Abstract
Chest pain is a common complaint in athletes and has a number of possible underlying causes. Although chest pain in athletes is most often caused by the musculoskeletal system, pain may originate from organs within the thoracic cage, such as the heart, lungs, or esophagus. Musculoskeletal chest injuries in athletes can be caused by direct trauma to the chest or arise from extreme or repetitive forces that occur through the structures comprising the thoracic cage during sports. Overuse injuries may affect the ribs, sternum, joints, and muscles of the chest wall. Referred pain from the thoracic spine may also be perceived as chest pain. This chapter focuses on functional anatomy, injury mechanisms, and clinical description of specific sports-related injuries of the chest wall.
Rib and sternal fractures are common traumatic chest injuries in athletes, caused by a direct blow. Elbows and other body parts may cause a hard-enough strike, as may bats, sticks, or projectiles. Overuse injuries of the chest wall, such as stress fractures of the ribs, are caused by repetitive forces of contracting muscles due to rowing or playing golf and may be harder to diagnose. Tietze’s syndrome and costochondritis, conditions of unknown etiology, may also occur in athletes and may be difficult to assess.
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References
Aitken AP, Lincoln RE (1939) Fracture of the first rib due to muscle pull. N Engl J Med 220:1063–1064
Asplund C, Pollard ME (2004) Posterior sternoclavicular joint dislocation in a wrestler. Mil Med 169(2):134–136
Bailey P (1985) Surfer’s rib: isolated first rib fracture secondary to indirect trauma. Ann Emerg Med 14(4):346–349
Barbaix EJ (1996) Stress fracture of the sternum in a golf player. Int J Sports Med 17(4):303–304
Bojanic I, Desnica N (1998) Stress fracture of the sixth rib in an elite athlete. Croat Med J 39(4):458–460
Bontempo NA, Mazzocca AD (2010) Biomechanics and treatment of acromioclavicular and sternoclavicular joint injuries. Br J Sports Med 44(5):361–369
Brooke R (1959) Jive fracture of the first rib. J Bone Joint Surg Br 41-B(2):370–371
Brukner P, Khan K (2012) Clinical sports medicine. McGraw-Hill, Sydney
Buckman R, Trooskin SZ, Flancbaum L et al (1987) The significance of stable patients with sternal fractures. Surg Gynecol Obstet 164(3):261–265
Christiansen E, Kanstrup IL (1997) Increased risk of stress fractures of the ribs in elite rowers. Scand J Med Sci Sports 7(1):49–52
Clemens MW, Evans KK, Mardini S et al (2011) Introduction to chest wall reconstruction: anatomy and physiology of the chest and indications for chest wall reconstruction. Semin Plast Surg 25(1):5–15
Culp B, Hurbanek JG, Novak J et al (2010) Acute traumatic sternum fracture in a female college hockey player. Orthopedics 33(9):683–685
Disla E, Rhim HR, Reddy A et al (1994) Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med 154(21):2466–2469
Fam AG, Smythe HA (1985) Musculoskeletal chest wall pain. Can Med Assoc J 133(5):379–389
Franck WM, Siassi RM, Hennig FF (2003) Treatment of posterior epiphyseal disruption of the medial clavicle with a modified balser plate. J Trauma 55(5):966–968
Gregory PL, Biswas AC, Batt ME (2002) Musculoskeletal problems of the chest wall in athletes. Sports Med 32(4):235–250
Grindstaff TL, Beazell JR, Saliba EN et al (2010) Treatment of a female collegiate rower with costochondritis: a case report. J Man Manip Ther 18(2):64–68
Gupta A, Jamshidi M, Rubin JR (1997) Traumatic first rib fracture: is angiography necessary? A review of 730 cases. Cardiovasc Surg 5(1):48–53
Gurtler R, Pavlov H, Torg JS (1985) Stress fracture of the ipsilateral first rib in a pitcher. Am J Sports Med 13(4):277–279
Hickey GJ, Fricker PA, McDonald WA (1997) Injuries to elite rowers over a 10-yr period. Med Sci Sports Exerc 29(12):1567–1572
Hill PF, Chatterji S, DeMello WF et al (1997) Stress fracture of the sternum: an unusual injury? Injury 28(5–6):359–361
Holden DL, Jackson DW (1985) Stress fracture of the ribs in female rowers. Am J Sports Med 13(5):342–348
Horikawa A, Miyakoshi N, Kodama H et al (2007) Insufficiency fracture of the sternum simulating myocardial infarction: case report and review of the literature. Tohoku J Exp Med 211(1):89–93
Huang ZY, Yi BL, Liu HY (2012) Sternal insufficiency fractures of post-menopausal women: retrospective analysis of 17 cases. Chin Med Sci J 27(2):101–105
Ian Rabey M (2008) Costochondritis: are the symptoms and signs due to neurogenic inflammation. Two cases that responded to manual therapy directed towards posterior spinal structures. Man Ther 13(1):82–86
