Extract
Isolated stress fractures of the first rib have previously been
reported in adults and adolescents who participate in sports such as
rugby1,
baseball2,
weight-lifting3,
basketball4, and
tennis5 as well as
in individuals who carry a heavy
schoolbag6. Stress
fractures of the first rib in children are rare, and only five fractures in
four patients have been reported (Table
I)1,7-9.
The clinical presentation usually ranges from mild vague discomfort to acute
pain in the shoulder region, cervical triangle, or clavicular region. Pain
also may radiate to the sternum or the pectoral region. No cases of painful
torticollis due to a stress fracture of the first rib in a child have been
reported, to our knowledge. Common causes of acquired painful torticollis are
trauma (atlantoaxial rotatory
displacement10, os
odontoideum11, and
C1 fracture12),
inflammation13
(Grisel syndrome14,
juvenile rheumatoid
arthritis15,
discitis15), and
tumor (eosinophilic
granuloma16,
osteoid osteoma17,
osteoblastoma18,
leukemia19). Less
common causes include calcified cervical
disc20, Sandifer
syndrome21, and
bacterial
meningitis22.