Ultrasound Identifies First Rib Stress Fractures: A Case Series in Division I Athletes

Abstract

ABSTRACT Isolated first rib stress fractures in athletes are thought to be rare. In this case series, three Division I athletes developed isolated first rib stress fractures over the span of one year, revealing that these may occur more often than previously understood. These fractures can be easily missed because of low incidence, lack of clinical suspicion, and vague presentation. Further, radiographs can fail to reveal such fractures. To our knowledge, this is the largest case series of athletes with first rib stress fractures presenting with vague rhomboid interscapular pain. We also demonstrate that ultrasound successfully visualizes these fractures, thus offering, in the hands of an ultrasonographer or clinical provider trained in musculoskeletal ultrasound, an advantageous point-of-care screening imaging modality.