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A collaborative review at three institutions documented nineteen cases of stress fractures of the fibs in golfers. Thirteen were males and six were females. The average age of the injured golfers was 39 years (range 29-51). The 4th-7th ribs were the most commonly injured. All fractures occurred along the posterolateral aspect of the ribs and involved multiple ribs in nine cases. Sixteen golfers sustained injury on the non-dominant side of the trunk, which is actually the "dominant" side in a golf swing. Eighteen golfers were beginners, while the one experienced golfer had dramatically increased his practice time on the diving range prior to injury. Plain radiographs were usually diagnostic. However, bone scintigrphy was necessary for diagnosis in three cases. A delay in diagnosis of six to eight month occurred in two cases which were originally mis-diagnosed as back strains. Stress fractures of the fibs in golfers may be more common that previously realized and may be incorrectly diagnosed as recalcitrant back strains. Based on other studies, fatigue of the serratus anterior appears to be the mechanism of injury. We recommend strengthening of the serratus anterior in the rehabilitation from this injury and in a general conditioning program for golfers. Golf in considered a leisure sport with minimal risk of injury. However, it demands tremendous skill which can only be attained through sustained prcatice. Hitting bucket after bucket of balls on the practice range can lead to overuse injury^20). The Back and non-dominant shoulder are among the most common sites injured^20,25). Symptomatology in this region is usually attributed to muscle strain. However, muscle fatigue may lead to stress fracture. In one large series of 169 stress fractures, golf was the fifth most common sport involved and the rib was the third most common bone injured^12). We present nineteen cases of stress fractures of the ribs in golfers. We have reviewed the biomechanics of the golf swing and analyzed the possible mechanism of injury. The prevention and treatment of these injuries is also discussed.
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