Dominant-Sided First-Rib Stress Fracture in a Collegiate Baseball Pitcher

he incidence of asymptomatic fatigue fractures of the first rib in the young, active male population is very low; these fractures were observed in only 0.001 % of retrospectively reviewed chest radiographs in one series1. First-rib fractures have been postulated to result from several primary mechanisms: high-energy direct impact such as a motor vehicle collision2, indirect trauma such as a fall on an outstretched arm3, fatigue fractures from repeated muscular contracture4, or sudden, violent muscular forces resulting in stress fractures5. Although the exact incidence of first-rib stress fracture caused by sudden muscular contracture is not known, many repetitive activities, including gymnastics, tennis, basketball, weightlifting, and even coughing or sneezing, have been associated with this mechanism6. We present the case of a first-rib stress fracture in a col-legiate baseball pitcher and discuss the relevant literature. Th