Stress fracture of the eighth rib in a female collegiate rower: a case report

J Athl Train. 2000 Oct;35(4):445-9.


Objective: To present the case of a stress fracture of the eighth rib in a female collegiate rower.

Background: A female collegiate rower experienced severe pain in her chest, increasing with movement, deep breathing, and erect posture. No acute mechanism of injury was apparent. The team physician diagnosed a rib stress reaction based on clinical examination. The athlete rested for 2 days and then was able to resume rowing workouts. Five months later, she experienced the same sharp pain, with the diagnosis and treatment being the same. The athlete was able to compete in the championships 3 weeks later. At the end of the season, a bone scan revealed a stress fracture of the eighth rib. The athlete rested for 3 weeks and then returned to activity.

Differential diagnosis: Intercostal muscle strain, serratus anterior muscle strain.

Treatment: Active rest, involving pain-free cardiovascular workouts and weight training, cessation of rowing until the athlete was asymptomatic, strengthening of dynamic support structures, and analgesic modalities.

Uniqueness: Most stress fractures occur in the lower extremity. Those that do occur in the rib cage most often involve the first rib. A limited number of published works have addressed stress fractures to the remaining ribs; of these, posterior and posterolateral fracture sites are most often reported. This case is unique in that the fracture site was on the anterolateral aspect of the eighth rib.

Conclusions: Stress fractures are thought to result from a variety of causes, including muscular fatigue, sudden changes in training intensity or duration, and microtrauma to bone at the muscular origin and insertion sites ("wear-and- tear" theory). In addition, hormonal factors in women can predispose an athlete with amenorrhea to a decrease in bone mineral content. Athletic trainers should be aware of these potential causes and focus on the prevention of stress fractures.