Iannotti JP, Williams GR (1999) Disorders of the shoulder: diagnosis and management. Lippincott Williams & Wilkins, Philadelphia, pp 765–813
Ikehira H, Kinjo M, Nagase Y et al (1999) Acute pan-costochondritis demonstrated by gallium scintigraphy. Br J Radiol 72(854):210–211
Jenkins SA (1952) Spontaneous fractures of both first ribs. J Bone Joint Surg Br 34-B(1):9–13
Jones MW, Matthews JP (1988) Rupture of pectoralis major in weight lifters: a case report and review of the literature. Injury 19(3):219
Karlson KA (1998) Rib stress fractures in elite rowers. A case series and proposed mechanism. Am J Sports Med 26(4):516–519
Keating TM (1987) Stress fracture of the sternum in a wrestler. Am J Sports Med 15(1):92–93
Lankenner PA Jr, Micheli LJ (1985) Stress fracture of the first rib. A case report. J Bone Joint Surg Am 67(1):159–160
Leighton D, Oudjhane K, Ben Mohammed H (1989) The sternoclavicular joint in trauma: retrosternal dislocation versus epiphyseal fracture. Pediatr Radiol 20(1–2):126–127
Lewonowski K, Bassett GS (1992) Complete posterior sternoclavicular epiphyseal separation. A case report and review of the literature. Clin Orthop Relat Res 281:84–88
Lord MJ, Ha KI, Song KS (1996) Stress fractures of the ribs in golfers. Am J Sports Med 24(1):118–122
Lorentzen JE, Movin M (1976) Fracture of the first rib. Acta Orthop Scand 47(6):632–634
Malghem J, Vande Berg B, Lecouvet F et al (2001) Costal cartilage fractures as revealed on CT and sonography. AJR Am J Roentgenol 176(2):429–432
Mamanee P, Weinberg J, Curl LA et al (1999) Bilateral first rib and unilateral second rib stress fractures in a female athlete. Clin J Sport Med 9(3):177–183
Marker LB, Klareskov B (1996) Posterior sternoclavicular dislocation: an American football injury. Br J Sports Med 30(1):71–72
Martetschläger F, Warth RJ, Millett PJ (2014) Instability and degenerative arthritis of the sternoclavicular joint: a current concepts review. Am J Sports Med 42(4):999–1007
McDonnell LK, Hume PA, Nolte V (2011) Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies. Sports Med 41(11):883–901
McKenzie DC (1989) Stress fracture of the rib in an elite oarsman. Int J Sports Med 10(3):220–222
Mendelson G, Mendelson H, Horowitz SF et al (1997) Can (99m)technetium methylene diphosphonate bone scans objectively document costochondritis? Chest 111(6):1600–1602
Miller JH (1980) Accumulation of gallium-67 in costochondritis. Clin Nucl Med 5(8):362–363
Mintz AC, Albano A, Reisdorff EJ et al (1990) Stress fracture of the first rib from serratus anterior tension: an unusual mechanism of injury. Ann Emerg Med 19(4):411–414
Pearsall AW 4th, Russell GV Jr (2000) Ipsilateral clavicle fracture, sternoclavicular joint subluxation, and long thoracic nerve injury: an unusual constellation of injuries sustained during wrestling. Am J Sports Med 28(6):904–908
Perron AD (2003) Chest pain in athletes. Clin Sports Med 22(1):37–50
Robertsen K, Kristensen O, Vejen L (1996) Manubrium sterni stress fracture: an unusual complication of non-contact sport. Br J Sports Med 30(2):176–177
Rowe C, Marble H (1958) Fractures and other injuries. In: Cave EF (ed) Shoulder girdle injuries. Year Book, Chicago
Sferopoulos NK (2003) Fracture separation of the medial clavicular epiphysis: ultrasonography findings. Arch Orthop Trauma Surg 123(7):367–369
Spencer EEJ, Wirth MA, Rockwood CAJ (2007) Disorders of the sternoclavicular joint: pathophysiology, diagnosis, and management. In: Iannotti JP, Williams GR (eds) Disorders of the shoulder: diagnosis and management, 2nd edn. Lippincott Williams & Wilkins, Philadelphia
Thomas PL (1988) Thoracic back pain in rowers and butterfly swimmers–costo vertebral subluxation. Br J Sports Med 22(2):81
Warden SJ, Gutschlag FR, Wajswelner H et al (2002) Aetiology of rib stress fractures in rowers. Sports Med 32(13):819–836
Yang J, al-Etani H, Letts M (1996) Diagnosis and treatment of posterior sternoclavicular joint dislocations in children. Am J Orthop (Belle Mead NJ) 25(8):565–569
Zaslav KR, Ray S, Neer CS 2nd (1989) Conservative management of a displaced medial clavicular physeal injury in an adolescent athlete. A case report and literature review. Am J Sports Med 17(6):833–836
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de Bruijn, M.C. (2015). Chest Injuries. In: Glaudemans, A., Dierckx, R., Gielen, J., Zwerver, J. (eds) Nuclear Medicine and Radiologic Imaging in Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46491-5_13
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DOI: https://doi.org/10.1007/978-3-662-46491-5_13
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