Disclosures: Jake Stephen, DO: No financial relationships or conflicts of interest

Case Diagnosis: 50 year old male, avid cyclist, with pneumothorax secondary to multiple rib fractures

Case Description or Program Description: 3 days prior to presentation, the patient was mountain biking and fell off of his bike, landing on the left side of his chest. Patient immediately had left-sided rib pain which he rated as 8/10. Pain was described as dull or sharp, based on activity, worsened with coughing and leaning forward. Minimal pain relief with ibuprofen. Denied any trouble breathing, chest pain, or previous rib injuries and had continued stationary biking without issue. Exam notable for O2 saturation of 98% on room air, mild tenderness to palpation of anterior mid-ribs and minimal tenderness to posterior ribs. Limited ultrasound evaluation was performed in clinic to visualize anterior ribs where pain was located, showing no cortical fractures. Chest x-ray obtained showed large pneumothorax on left side and fractures to ribs 6 and 7 posterolaterally

Setting: Outpatient Sports and Musculosketal Medicine Clinic

Assessment/Results: Patient was sent to a nearby ER for further evaluation and treatment following peer-to-peer handoff. He required trauma surgery evaluation and chest tube placement. Patient was admitted for 3 days, with resolution of pneumothorax. He was evaluated in clinic about a month after his initial visit. He endorsed some left-sided pain with deep inspiration, which was managed well with PRN ibuprofen. Patient subsequently returned to mountain biking activities, utilizing a chest protector while biking.

Discussion (relevance): Despite no respiratory symptoms and minimal tenderness on palpation, the patient was diagnosed with pneumothorax secondary to multiple rib fractures, requiring chest tube placement.

Conclusions: Rib fractures are a common thorax injury in sports. An important complication to recognize is pneumothorax even in the absence of significant respiratory symptoms. Early recognition and management of this potentially life threatening injury is imperative. Discussing RTP protocol with athletes following rib fractures is also important.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pneumothorax-after-fall-from-mountain-biking-a-case-report/