Skip to main content

Advertisement

SpringerLink
Log in

Chest Wall Injuries in Athletes

  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Musculoskeletal injuries of the chest wall are underrecognized by sports medicine clinicians. The purpose of this review is to highlight key elements of the presentation and management of chest wall injuries seen in an athletic population.

Recent Findings

Chest wall injuries may arise from the bony or cartilaginous structures, joints, or myofascial structures of the trunk. Injury can occur in the setting of trauma during sport or may occur due to overuse. Many chest wall injuries can be successfully rehabilitated, allowing return to the athlete’s prior level of play. However, some injuries carry a risk of complications and should be monitored closely.

Summary

Chest wall pain is common in athletes and can arise from a variety of musculoskeletal structures. Timely recognition and treatment helps to minimize lost fitness and hasten return to play. Further research is needed to identify modifiable risk factors and optimize rehabilitation outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Liem BC, Olafsen N. Pectoralis major injuries: return to play potential. Curr Phys Med Rehab Rep. 2017;5:91–7.

    Article  Google Scholar 

  2. Warden SJ, Gutschlag FR, Wajswelner H, Crossley KM. Aetiology of rib stress fractures in rowers. Sports Med. 2002;32(13):819–36.

    Article  PubMed  Google Scholar 

  3. Karlson KA. Thoracic region pain in athletes. Curr Sports Med Rep. 2004;3(1):53–7.

    Article  PubMed  Google Scholar 

  4. • Harris R, Trease L, Wilkie K, Drew M. Rib stress injuries in the 2012-2016 (Rio) Olympiad: a cohort study of 151 Australian Rowing Team athletes for 88 773 athlete days. Br J Sports Med. 2020;54(16):991–6. This reference describes the rib injuries seen in a large cohort of elite rowers followed for a 4-year period of training and competition and observes greater time lost to injury than previous reports.

    Article  PubMed  Google Scholar 

  5. Miller TL, Harris JD, Kaeding CC. Stress fractures of the ribs and upper extremities: causation, evaluation, and management. Sports Med. 2013;43(8):665–74.

    Article  PubMed  Google Scholar 

  6. Gundersen A, Borgstrom H, McInnis KC. Trunk injuries in athletes. Curr Sports Med Rep. 2021;20(3):150–6.

    Article  PubMed  Google Scholar 

  7. McDonnell LK, Hume PA, Nolte V. Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies. Sports Med. 2011;41(11):883–901.

    Article  PubMed  Google Scholar 

  8. Gregory PL, Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Med. 2002;32(4):235–50.

    Article  PubMed  Google Scholar 

  9. Lin HC, Chou CS, Hsu TC. Stress fractures of the ribs in amateur golf players. Zhonghua Yi Xue Za Zhi (Taipei). 1994;54(1):33–7.

    CAS  PubMed  Google Scholar 

  10. Horner DB. Lumbar back pain arising from stress fractures of the lower ribs: report of four cases. J Bone Joint Surg Am. 1964;46:1553–6.

    Article  CAS  PubMed  Google Scholar 

  11. Schowalter S, Le B, Creps J, McInnis KC. Rib fractures in professional baseball pitchers: mechanics, epidemiology, and management. Open Access J Sports Med. 2022;13:89–105.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Funakoshi T, Furushima K, Kusano H, Itoh Y, Miyamoto A, Horiuchi Y, et al. First-rib stress fracture in overhead throwing athletes. J Bone Joint Surg Am. 2019;101(10):896–903.

    Article  Google Scholar 

  13. Sheng DL, Burnham K, Boutin RD, Ray JW. Ultrasound identifies first rib stress fractures: a case series in division I athletes. J Athl Train. 2022. https://doi.org/10.4085/1062-6050-0375.21.

  14. Roston AT, Wilkinson M, Forster BB. Imaging of rib stress fractures in elite rowers: the promise of ultrasound? Br J Sports Med. 2017;51(14):1093–7.

