Clinical Practice and Cases in Emergency Medicine

Introduction: Shoulder pain is a common emergency department (ED) presentation. Scapular winging is a rare condition often associated with long thoracic nerve injury. This case report describes an even rarer case of dorsal scapular nerve injury caused by a nontraumatic first rib fracture in a young weightlifter, an injury mechanism not previously reported in the literature.

Case Report: A 17-year-old male presented to the ED with left shoulder pain following weightlifting. Physical examination demonstrated scapular winging, and a clinical diagnosis of dorsal scapular neuropraxia was made. Imaging revealed a nontraumatic first rib fracture. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and rest, resulting in complete resolution of symptoms within two weeks at clinic follow-up.

Conclusion: To our knowledge, this is the first case in the emergency medicine literature of a nontraumatic rib fracture with associated dorsal scapular nerve injury and scapular winging. This case highlights the importance of thorough visual inspection and movement assessment by emergency physicians in patients presenting with shoulder pain, as key findings such as scapular asymmetry and neurologic injuries may otherwise be missed. Recognizing rare injuries like nontraumatic first rib fractures with associated neurologic deficits is critical for timely diagnosis and management, which can lead to excellent outcomes.