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superiorly dislocated 1st rib? - HELP

 
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superiorly dislocated 1st rib? - HELP - May 4, 2007 10:57:00 AM   
Tom Reeves DPT ATC

 

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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.

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Re: superiorly dislocated 1st rib? - HELP - May 7, 2007 7:04:00 PM   
Rwantz

 

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Are there any x-rays?

(in reply to Tom Reeves DPT ATC)
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Re: superiorly dislocated 1st rib? - HELP - May 8, 2007 7:35:00 AM   
Tom Reeves DPT ATC

 

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the shoulder xray showed, a pair of cervical ribs that weren't discussed by the radiologist. they did a follow up film at my request of the lower cervical to be sure that there were no fractures. Thr Right (throwing side) was clearly elevated on the film and was exactly where the lump was.

He is feeling better and playing ball without any problems.

Thanks for thinking about it though. He probably has a scalene attached to the c-rib and pulled it upward.

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He who is wise in the ways of science
The Omniscient One

(in reply to Tom Reeves DPT ATC)
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Re: superiorly dislocated 1st rib? - HELP - May 21, 2007 6:49:00 AM   
ginger

 

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Just a few thoughts Tom , re this young pitcher. Like many of the observation that occur in the throes of drawing conclusions together, x-rays, such as of this boys cervical ribs, may alter the viewers perspective , enough perhaps to regard the x-ray evidence as more than what it is, an addition to clinical obs. Though you may well be correct in your conclusions in regard to this ball throwers shoulder, we must all keep a tight rein on our enthusiasm when identifying what appears to provide a stand alone diagnosis with x-ray.
Having said that , I see liitle reason to reject your obs and conclusions based on what you have posted. The short period for improvement suggests a possible dislocation event as you have suggested, the lack of "neuro" signs add to that, no fracture, was able to continue to play, you are not cracked mate.
Oz ball throwing sports consist of very different biomechanics than pitching, so can't speak with any experience about your sport.
Stay well.

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Geoff Fisher
Physiotherapist
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(in reply to Tom Reeves DPT ATC)
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RE: superiorly dislocated 1st rib? - HELP - September 27, 2007 1:10:18 AM   
spaniard

 

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Please don't hesitate to let your enthusiasm fly when you encounter a cervical rib. They are not that common! In the case of a sub-luxed 1st rib there are mobilization and manipulation techniques available, most of them during the espiratory cycle. Best results with the MET in my opinion; if you are really interested I can describe it for you. Are the symptoms mostly related to a cervical rib (x-ray confirmation, C8 likely involvement, limited ipsilateral rotation) or are they mostly related to a 1st rib (<1cm elevation 1st rib, limited contralateral cervical sidebending, relief to manip and MRT of 1st rib)? Good luck

(in reply to Tom Reeves DPT ATC)
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