    Article  PubMed  Google Scholar 

  15. Chaudhury S, Hobart SJ, Rodeo SA. Bilateral first rib stress fractures in a female swimmer: a case report. J Shoulder Elbow Surg. 2012;21(3):e6–10.

    Article  PubMed  Google Scholar 

  16. Miles JW, Barrett GR. Rib fractures in athletes. Sports Med. 1991;12(1):66–9.

    Article  CAS  PubMed  Google Scholar 

  17. Tullos HS, Erwin WD, Woods GW, Wukasch DC, Cooley DA, King JW. Unusual lesions of the pitching arm. Clin Orthop Relat Res. 1972;88:169–82.

    Article  CAS  PubMed  Google Scholar 

  18. Marcussen B, Negaard M, Hosey RG, Smoot MK. A case series and literature review: isolated traumatic first rib fracture in athletes. Clin J Sport Med. 2020;30(3):257–66.

    Article  PubMed  Google Scholar 

  19. Colosimo AJ, Byrne E, Heidt RS Jr, Carlonas RL, Wyatt H. Acute traumatic first-rib fracture in the contact athlete: a case report. Am J Sports Med. 2004;32(5):1310–2.

    Article  PubMed  Google Scholar 

  20. Sakellaridis T, Stamatelopoulos A, Andrianopoulos E, Kormas P. Isolated first rib fracture in athletes. Br J Sports Med. 2004;38(3):e5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Sclafani MP, Amin NH, Delehanty E, Figler R, Williams J. Rehabilitation following an acute traumatic first rib fracture in a collegiate football player: a case report and literature review. Int J Sports Phys Ther. 2014;9(7):1021–9.

    PubMed  PubMed Central  Google Scholar 

  22. Tekyol D, Akman G, Dogruyol S, Akbas I. Injuries in recreational footballers and the severe consequences of player-to-player contact: a prospective observational study. Cureus. 2022;14(1):e21758.

    PubMed  PubMed Central  Google Scholar 

  23. Westcott J, Davis SD, Fleishon H, Gefter WB, Henschke CI, McLoud TC, et al. Rib fractures. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215(Suppl):637–9.

    PubMed  Google Scholar 

  24. Scott EM, Scott BB. Painful rib syndrome--a review of 76 cases. Gut. 1993;34(7):1006–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Copeland GP, Machin DG, Shennan JM. Surgical treatment of the ‘slipping rib syndrome’. Br J Surg. 1984;71(7):522–3.

    Article  CAS  PubMed  Google Scholar 

  26. Arroyo JF, Vine R, Reynaud C, Michel JP. Slipping rib syndrome: don’t be fooled. Geriatrics. 1995;50(3):46–9.

    CAS  PubMed  Google Scholar 

  27. Foley CM, Sugimoto D, Mooney DP, Meehan WP 3rd, Stracciolini A. Diagnosis and treatment of slipping rib syndrome. Clin J Sport Med. 2019;29(1):18–23.

    Article  PubMed  Google Scholar 

  28. McMahon LE. Slipping rib syndrome: a review of evaluation, diagnosis and treatment. Semin Pediatr Surg. 2018;27(3):183–8.

    Article  PubMed  Google Scholar 

  29. Udermann BE, Cavanaugh DG, Gibson MH, Doberstein ST, Mayer JM, Murray SR. Slipping rib syndrome in a collegiate swimmer: a case report. J Athl Train. 2005;40(2):120–2.

    PubMed  PubMed Central  Google Scholar 

  30. Peterson LL, Cavanaugh DG. Two years of debilitating pain in a football spearing victim: slipping rib syndrome. Med Sci Sports Exerc. 2003;35(10):1634–7.

