. 2016;25(11):e353-e357.
61.
YoungEJCurtisRJ. First-rib stress fractures related to hitting in two baseball teammates. Clin J Sport Med. 2008;18(3):300-301.
62.
XiaHZhuPLiJ. Thorascope combined with internal support system of chest wall in open reduction and internal fixation for multiple rib fractures. Exp Ther Med. 2018;16(6):4650-4654.
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