Event Title
Rare first rib pseudoarthrosis with thoracic outlet syndrome in pediatric gymnast: A case report
Location
Suwanee, GA
Start Date
11-5-2023 1:00 PM
End Date
11-5-2023 4:00 PM
Description
Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.
Case presentation: A 10 year old Caucasian male presented with a two to three month history of worsening left shoulder pain. He was a competitive gymnast who practiced approximately ten hours per week. His shoulder pain was accompanied by a "tic" type movement consisting of hyperextension of the left shoulder multiple times per day. The patient was seen by a pediatric orthopedic surgeon who diagnosed the patient with "overuse syndrome" and prescribed physical therapy. Within one to two months, the patient's shoulder pain and tightness returned. For two years, the patient continued the cycle multiple times of two to three months of physical therapy two to three times a week, relative rest, then returned to activity. He continued to be diagnosed with “overuse syndrome”. At the age of 12, the patient's mother noticed atrophy to the left upper scapula region and vague weakness of the left upper extremity. Cervical MRI showed “unusual nodular mass at the apex of the left hemithorax involving the antero-lateral aspect of the left first rib.” 3D reconstructed CT images were done showing first rib pseudoarthrosis as well as demonstrating a non-displaced fracture through the left second rib. The patient underwent a left first rib resection without complication. He recovered well post operatively; the pain, “tic”, and atrophy drastically improved, and he returned to his baseline activity level.
Conclusions: Children involved in high impact sports are subject to fractures due to the muscles pulling on the bone. Our patient not only had a first rib fracture, but also had incorrect healing of the fracture leading to pseudoarthrosis and eventual thoracic outlet syndrome. With the continued failure of conservative treatment for pain, more imaging studies should be ordered to evaluate for any missed pathologies. Removal of the first rib is a definitive treatment and should be considered if the patient’s thoracic outlet syndrome symptoms do not improve with conservative measures such as lifestyle modifications or physical therapy.
Embargo Period
6-22-2023
Included in
Rare first rib pseudoarthrosis with thoracic outlet syndrome in pediatric gymnast: A case report
Suwanee, GA
Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.
Case presentation: A 10 year old Caucasian male presented with a two to three month history of worsening left shoulder pain. He was a competitive gymnast who practiced approximately ten hours per week. His shoulder pain was accompanied by a "tic" type movement consisting of hyperextension of the left shoulder multiple times per day. The patient was seen by a pediatric orthopedic surgeon who diagnosed the patient with "overuse syndrome" and prescribed physical therapy. Within one to two months, the patient's shoulder pain and tightness returned. For two years, the patient continued the cycle multiple times of two to three months of physical therapy two to three times a week, relative rest, then returned to activity. He continued to be diagnosed with “overuse syndrome”. At the age of 12, the patient's mother noticed atrophy to the left upper scapula region and vague weakness of the left upper extremity. Cervical MRI showed “unusual nodular mass at the apex of the left hemithorax involving the antero-lateral aspect of the left first rib.” 3D reconstructed CT images were done showing first rib pseudoarthrosis as well as demonstrating a non-displaced fracture through the left second rib. The patient underwent a left first rib resection without complication. He recovered well post operatively; the pain, “tic”, and atrophy drastically improved, and he returned to his baseline activity level.
Conclusions: Children involved in high impact sports are subject to fractures due to the muscles pulling on the bone. Our patient not only had a first rib fracture, but also had incorrect healing of the fracture leading to pseudoarthrosis and eventual thoracic outlet syndrome. With the continued failure of conservative treatment for pain, more imaging studies should be ordered to evaluate for any missed pathologies. Removal of the first rib is a definitive treatment and should be considered if the patient’s thoracic outlet syndrome symptoms do not improve with conservative measures such as lifestyle modifications or physical therapy.