48 year-old right-handed woman with fairly acute onset chest pain with deep inspiration, occurred after a weekend of golf.
Minimally displaced fractures of the posterior aspect of the left 5th and 6th ribs are seen. No pneumothorax, pleural fluid collections, or evidence of pulmonary contusion were evident.
stress fracture, ribs
Chronic repetitive stresses from sports such as golf, especially in a relatively de-conditioned â€śweekend athletesâ€ť, can cause musculoskeletal injuries. In particular, rib fractures have been seen in patients who are avid golfers, commonly misdiagnosed as â€śback strainsâ€ť. The current medical literatureâ€™s most extensive series of this phenomenon is Lord et al.â€™s published results in 19 golfers. Eighteen golfers were beginners, and one golfer was more experienced, who substantially intensified his practice regimen. Sixteen of these golfers had fractures on the leading arm side of the thorax, as in this case (the patient is right-handed, and her left side would be the leading side in the typical golf stance). For most of these patients, plain films were diagnostic, but three cases required skeletal scintigraphy. These rib fractures generally occur in the posterior and/or posterolateral aspects of the ribs, usually affecting the 4th through 6th ribs, as in this case. The leading theory is that the fatigue of serratus anterior muscle is the major contributor to these injuries. Rehabilitation from these rib fractures includes strengthening the serratus anterior muscle (1). Rib fractures in general have been also associated with baseball pitchers and rowers (2).
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