Fractures may result either from trauma or from stress. Traumatic fractures result from a single instance of injury or trauma which results in a fractured bone; stress fractures, on the other hand, stem from continued excessive stress over an extended period of time and are more in the nature of ‘overuse injuries.’ Stress fractures cannot usually be found through x-rays because the fractures are very small; however, stress fractures can deteriorate to become major fractures if they are not detected and treated in time.
Any of the 24 ribs (12 on either side) may suffer a fracture, traumatic or stress. Usually, it is the first rib that is more prone to a fracture because of certain anatomical features which make the first rib relatively weak in some places.
Stress rib fractures are fairly uncommon but they are often found in athletes whose activities place extreme stress on the ribs, as in the case of rowers, dancers, golfers, tennis-players, etc.
Causes
- Repetitive, extreme stress stemming from vigorous movement of the shoulders as in certain sports.
- Poor or incorrect technique in sports that involve excessive use of shoulders
- Sudden changes in weight-lifting training
- Deficiency of Calcium and Vitamin D
- Weakness of bones
- Damaged or worn-out training equipment
- Weak rib muscles which increase the stress on ribs
- Stiffness of the joints between the ribs and vertebrae
- Age, which often results in reduced bone density
- Gender, women being more likely to be affected because of the effect of female hormones
Symptoms
- Pain in the chest and/or back developing gradually
- Pain gradually develops in the upper back and side of the neck
- Pain in the back of the shoulder
- Coughing, sneezing aggravates pain
- Pain while breathing, particularly while taking deep breaths
- Pain occurs with overhead movement of arms
- Routine physical exercises like push-ups and sit-ups can be uncomfortable
- Pain on pushing heavy objects
- Pain ameliorating from rest
- Tender, palpable formations of callus around the fractured area
Diagnosis
- Physical examination by an orthopedic doctor to reveal the site and probable cause of pain
- Pressure may be applied on the affected rib or on the trapezius muscle at the base of the neck to check if it causes pain
- X-ray can show major cracks and also reveal the formation of callus or scar tissue around the cracks
- Bone Scan where a dye is injected into the body
- MRI Scan
- CT Scan
Treatment
- The preferred treatment is rest for 4 to 6 weeks during which no activity which causes or aggravates the pain should be undertaken
- During the rest period, painless exercises are allowed to avoid muscular atrophy
- Ice packs when pain is severe can provide relief
- Non-steroidal anti-inflammatory medication may be prescribed
- Supplements of Vitamin D and Calcium may be taken
- Balanced diet to correct nutritional imbalances is recommended
- Improvement/modification of technique and posture while training or exerting
- Changes in training – which may involve duration, type and other factors
- Surgery in extremely rare cases to correct any nerve-compression arising from the callus formed during healing
