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Jean M. Fruh

This paper discusses the case of an 18-year-old collegiate soccer player who developed right shoulder and scapular pain following a preseason practice session. Initial evaluation revealed tenderness of the right trapezius muscle but no swelling, deformity, loss of range of motion, or neurological signs. Subsequent radiographic examination revealed a fracture of the first rib. Although uncommon in sports, a nontraumatic fracture of the first rib may result from a sudden violent contraction of the scalenus anterior muscle. Symptoms of a first rib fracture include an acute, knifelike pain in the anterior neck, a dull ache in the shoulder or scapular region, a “snapping” sensation in the shoulder, and possible neurological symptoms due to involvement of the brachial plexus. Proper care includes application of ice, use of a sling for immobilization, and careful attention to the possibility of complications. Rehabilitation consists of a gradual range of motion and strengthening program.