Diagnosing Zach Ertz’s Rib Injury

Eagles tight end Zach Ertz sustained an injury to his ribs in the game against the Browns in Week 1.  Last Thursday, Coach Pederson stated Ertz has a seven-millimeter displacement of his first rib and will sit out tonight’s game against the Bears.  Let’s talk specifics about first rib injuries.
Ertz’s injury is being described as a displaced rib under the collarbone, which is very rare.  It is reported that he sustained the injury in the first quarter when he was hit along the sidelines after making a catch and he continued to play the rest of the game.  Injuries to the first rib can cause severe pain around the shoulder and neck and may also cause chest pain due to the rib’s attachment to the spine and sternum (breastbone). 

A displaced first rib fracture is extremely uncommon due to its strong ligamentous and muscular attachments that help to maintain the alignment of the bone.  Displaced fractures of the first rib are more serious because of the proximity to the brachial plexus and vascular structures.  The brachial plexus is a collection of nerves that run under the first rib.  Injuring the brachial plexus can lead to pain and weakness of the shoulder and arm. 

An injury like this is generally a stress fracture, which occurs from repetitive micro trauma. Stress fractures are rare in contact sports such as football. They are typically seen in “overhead” athletes such as swimmers, tennis players, baseball pitchers, and rowers. Complete fractures occur either from trauma or a powerful contraction of the neck muscles. 

Even rarer is a displaced rib without a fracture.  This is what Ertz’s injury is according to media reports.  These injuries are similar to a shoulder separation where the injury needs time to heal and ultimately will be stable.  There is little research and little reported data on the topic of first rib fracture, let alone first rib displacement.  Most articles are single case studies or clinical commentary.  There is no published literature on this specific injury in NFL players.  There are two case reports of first rib fracture in football players, one college and one high school, who returned to play after several months. 

The good news for Ertz and the Eagles is that there is no report of fracture and he was not in severe pain.  For Ertz, return to play will be based on repeat imaging such as X-rays, MRI, and/or CT scans to confirm that it is healing appropriately, as well as physical examination and the player’s symptoms.  We should have more information in the next week or so as the team releases an update on Ertz’s progress.