Management of First Rib Dysfunction in a 25-Year-Old Female CrossFit Athlete With Persistent Shoulder Pain and a Type III Superior Labrum Anterior to Posterior Lesion: A Case Report

BACKGROUND: Superior labrum anterior and posterior (SLAP) lesions are frequently diagnosed with shoulder pain and dysfunction following sports trauma, and many patients are managed conservatively. Persistent pain, restricted movement, or instability may be attributed to intra-articular pathology, while regional mechanical contributors may be overlooked.

CASE PRESENTATION: A 25-year-old CrossFit athlete presented with left shoulder pain and dysfunction. Symptoms were initially triggered by high training volume two years prior to referral and later exacerbated by a traumatic handstand incident three months prior to referral, resulting in restricted overhead shoulder range of motion, a sense of instability, and reduced confidence. Magnetic resonance arthrography demonstrated a type III SLAP lesion. Conservative management was recommended. Despite adherence to shoulder-specific rehabilitation, active shoulder elevation remained restricted and painful.

OUTCOME AND FOLLOW-UP: Several months later, clinical findings upon evaluation by a sports physical therapist suggested first rib dysfunction as a potential contributor to the patient's shoulder symptoms. A targeted first rib intervention resulted in immediate improvements in pain and shoulder function, with further improvements maintained at the 3-week and 6-week follow-ups.

DISCUSSION: This case highlights the potential role of first-rib mechanics in shoulder pain and perceived instability in patients with imaging-confirmed SLAP lesions who are managed conservatively. It introduces a simple clinical assessment and treatment approach that may assist clinicians in optimizing conservative shoulder rehabilitation.