Atraumatic first rib fractures are an uncommon diagnosis in the emergency department and case reports are lacking in the Emergency Medicine literature. A 26-year-old man presented to the emergency department with significant right shoulder pain after weightlifting. Plain radiographs showed no fracture or dislocation with a subsequent CT revealing a first rib fracture. Given the uncommon nature of this injury, first rib fractures should be considered in patients with recent weightlifting or similarly explosive activity.