first rib dislocation superiorly ?? HELP

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first rib dislocation superiorly ?? HELP - May 4, 2007 5:58:00 AM

Tom Reeves DPT ATC

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Joined: March 14, 2006
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I have a 14 yo male patient who was pitching 10 days ago. He felt a non-painful supraclavicular pop on his throwing side. He was moved to shortstop ande continued to hit without decline of any kind. The root of his neck is painful with palpation, very firm (feels bony), passive L SB is painful, resisted R SB is painful but strong. No neurological symptoms whatsoever.

I watched him throw and he opens up early and does not allow for enough acceleration time during the cocking phase.

I think he dislocated his first rib superiorly via a freak scalene contraction. First of all, am I cracked? Second, other than mobiliizing it and doing force exhalation exercises how do I treat it?????

I am going to cross post this on the orthopedics forum and manual therapy forum.

Post #: 1

Re: first rib dislocation superiorly ?? HELP - May 4, 2007 6:32:00 AM

3.5fig

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Joined: July 13, 2005
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If you suspect a dislocation, I would obtain an x-ray before doing any treatment. That would help confirm your findings....just my two cents

(in reply to Tom Reeves DPT ATC)

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Re: first rib dislocation superiorly ?? HELP - May 4, 2007 6:37:00 AM

Tom Reeves DPT ATC

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Joined: March 14, 2006
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he has had shoulder and elbow xrays (later complained of medial epicondyle pain after probably modifying his throwing mechanics.)

those plain films were negative but the 1st rib really doesn't show up on the shoulder films

(in reply to Tom Reeves DPT ATC)

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Re: first rib dislocation superiorly ?? HELP - May 4, 2007 7:54:00 AM

Shill

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Joined: February 13, 2003
From: Madison WI USA
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My opinion is that there is no way he would be able to have a strong contraction of the scalenes if their attachment point was dislocated. It would hurt way too much to generate any force. Im sure you checked his SC joint. As an aside, I would also doubt you are getting a good look at his real throwing mechanics if it hurts to SB (L). I will make no guesses as to whether you are cracked or not:] Is he improving at all since the incident? I know you said no neuro signs, but what about ULTT for the ulnar nerve? Perhaps he yanked the cervical root?

_____________________________

Steve Hill PT

(in reply to Tom Reeves DPT ATC)

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Re: first rib dislocation superiorly ?? HELP - May 4, 2007 9:01:00 AM

Tom Reeves DPT ATC

Posts: 444
Joined: March 14, 2006
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I earlier said that the xray didn't show the neck. I only read the report, no comment. I looked at the actual film and it looks like he may have either a cervical rib that is not yet completely ossified, or that he has an occult fx of the 1st thoracic rib. The doc is going to do a chest xray with a cone on the upper thoracic/lower cervical to better define the funkiness.

Thanks shill

(in reply to Tom Reeves DPT ATC)

Post #: 5