Management of Proximal Humeral and First Rib Stress Fractures

Stress fractures in athletes classically are seen in the bones of the lower extremity, often in association with repetitive weight-bearing activities. Upper-extremity stress fractures are relatively uncommon and are mostly described in the literature as individual case reports or small series. It is important to consider the diagnosis of stress fracture in athletes with upper limb pain of bony origin associated with overuse. These injuries typically are the result of intense repetitive motions in the young athlete. Proximal humeral stress fractures most often are seen in athletes engaged in overhead activities, whereas both throwers and weightlifters are at risk of developing stress fractures of the first rib. The diagnosis can be made with the use of adequate history, physical examination, and plain radiographs. These fractures commonly heal with conservative management of analgesics and activity modification and very rarely need any type of surgical intervention.