Stress Fractures of the First Rib Related to Soft Tennis, Associated with the Tennis Ground Stroke

Abstract: Stress fractures of the first rib are uncommon and thought to be associated with overhead-throwing athletes. Soft tennis is similar to regular tennis but uses a much softer rubber ball. In the current report, a 14-year-old girl suffered from shoulder girdle pain, especially at the end of her tennis ground stroke. Plain radiographs showed overgrowth of bone with a fracture line on the first rib, and a diagnosis of stress fracture was made. She was advised to amend her stroke form to reduce force to the shoulder and was able to continue sports activity without pain 10 months after the appearance of her symptoms and before confirmation of bone healing. The current case is not associated with overhead-throwing, but possibly with repetitive exercises of her tennis ground strokes. Conservative medical follow-up with proper sport-specific professional advice allows continuation of the sport.

Plain Language Summary: Stress fractures of the first rib are rare, mainly linked to overhead-throwing athletes. Soft tennis resembles regular tennis but uses a softer rubber ball. In this case, a 14-year-old girl with shoulder girdle pain, especially during tennis strokes, was diagnosed with a first rib stress fracture via plain radiographs. She improved by adjusting her stroke and resumed sports pain-free within 10 months, even before full bone healing. This case was not linked to overhead-throwing but potentially resulted from repetitive ground strokes. Proper medical guidance supports sport continuation.

Keywords: first rib, stress fracture, tennis, tennis stroke