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Objective: To present a case of a rodeo cowboy who suffered a seemingly routine 1st degree acromioclavicular (AC) sprain. The AC sprain was exacerbated by an elevated 1st rib. Background: Saddle bronc riding is one of three rough stock events in North American rodeo and the least common event for injury relative to bull riding and bareback riding. Shoulder injury in rodeo rough stock events make up 9.3% of all injuries. Approximately 28% of injuries in rodeo are considered minor sprains. The professional cowboy was thrown from his horse landing on the tip of his shoulder. The cowboy presented with a routine 1st degree AC sprain based on the Tossey and Rockwood definitions. Differential Diagnosis: Due to the mechanism of injury and forces produced with the cowboy being thrown to the ground, elimination of serious neck injury was critical. A scanning examination revealed some neck dysfunction. A cervical rotation, lateral flexion special test confirmed the additional elevated 1st rib in addition to the 1st degree AC sprain. Treatment: A chiropractic adjustment of the 1st rib reduced pain in the AC joint from a 6/10 to 1/10 immediately. Subsequently, the patient iced and was treated with one other 1st rib adjustment at a later date. Uniqueness: There were no cases of 1st degree AC sprains with an associated elevated first rib in the literature. It was very unique to relieve to the patient’s shoulder symptoms so dramatically in a short period of time with manual therapy to the first rib. Conclusions: It is important to follow a thorough history and physical examination of patients who suffer from a 1st degree AC sprain. The use of a scanning examination will help identify the primary source of pain (i.e. neck and/or shoulder). Manual therapy of the 1st rib may be useful in the treatment.

1st degree acromioclavicular sprain, elevated 1st rib, or both? A case study of a rodeo cowboy