    Article  PubMed  Google Scholar 

  31. Chhipa I, Cheesman Q. Slipping rib syndrome in an adolescent wrestler. BMJ Case Rep. 2020;13(1):e232514.

  32. Heinz GJ, Zavala DC. Slipping rib syndrome. JAMA. 1977;237(8):794–5.

    Article  CAS  PubMed  Google Scholar 

  33. Girbau A, Alvarez-Rey G, Cano-Herrera CL, Balius R. Slipping rib syndrome: a clinical and dynamic-sonographic entity. A serial cases report. J Back Musculoskelet Rehabil. 2022;35(2):253–9.

    Article  PubMed  Google Scholar 

  34. Van Tassel D, McMahon LE, Riemann M, Wong K, Barnes CE. Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal Radiol. 2019;48(5):741–51.

    Article  PubMed  Google Scholar 

  35. Migliore M, Signorelli M, Caltabiano R, Aguglia E. Flank pain caused by slipping rib syndrome. Lancet. 2014;383(9919):844.

    Article  PubMed  Google Scholar 

  36. McMahon LE. Recurrent slipping rib syndrome: initial experience with vertical rib stabilization using bioabsorbable plating. J Laparoendosc Adv Surg Tech A. 2020;30(3):334–7.

    Article  PubMed  Google Scholar 

  37. Hill PF, Chatterji S, DeMello WF, Gibbons JR. Stress fracture of the sternum: an unusual injury? Injury. 1997;28(5-6):359–61.

    Article  CAS  PubMed  Google Scholar 

  38. Baker JC, Demertzis JL. Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature. Skeletal Radiol. 2016;45(6):833–7.

    Article  PubMed  Google Scholar 

  39. Barbaix EJ. Stress fracture of the sternum in a golf player. Int J Sports Med. 1996;17(4):303–4.

    Article  CAS  PubMed  Google Scholar 

  40. Keating TM. Stress fracture of the sternum in a wrestler. Am J Sports Med. 1987;15(1):92–3.

    Article  CAS  PubMed  Google Scholar 

  41. Lee J, Fields KB. Sternal stress fracture in a middle-aged woman. BMJ Case Rep. 2017;2017:bcr2016218203.

  42. McCurdie I, Etherington J, Buchanan N. Sternal fracture in a female army officer cadet. Br J Sports Med. 1997;31(2):164.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Robertsen K, Kristensen O, Vejen L. Manubrium sterni stress fracture: an unusual complication of non-contact sport. Br J Sports Med. 1996;30(2):176–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Culp B, Hurbanek JG, Novak J, McCamey KL, Flanigan DC. Acute traumatic sternum fracture in a female college hockey player. Orthopedics. 2010;33(9):683.

    Article  PubMed  Google Scholar 

  45. Larson CM, Fischer DA. Injury to the developing sternum in an adolescent football player: a case report and literature review. Am J Orthop (Belle Mead NJ). 2003;32(11):559–61.

    PubMed  Google Scholar 

  46. Odell DD, Peleg K, Givon A, Radomislensky I, Makey I, Decamp MM, et al. Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries--analysis of 1,867 cases. J Trauma Acute Care Surg. 2013;75(3):448–52.

    Article  PubMed  Google Scholar 

  47. Rainer TH, Griffith JF, Lam E, Lam PK, Metreweli C. Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury. J Trauma. 2004;56(6):1211–3.

    Article  PubMed  Google Scholar 

  48. Uluşan A, Karakurt Ö. Cardiac findings of sternal fractures due to the thoracic trauma: A five-year retrospective study. Turkish J Trauma Emerg Surg. 2018;24(3):249–54.

    Google Scholar 

  49. Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock. 2013;6(2):113–6.

    Article  PubMed  Google Scholar 

  50. Alent J, Narducci DM, Moran B, Coris E. Sternal injuries in sport: a review of the literature. Sports Med. 2018;48(12):2715–24.

    Article  PubMed  Google Scholar 

  51. Bardos A, Sabhrawal S, Tytherleigh-Strong G. Management of vertical sternal fracture nonunion in elite-level athletes. Orthop J Sports Med. 2021;9(6):23259671211010804.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Grindstaff TL, Beazell JR, Saliba EN, Ingersoll CD. Treatment of a female collegiate rower with costochondritis: a case report. J Man Manip Ther. 2010;18(2):64–8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321–5.

