Stress fractures of the first rib in athletes are rare. A 14-year-old male, a baseball pitcher who changed from an overhand to a sidearm style, with a stress fracture of the first rib, was reported. Most Stress fractures in the first rib occur at the subclavian groove, between the attachments of the scalenus anterior and scalenus medius muscles, which is the thinnest and weakest portion of the rib. However, in this case the stress fracture occurred at the uncommon region, posterior to the insertion of the scalenus medius muscle, in the first rib. The motion analysis of the pitching in this case demonstrated that the sidearm style induced much more horizontal abduction in the shoulder at the top position than did the overhand style. The findings of electromyography in the serratus anterior muscle, one of the muscles which insert on the first rib, through the pitching motion did not demonstrate any significant differences between the two styles. In this case, the repetition of horizontal over-abduction of the shoulder when sidearm pitching appears to have been the cause of the unusual stress fracture of the first rib at this site