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Two Years of Debilitating Pain in a Football Spearing Victim: Slipping Rib Syndrome


Medicine & Science in Sports & Exercise: October 2003 - Volume 35 - Issue 10 - pp 1634-1637
CLINICAL SCIENCES: Clinical Investigations

PETERSON, L. L., and D. G. CAVANAUGH. Two Years of Debilitating Pain in a Football Spearing Victim: Slipping Rib Syndrome. Med. Sci. Sports Exerc., Vol. 35, No. 10, pp. 1634–1637, 2003.

Introduction: Blunt chest trauma can occur in a variety of sports, and lead to rib fractures and less commonly known and diagnosed injuries. We report the case of a 14-yr-old student athlete who was speared (helmet tackled) in a practice scrimmage sustaining a painful injury that eluded diagnosis and treatment for more than 2 yr.

Methods : The case history of pain treatments and radiological evaluations is presented.

Results: Ultimately, a definitive diagnosis of “slipping rib syndrome” was achieved through a simple clinical manipulation (the hooking maneuver), combined with a history of symptomatic relief provided with costochondral blockade. Surgical resection of the slipping rib provided total resolution of the problem.

Conclusion: Very few clinicians are aware either of the syndrome or the maneuver used to diagnose this condition. Although spearing has been outlawed in American football for years, it remains a commonplace occurrence, and sports physicians should be aware of the potential consequences to the victim as well as those to the perpetrator.

Rib-cage injuries can be particularly painful and debilitating. Blunt rib-cage trauma can occur in any sports activity where an individual collides forcefully with balls, pucks, sticks, the ground, objects on the sidelines, and other players. Each year, more than 150,000 football players under the age of 15 seek treatment for injuries in hospital emergency rooms. Studies have shown that 15–20% of players age 8–14 are injured during the football season. Among tackle football players on high school teams, the injury rate is reported as high as 64%. Although many of these injuries are concussions, sprains and strains of the upper and lower extremities, rib-cage injuries constitute from 2.3% to 4.2% of the cases (14).

We report a case of a 14-yr-old victim of a school football spearing incident who sustained a debilitating rib-cage injury that eluded diagnosis for more than 2 yr despite extensive state-of-the-art radiological examination. The ultimate definitive diagnosis was made through a little known, simple clinical examination procedure that could have saved this individual and his family years of pain, medical costs, and disability. In that this injury can occur in any sport with impact to the chest wall from opponents or equipment, including hockey, rugby, gymnastics, etc., clinicians should be more widely aware of this syndrome and diagnostic maneuver. Reporting of this case has received Institutional Review Board approval.

1Department of Pediatrics, Marshfield Clinic-Chippewa Center, Chippewa Falls, WI; and

2Department of General Surgery, Marshfield Clinic-Eau Claire Center, Eau Claire, WI

Address for correspondence: Dr. Laurie L. Peterson, Department of Pediatrics, Marshfield Clinic-Chippewa Center, 2655 County Hwy. I, Chippewa Falls, WI 54729; E-mail:

Submitted for publication May 2002.

Accepted for publication April 2003.

©2003The American College of Sports Medicine