Point break: atraumatic first rib fracture in a surfer

A 16-year-old boy presented to the emergency department with a 2-week history of atraumatic left-sided chest pain. This was following a surfing holiday involving 3–4 hours of sessions daily. His pain started after extending his arm while surfing. Initial investigations including ECG and bloods were unremarkable except for mildly raised alkaline phosphatase. Chest X-ray (figure 1) revealed possible first rib fracture. CT of the chest (figure 2) confirmed the diagnosis and showed callus formation. First rib fractures are often the result of major trauma and are associated with injury to the great vessels or spine.1 However, there are reports of atraumatic isolated first rib fractures secondary to forces from opposing muscles.2 This has been reported in surfers, cheerleaders and basketball players.2 It occurs when the neck is extended posterolaterally and a traction force is applied to the contralateral arm.
Source: Archives of Disease in Childhood - Category: Pediatrics Authors: Tags: Miscellanea Source Type: research