First Rib Dysfunction Mimicking Failed SLAP Repair: A Case Report

BACKGROUND: SLAP lesions commonly cause shoulder pain and dysfunction. Most patients recover after repair, but some have persistent limitations from stiffness or anchor over-tightening. However, first rib dysfunction represents an extra-articular contributor that may mimic failed SLAP repair.

CASE PRESENTATION: A 30-year-old female experienced pain and persistent restriction in active shoulder movement eight months after arthroscopic SLAP repair. Despite adequate surgical healing, a steroid injection, and compliance with a structured rehabilitation program, she remained limited to 135° active abduction (compared to 180° on the contralateral side). Her surgeon suspected over-tightening of the superior labrum and planned follow-up imaging, with consideration of biceps tenotomy. However, a specialist sports physiotherapy assessment identified a first rib (costa 1) dysfunction.

OUTCOME AND FOLLOW-UP: A manual mobilization technique involving sustained rib pressure during shoulder shrug and abduction movement within the patient’s pain tolerance normalized her range of motion immediately, and the effect was sustained two months after the initial consultation.

DISCUSSION: This case highlights the role of first rib mechanics in shoulder dysfunction and introduces an innovative clinical test and treatment approach for physicians, physiotherapists, and other healthcare professionals involved in shoulder rehabilitation.