Lin H C, Chou C S, Hsu T C
Department of Physical Medicine & Rehabilitation, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jul;54(1):33-7.
Stress fractures of the ribs are sometimes seen at the Outpatient Department in patients with a history of playing golf enthusiastically. Many are diagnosed as "muscle strain" or "myofascial pain" and patients are simply advised to take some rest or are treated with analgesics and local injection. This case study investigated 11 amateur golfers whose chief complaint was anterior, posterior or lateral chest pain. After X-ray and bone scan evaluation, "stress fracture of the ribs" was diagnosed. A questionnaire presented to them trying to find the possible mechanisms of these stress fractures. Biomechanical analysis showed that the bending force of the ribs was located at posterolateral segments where fractures tend to occur. Overuse, poor technique and inadequate stretch in beginners are postulated as causes for apparent increased susceptibility to these skeletal injuries.
Questionnaires inquired about (1) warm-up time, (2) number of strikes, (3) fracture sites, (4) pain patterns, (5) combined injuries.
All 11 patients were beginners with right side hand dominance who had begun to play golf within the year. Right side ribs fracture occurred in six cases; left side ribs fracture occurred in eight cases including three patients with two fracture sites. Localized pain was reported in six cases and there were five cases with radiating pain along costal margins. All the golfers had spent no more than 10 minutes in warm up them. Seven patients suffered from multiple injuries after they had played. Five were diagnosed by X-ray and six showed positive finding after Tc-99m MDP bone scan. All lesions were located at the posterolateral segments of the ribs.
Stress fractures of the ribs in amateur golfers are certainly not uncommon. Predominant muscle forces are generated by forced coupling of scapular retraction and protraction, acting through the serratus anterior. With early diagnosis and relative rest for four to eight weeks, the pain will improve. Overuse, poor technique and inadequate stretch will probably lead to stress fracture of the rib.
在门诊中，有时会见到热衷于打高尔夫球的患者出现肋骨应力性骨折。许多此类患者被诊断为“肌肉拉伤”或“肌筋膜疼痛”，医生只是简单建议他们休息，或给予止痛药物及局部注射治疗。本病例研究调查了11名以胸前区、胸后区或胸侧部疼痛为主诉的业余高尔夫球手。经X线和骨扫描评估后，确诊为“肋骨应力性骨折”。向他们发放了一份问卷，试图找出这些应力性骨折可能的机制。生物力学分析表明，肋骨的弯曲力位于骨折易发生的后外侧段。过度使用、技术不佳以及初学者伸展不足被认为是这些骨骼损伤易感性明显增加的原因。
问卷询问了（1）热身时间，（2）击球次数，（3）骨折部位，（4）疼痛模式，（5）合并损伤情况。
所有11名患者均为初学者，惯用右手，且在一年内开始打高尔夫球。右侧肋骨骨折6例；左侧肋骨骨折8例，其中3例有两个骨折部位。6例报告有局部疼痛，5例有沿肋缘放射痛。所有高尔夫球手热身时间均不超过10分钟。7名球手在打球后出现多处损伤。5例经X线诊断，6例经锝-99m亚甲基二膦酸盐（Tc-99m MDP）骨扫描显示阳性结果。所有损伤均位于肋骨后外侧段。
业余高尔夫球手的肋骨应力性骨折确实并不少见。主要的肌肉力量是由肩胛骨后缩和前伸的强制耦合产生的，通过前锯肌起作用。早期诊断并相对休息4至8周，疼痛会有所改善。过度使用、技术不佳和伸展不足可能会导致肋骨应力性骨折。
