OBJECTIVE: The purpose of this study is to describe the case of a patient with a first rib fracture discovered with advanced imaging once the patient did not respond to an initial course of care.
CLINICAL FEATURES: A 24-year-old otherwise healthy male electrician had medial scapular, upper thoracic, and sternal pain while using a power drill in the overhead position.
INTERVENTION AND OUTCOME: An initial trial of treatments consisting of spinal manipulation and modalities failed to alleviate the patient's symptoms. Chiropractic treatment was discontinued and further diagnostic testing with advanced imaging was performed. Once the pathology was identified, the patient was placed on light duty at work with restrictions limiting overhead activities. No other treatment was rendered. The patient was symptom-free approximately 10 months after the onset of pain.
CONCLUSIONS: Patients with complaints of spine and scapular pain may commonly present to a chiropractor for care. When these types of symptoms do not respond to conservative therapy, other causes should be investigated. In this case, the patient's symptoms resulted from a nontraumatic fracture of the first rib. First rib fractures should be considered in the differential diagnosis of patients with upper quadrant pain that is not responsive to conservative care.
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