A 19-year-old, right-hand-dominant female rower presented to the clinic with left periscapular pain. She had previously experienced right-sided pain of a similar nature when she had been a port-side rower. When she had switched to become a starboard-side rower, the right-sided pain gradually subsided, but over the next year she had developed left-sided pain. She described the pain as starting at the beginning of the finish phase, as well as with full extension and scapular protraction. She noticed this pain most often when she was training on the ergometer. The pain had progressed to the point where she had pain at rest and during sleep, as well as pain in the periscapular region while taking a deep breath. She reported the sensation of having a knot in the muscles surrounding the inferior aspect of the left scapula. There was no reported mechanism for an acute injury. There was no history of scoliosis or other back problems. Examination demonstrated neck and shoulder motion within normal limits. There was tenderness over the inferior aspect of the left scapula as well as the lateral chest wall, over the serratus anterior muscle. There was mild restriction in left-sided shoulder internal and external rotation (T5 versus T3) compared with the right shoulder. There was mild winging of the left scapula noted on observation of a wall push-up.
At the initial visit, radiographs of the left shoulder demonstrated no abnormalities. A subsequent magnetic resonance imaging (MRI) scan demonstrated increased marrow signal along the posterior level of the eighth rib. The difference between normal and abnormal marrow was clearly seen in axial short tau inversion recovery (STIR) images (Figs. 1-A and 1-B). Sagittal images demonstrated increased signal intensity in the eighth rib compared with the other ribs (Fig. 2).
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