Stress Fracture of the First Rib in a Weightlifter

A 20-year-old woman elite weightlifter presented with acute onset debilitating right shoulder pain while attempting the “clean and jerk.” There was no previous relevant history, including no prior fracture in the region. Examination confirmed vague tenderness in the right supraclavicular fossa with no discernible neurologic or vascular deficit within the right arm. X-ray was normal. The patient had a bone scan, including SPECT, suggesting a fracture of the right first rib, subsequently confirmed on CT examination.