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Alan L. Hammond TennisMD News
Mar 22, 2010
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Many tennis players can attest to having experienced shoulder pain after frequent play or practice.
Most of these occurrences are relieved with hot or cold compresses, rest, and the occasional chiropractor visit. In other cases, however, chronic pain with little or no relief regardless of treatment can develop. An X-ray will help determine if anything can or needs to be done for the shoulder, but unless a full torso scan is done, pseudarthrosis of the first rib will go undetected.
A case of this happening was discussed recently in The Journal of Sports Medicine and Physical Fitness. An international-level tennis player, practicing 5 times a week, and complaining about constant load-dependent pain in the shoulder was examined thoroughly by researchers. A standard diagnosis was given, followed by X-rays, an MRI scan, and a computed tomography (CT) scan with 3-D reconstruction. The results showed that a pseudarthrosis of the first rib was the cause of the pain.
Further treatment was conservative, and did not relieve the pain. Five years after the initial examination, the player did not complain of pain anymore because he no longer played tennis. A control scan showed that the pseudarthrosis was still present. Researchers concluded that is important to think of the possibility of this type of injury, when treating the overhead athlete for shoulder pain.
So what is pseudarthrosis of the first rib? Pseudarthrosis which comes from the Greek words “pseudo”, meaning “false”, and “arthrosis”, meaning “joint”, is exactly as the term implies, a “false joint”. This is a non-union site comprised of fibrous tissue between parts of a bone that haven't been allowed to heal correctly. A non-union site is not a true joint. It has no ligamentious support, but will often have some motion, and remodel itself to a rounded shape like a true joint.
Stress fractures of the first rib are uncommon in non-contact sports. However, overhead or swinging athletes, such as tennis players can develop stress fractures from constant playing and practice, doctors say. If left untreated, and the athlete continues to be active, the stress fracture can turn into a pseudarthrosis. Unfortunately, at this stage, some type of surgery is unavoidable. Recently bone grafts, using bone tissue from another area to stimulate bone regrowth, and internal and external fixation, using pins, screws, and rods driven into the bone to stabilize the 2 fragments, have been used successfully to counter this problem. Junior-level, as well as professional-level players with moderate to chronic shoulder pain, and their trainers, should certainly be aware of this elusive, and potentially career-ending problem.
Sources: A Rare Reason For The End Of A Career In Competitive Tennis, Trieb, K., Huber, W., Kainberger, F., The Journal of Sports Medicine and Physical Fitness, Volume: 48 (1), March 2008, 120-2. Pseudarthrosis Of The First Rib In An Overhead Athlete, Mithofer, K., Giza, E., British Journal of Sports Medicine, Volume: 38 (2), April 2004, 221-2.
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