Ulnar stress fracture of the nondominant arm in a tennis player using a two-handed backhand

Ulnar stress fracture in a softball player

Clinicians need to have a high index of suspicion in overhead athlete with persistent pain. MRI and bone scans are more sensitive than X-rays in detecting ulnar stress fractures. Increased awareness will improve diagnosis and patient outcomes.

Wrist Injuries in Tennis Players: A Narrative Review

The wrist/hand complex forms the crucial final link in the kinetic chain between the body and the racquet and therefore has a number of important roles in the production of all tennis strokes. However, the internal and external loads that are created at the wrist during these strokes have the potential to contribute to pain and injury. Therefore, the purposes of this narrative review are to (1) determine the extent of the problem of wrist pain/injury in tennis players, (2) identify bony and soft tissue structures of the wrist that are susceptible to damage as a result of tennis play and (3) explore factors that may influence the development of wrist pain/injury in tennis players. The epidemiological data revealed two important points. First, some evidence suggests wrist pain/injury accounts for a higher percentage of total injuries in more recent studies (2014-2015) than in early studies (1986-1995). Second, the relative frequency of wrist pain/injury compared with other well-recognized problem areas for tennis players such as the shoulder complex, elbow and lumbar spine is noticeably higher in more recent studies (2014-2015) than in early studies (1986-1995), particularly among females. Collectively, this would seem to indicate that the problem of wrist pain/injury has increased in the modern game. In fact, some wrist injuries appear to be related to the use of certain forehand grip types and the predominant use of the two-handed backhand. While the loads experienced at the wrist during tennis stroke production seem to be below threshold levels for a single event, the cumulative effects of these loads through repetition would appear to be an important consideration, especially when inadequate time is allowed to complete normal processes of repair and adaptation. This is supported by the evidence that most wrist injuries in tennis are associated with overuse and a chronic time course. The complex interaction between load, repetition, and training practices in tennis, particularly among young developing players who choose a path of early specialization, needs to be further explored.

Bilateral stress fractures of the ulna in a young adolescent

We present a case of bilateral ulnar stress fractures in a young male adolescent (15 years old) due to honour guard training and discuss the possible mechanism of this injury. In addition to acquisition of medical history, physical examination and plain radiography, we performed MRI to exclude pathological causes and confirm the plain radiographic findings, indicating stress reactions. Ulnar stress fractures are bone injuries caused by repetitive muscle pull and the reaction of supporting tissues. In honour guard training, the acceleration due to gravity and chronic torsional stress may also contribute to overloading. Thus, such fractures are best managed by avoiding overloading. In addition, we review the literature on stress fractures of the ulnar shaft to map this special kind of fracture.

Ulnar shaft stress fracture in a high school softball pitcher

This article presents a case of a 17-year-old softball pitcher with insidious onset of right forearm pain. On presentation, the patient had tenderness on palpation of the midshaft of the ulna, pain with resisted pronation, and pain with fulcrum-type stressing of the forearm. A bone scan revealed increased uptake in the right ulna, and a subsequent magnetic resonance imaging revealed bone marrow edema and numerous small ulnar stress fractures. She was treated with bone stimulation and complete rest and is in the process of returning to pitching.

Spontaneous bilateral distal ulna fracture: an unusual complication in a rheumatoid patient

Bilateral ulna stress fractures are extremely rare. Patients with rheumatoid arthritis have osteopenic bone secondary to a variety of causes. We report a case of bilateral stress fractures of the ulna in an elderly patient with rheumatoid arthritis, and literature on this condition is reviewed. Prompt recognition and activity modification are essential to treat this rare injury. Recovery can take up to 12 weeks.

MRI of Stress Reaction of the Distal Humerus in Elite Tennis Players

OBJECTIVE

The purpose of this study was to describe the MRI appearance of stress reaction in the distal humerus in 12 elite tennis players. In addition, we aimed to determine whether any MRI findings were associated with changes in recovery times.

CONCLUSION

Stress injury to the distal humerus is a cause of chronic arm pain among elite tennis players and may be exacerbated during full competition. The degree of marrow edema on STIR MRI may be predictive of time to return to competition.

