Rehabilitation following an acute traumatic first rib fracture in a collegiate football player: a case report and literature review.

BACKGROUND AND PURPOSE: Isolated fractures involving the first rib are rare and often difficult to diagnose. There is a paucity of literature regarding isolated fractures and even fewer reported cases involving those due to contact. The purpose of this case report is to describe the mechanism of injury, differential diagnosis, rehabilitation, and return to sport decision making for an isolated first rib fracture secondary to acute trauma in a collegiate football player.

CASE DESCRIPTION: An 18 year-old right-hand dominant male collegiate football player was involved in a facemask-to-facemask collision during a football game while playing defensive back. His chief complaint during the sideline evaluation was left-sided neck and shoulder pain with concomitant clicking reported with active movement of his left shoulder.

OUTCOMES: A musculoskeletal ultrasound performed in the training room suggested a possible scapular spine fracture. However, a subsequent magnetic resonance image revealed an acute isolated anterolateral fracture of the first rib. The subject was treated conservatively with extensive rehabilitation and was able to return to full participation for summer training camp as well as the fall football season at the same level of play as prior to injury.

DISCUSSION: An isolated first rib fracture is extremely rare due to the unique anatomical location of the first rib posterior to the clavicle, as well as the surrounding shoulder girdle and associated layer of musculature. Identifying this injury can be challenging due to vaguely reported symptoms and the paucity of reported incidences. In the setting of an isolated injury, conservative management including structured rehabilitation can lead to successful outcomes and return to play. This is the first published rehabilitation guideline for an acute isolated first-rib fracture secondary to trauma.

LEVEL OF EVIDENCE: 4 - Single case report.