    Article  PubMed  Google Scholar 

  54. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80(6):617–20.

    PubMed  Google Scholar 

  55. Gill GV. Epidemic of Tietze’s syndrome. Br Med J. 1977;2(6085):499.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Aeschlimann A, Kahn MF. Tietze’s syndrome: a critical review. Clin Exp Rheumatol. 1990;8(4):407–12.

    CAS  PubMed  Google Scholar 

  57. Volterrani L, Mazzei MA, Giordano N, Nuti R, Galeazzi M, Fioravanti A. Magnetic resonance imaging in Tietze’s syndrome. Clin Exp Rheumatol. 2008;26(5):848–53.

    CAS  PubMed  Google Scholar 

  58. Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietze’s syndrome. Br J Rheumatol. 1997;36(5):547–50.

    Article  CAS  PubMed  Google Scholar 

  59. Gologorsky R, Hornik B, Velotta J. Surgical management of medically refractory Tietze syndrome. Ann Thorac Surg. 2017;104(6):e443–e5.

    Article  PubMed  Google Scholar 

  60. Mudgal C, Waters PM. Isolated fracture-subluxation of the second sternocostal synchondrosis. A case report. Am J Sports Med. 1998;26(5):729–30.

    Article  CAS  PubMed  Google Scholar 

  61. •• Varada SL, Popkin CA, Hecht EM, Ahmad CS, Levine WN, Brown M, et al. Athletic injuries of the thoracic cage. Radiographics. 2021;41(2):E20–39. This reference outlines the indications for imaging as well as important imaging correlates of chest wall injuries in athletes.

    Article  PubMed  Google Scholar 

  62. Cruz MF, Erdeljac J, Williams R, Brown M, Bolgla L. Posterior sternoclavicular joint dislocation in a division I football player: a case report. Int J Sports Phys Ther. 2015;10(5):700–11.

    PubMed  PubMed Central  Google Scholar 

  63. Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: a review of the literature. World J Orthop. 2016;7(4):244–50.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Ogawa T, Masuya M, Onishi S, Iwabuchi S, Yoshii Y, Hirano A, et al. Positional anterior sternoclavicular joint dislocation in the acceleration phase of throwing: a case report. JSES Int. 2020;4(3):532–5.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Fournier MN, Sinclair MR, Zheng ET, Spiegel DA, Johnson AL, Shah AS, et al. The frequency of mediastinal injury in acute posterior sternoclavicular dislocations: a multicenter study. J Pediatr Orthop. 2020;40(10):e927–e31.

    Article  PubMed  Google Scholar 

  66. Calderazzi F, Menozzi M, Valenti P, Colacicco A, Bastia P, Pogliacomi F, et al. A rare case of complicated pure posterior sternoclavicular dislocation in a young athlete. Acta Biomed. 2020;91(14-S):e2020015.

    PubMed  PubMed Central  Google Scholar 

  67. Albors LM, Lee RJ. Chronic posterior sternoclavicular dislocation in a contact athlete: a case report. JBJS Case Connect. 2020;10(1):e0032.

    Article  PubMed  Google Scholar 

  68. Blakeley CJ, Harrison HL, Siow S, Hashemi K. The use of bedside ultrasound to diagnose posterior sterno-clavicular dislocation. Emerg Med J. 2011;28(6):542.

    Article  CAS  PubMed  Google Scholar 

  69. Bengtzen RR, Petering RC. Point-of-care ultrasound diagnosis of posterior sternoclavicular joint dislocation. J Emerg Med. 2017;52(4):513–5.

    Article  PubMed  Google Scholar 

  70. Singer G, Ferlic P, Kraus T, Eberl R. Reconstruction of the sternoclavicular joint in active patients with the figure-of-eight technique using hamstrings. J Shoulder Elbow Surg. 2013;22(1):64–9.

