Ultrasound Identifies First Rib Stress Fractures: A Case Series in National Collegiate Athletic Association Division I Athletes

Isolated first rib stress fractures in athletes are thought to be rare. In this case series, 3 National Collegiate Athletic Association Division I athletes developed isolated first rib stress fractures over the span of 1 year, indicating that these injuries may occur more often than previously understood. These fractures can be easily missed because of the low incidence, lack of clinical suspicion, and vague presentation. Further, radiographs can fail to reveal such fractures. To our knowledge, this is the largest case series of athletes with first rib stress fractures presenting with vague rhomboid interscapular pain. We also demonstrated that ultrasound successfully visualized these injuries; in the hands of an ultrasonographer or clinical provider trained in musculoskeletal ultrasound, this technique offers an advantageous point-of-care screening imaging modality.

Clonidine as an Adjunct for the Successful Treatment of Labor Epidural Infusion-Associated Interscapular Pain

Epidural infusion-associated interscapular pain for laboring parturients is a treatment dilemma for obstetric anesthesiologists. We report a case of a parturient who was successfully treated for labor epidural analgesia-associated interscapular pain. Our treatment plan included reducing the volume of local anesthetic administered by adding the adjunct of clonidine, increasing the epidural solution concentration of local anesthetic, and reducing the overall infusion rate. We conclude that epidural clonidine should be considered a safe adjunct when treating laboring parturients who report epidural infusion-associated interscapular pain.