{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:55:04Z","timestamp":1790934904061,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: First rib stress fractures (FRSFs) are exceptionally rare in skeletally immature athletes and are frequently overlooked because their symptoms mimic more common scapular conditions such as scapular dyskinesis or thoracic outlet syndrome. Early and accurate identification is critical to avoid delayed union, prolonged disability, and misdirected management. Case Presentation: We report a 12-year-old elite baseball pitcher with progressive scapular winging and audible snapping during pitching. Unlike typical posterior-type fractures near the costotransverse joint, imaging revealed a cortical discontinuity precisely at the serratus anterior enthesis, consistent with repetitive traction enthesopathy. High-resolution musculoskeletal ultrasound (MSK-US) identified cortical disruption with periosteal edema, and dynamic ultrasound reproduced the patient\u2019s snapping and pain in real time, establishing a direct clinical\u2013imaging correlation. Conservative three-phase rehabilitation (scapular stabilization, serratus anterior activation, and structured return-to-throwing) led to complete union and pain-free return to sport within 12 weeks. Discussion: This case highlights the superior diagnostic efficacy of MSK-US for FRSFs in adolescents. The posterior scanning approach facilitated bilateral comparison and growth plate assessment. Dynamic examination provided a functional correlation beyond static imaging, identifying a novel snapping mechanism. This underscores the value of MSK-US in visualizing not just anatomy but also pathophysiology. Conclusions: This is among the youngest documented cases of first rib stress fracture diagnosed with dynamic ultrasound. Its novelty lies in the following: (1) occurrence at the serratus anterior enthesis, (2) reproduction of snapping during provocative maneuvers, and (3) expansion of the etiological spectrum of scapular dyskinesis to include rib pathology. Dynamic ultrasound should be considered a frontline modality for adolescent throwers with unexplained periscapular pain.<\/jats:p>","DOI":"10.3390\/diagnostics15192437","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T13:16:11Z","timestamp":1758719771000},"page":"2437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Innovative Dynamic Ultrasound Diagnosis of First Rib Stress Fracture in an Adolescent Athlete\u2014A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"},{"name":"Incheon Terminal Orthopedic Surgery Clinic, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"International Academy of Regenerative Medicine, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Board of Clinical Research, International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King Hei Stanley","family":"Lam","sequence":"additional","affiliation":[{"name":"Board of Clinical Research, International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"The Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong"},{"name":"The Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1207-348X","authenticated-orcid":false,"given":"Chanwool","family":"Park","sequence":"additional","affiliation":[{"name":"Incheon Terminal Orthopedic Surgery Clinic, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Incheon Terminal Orthopedic Surgery Clinic, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jangkeun","family":"Kye","sequence":"additional","affiliation":[{"name":"Rolfing Spine Posture Institute, Seoul 06236, Republic of Korea"},{"name":"Korean Association of Cyriax Orthopaedic Medicine, 375-1 Yongmun-ro, Yongmun-myeon, Yangpyeong 12522, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeeun","family":"Kim","sequence":"additional","affiliation":[{"name":"Korean Association of Cyriax Orthopaedic Medicine, 375-1 Yongmun-ro, Yongmun-myeon, Yangpyeong 12522, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seonghwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Korean Association of Cyriax Orthopaedic Medicine, 375-1 Yongmun-ro, Yongmun-myeon, Yangpyeong 12522, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhan","family":"Kang","sequence":"additional","affiliation":[{"name":"Korean Association of Cyriax Orthopaedic Medicine, 375-1 Yongmun-ro, Yongmun-myeon, Yangpyeong 12522, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0988","authenticated-orcid":false,"given":"Anwar","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"Board of Clinical Research, International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Rehabilitation Medicine, University Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6722-0268","authenticated-orcid":false,"given":"Teinny","family":"Suryadi","sequence":"additional","affiliation":[{"name":"Board of Clinical Research, International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta 14350, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 12950, Indonesia"},{"name":"Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11510, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-0918","authenticated-orcid":false,"given":"Daniel Chiung-Jui","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan 710, Taiwan"},{"name":"Tempo Regeneration Center for Musicians, Tainan 700, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-2326","authenticated-orcid":false,"given":"Kenneth Dean","family":"Reeves","sequence":"additional","affiliation":[{"name":"Independent Researcher, Roeland Park, KS 66205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Cavallino","sequence":"additional","affiliation":[{"name":"European School of Prolotherapy (ESP), 1st Mednikarska Str., 1510 Sofia, Bulgaria"},{"name":"Hackett Hemwall Patterson Foundation (HHPF), 7880 Sweeny Rd., Barneveld, WI 53507, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e230094","DOI":"10.1148\/rg.230094","article-title":"Shoulder and elbow injuries in adult overhead throwers: Imaging 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