    Article  PubMed  Google Scholar 

  71. Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular joint instability: symptoms, diagnosis and management. Orthop Res Rev. 2020;12:75–87.

    PubMed  PubMed Central  Google Scholar 

  72. Wirth MA, Rockwood CA Jr. Acute and chronic traumatic injuries of the sternoclavicular joint. J Am Acad Orthop Surg. 1996;4(5):268–78.

    Article  CAS  PubMed  Google Scholar 

  73. Damschen J, Nowak M, Murphy A, Park S, Li X, Galvin J. Return to sports after closed reduction of acute traumatic posterior sternoclavicular joint dislocations: a systematic review. Am J Sports Med. 2022;51(11). https://doi.org/10.1177/03635465221131900.

  74. Tytherleigh-Strong G, Sabharwal S, Peryt A. Clinical outcomes and return to sports after open reduction and hamstring tendon autograft reconstruction in patients with acute traumatic first-time posterior dislocation of the sternoclavicular joint. Am J Sports Med. 2022;50(13):3635–42.

    Article  PubMed  Google Scholar 

  75. Lacheta L, Dekker TJ, Goldenberg BT, Horan MP, Rosenberg SI, Pogorzelski J, et al. Minimum 5-year clinical outcomes, survivorship, and return to sports after hamstring tendon autograft reconstruction for sternoclavicular joint instability. Am J Sports Med. 2020;48(4):939–46.

    Article  PubMed  Google Scholar 

  76. Gowd AK, Liu JN, Garcia GH, Cabarcas BC, Agarwalla A, Nicholson GP, et al. Figure-of-eight reconstruction of the sternoclavicular joint: outcomes of sport and work. Orthopedics. 2019;42(4):205–10.

    Article  PubMed  Google Scholar 

  77. LaStayo PC, Woolf JM, Lewek MD, Snyder-Mackler L, Reich T, Lindstedt SL. Eccentric muscle contractions: their contribution to injury, prevention, rehabilitation, and sport. J Orthop Sports Phys Ther. 2003;33(10):557–71.

    Article  PubMed  Google Scholar 

  78. O'Neal ML, McCown K, Poulis GC. Complex strain injury involving an intercostal hematoma in a professional baseball player. Clin J Sport Med. 2008;18(4):372–3.

    Article  PubMed  Google Scholar 

  79. Carr JB 2nd, John QE, Rajadhyaksha E, Carson EW, Turney KL. Traumatic avulsion of the serratus anterior muscle in a collegiate rower: a case report. Sports Health. 2017;9(1):80–3.

    Article  PubMed  Google Scholar 

  80. Gaffney KM. Avulsion injury of the serratus anterior: a case history. Clin J Sport Med. 1997;7(2):134–6.

    Article  CAS  PubMed  Google Scholar 

  81. Otoshi K, Itoh Y, Tsujino A, Hasegawa M, Kikuchi S. Avulsion injury of the serratus anterior muscle in a high-school underhand pitcher: a case report. J Shoulder Elbow Surg. 2007;16(6):e45–7.

    Article  PubMed  Google Scholar 

  82. Winther AK, Ohlenschlaeger TF. Avulsion fracture of the serratus anterior muscle in a golfer. Ugeskr Laeger. 2015;177(2A):56–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St. Louis, School of Medicine, Campus Box 8233, 660 Euclid Ave, St. Louis, MO, 63110, USA

    Stephanie R. Douglas & Nathan P. Olafsen

Authors
  1. Stephanie R. Douglas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathan P. Olafsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathan P. Olafsen.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Right and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Douglas, S.R., Olafsen, N.P. Chest Wall Injuries in Athletes. Curr Phys Med Rehabil Rep 11, 450–457 (2023). https://doi.org/10.1007/s40141-023-00421-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-023-00421-7

Keywords

Search

Navigation