The Shoulder

Shoulder Girdle

Fracture of the first rib

Occurence

A Stress fracture (very often complicating an obstructive pulmonary disease) rather than a trauma is usually the cause.
There is unilateral pain in the supraclavicular area.

Clinical signs

The lesion is characterised by the presence of positive neck signs, scapular signs and shoulder signs:

Active and passive side flexion of the neck to the painless side increase the pain (passive pull of the scaleni muscles); consequently, resisted side flexion towards the pain is painfull and weak (active pull of the scaleni).
All active and passive and resisted movements of the scapulae provoke pain through a pull on the costoclavicular ligament.
The active elevation of the arm is extremely painful and in most cases the patient cannot raise the arm actively beyond the horizontal.This is caused once again by the the indirect pull on the fracture via the costoclavicular ligament.

Treatment

Spontaneous cure within two months.

Main Menu / Preliminary Examination / Interpretation of the preliminary examination / Pathology