Tennis injuries: occurrence, aetiology, and prevention

A systematic search of published reports was carried out in three electronic databases from 1966 on to identify relevant articles relating to tennis injuries. There were 39 case reports, 49 laboratory studies, 28 descriptive epidemiological studies, and three analytical epidemiological studies. The principal findings of the review were: first, there is a great variation in the reported incidence of tennis injuries; second, most injuries occur in the lower extremities, followed by the upper extremities and then the trunk; third, there have been very few longitudinal cohort studies that investigated the association between risk factors and the occurrence of tennis injuries (odds ratios, risk ratios, hazard ratios); and fourth, there were no randomised controlled trials investigating injury prevention measures in tennis. More methodologically sound studies are needed for a better understanding of risk factors, in order to design useful strategies to prevent tennis injuries.

Upper Extremity Stress Fractures

Although less common than lower-extremity stress fractures, upper-extremity stress fractures are becoming recognized much more frequently. A majority of these fractures are caused by overuse and fatigue of the surrounding musculature and, as a result, may be prevented by appropriate training and conditioning. Diagnosis is made by history and physical examination with the aid of plain radiographs, bone scans, and MRI. Most of these fractures heal with a period of relative rest followed by a structured rehabilitation program. A small percentage of these fractures, however, may require surgical fixation. The present article reviews the different types of upper extremity and torso stress fractures seen in athletes, starting with the sternum and extending outward to the fingers. The presentation, diagnosis, mechanism of injury, treatment, prevention, and prognosis for each of these injuries will be discussed.

Stress Fracture of the Ulnar Styloid Protuberance

Stress fractures of the upper extremities are uncommon but can be a serious source of morbidity if not correctly diagnosed. We present a rare case of a 49-year-old female typist, who reported a 4-month history of a pain located in the region of the left lower ulnar epiphysis and extended to the left portion of the wrist. The patient did not mention any injury. The pain was exacerbated during typing and the clinical diagnosis of tendonitis was made initially. Because of the patient's persistent symptoms, she underwent a plain radiograph investigation in the region of the left lower forearm and wrist, which did not reveal any bone lesion. Consequently, we performed a 3-phase bone scan that showed findings consistent with a fracture of the left ulnar styloid protuberance. The fracture was thought to have a stress origin attributed to the patient's tough working.

Stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a spinner bowler: a case report and a review of the literature

Stress fractures of the ulnar shaft are uncommon injuries, which have been documented in a variety of sports. The location of the fracture is influenced by the activity and mechanism of injury with which it is associated. The combined traditional approach of clinical history, physical examination, plain radiographs and nuclear scintigraphy for unusual stress fracture may be troublesome. This report is the first to describe a stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a bowler due to chronic torsional stress. We discuss the possible mechanism of injury and describe the diagnostic imaging. A review of the literature is also given and compared with the findings and data of this case.

Stress fracture of the ulna associated with crutch use

Stress fractures of the ulna are extremely rare. The purpose of this article is to report one more case of this occurrence in an eleven-year-old girl, who was using adjustable metal crutches, and to discuss the possible cause.

Stress fracture of the ulnar styloid process in kendo player--a case report

We present a case report of a 15-year-old kendo (Japanese fencing) player who suffered a stress fracture of the ulnar styloid process. Exercise of the kendo requires the athlete to flex his non-dominant wrist repeatedly in an ulnar direction, and causes the disorder. Excision of the osteochondral fragment relieved the symptoms. This lesion is likely to occur with other sports or activities which demand similar motion of the wrists.

Overuse injuries of the upper extremity in tennis players

Several overuse injuries can affect the upper extremity of tennis players. A thorough understanding of anatomy and knowledge of these common conditions and their treatment facilitates the management of these athletes.

Musculoskeletal injuries in the young tennis player

Tennis is becoming increasingly popular, especially with young athletes. Despite recent advances in epidemiologic research of tennis injuries, there still is a need for more injury research in all of the racquet sports. The data that does exist show that the young athlete is susceptible to injury in these different sports. Injury patterns in the skeletally immature racquet sports athlete are becoming apparent. Although most of the sports result in similar injury patterns, such as a predominance of lower extremity injury, there are differences. It appears that the physical demands of the sport are becoming more clearly documented, and the adaptive response to these demands is becoming understood. The adaptive response reveals a common origin for many of the injuries in the different sports. This is related most often to repetitive microtrauma with resultant loss in flexibility and strength. The sports medicine practitioner must understand these differences, know the demands, do serial musculoskeletal evaluations for maladaptations, and adhere to a periodized prehabilitation program of preventative exercises to maximize performance and minimize injury risk.

Selected topics in orthopedic nuclear medicine

Nuclear medicine provides information about bone physiology that complements anatomic imaging modalities. Following a review of the principles of bone scintigraphy, scintigraphic imaging of orthopedic problems, such as primary and secondary neoplastic disease of the skeleton, occult fracture, stress fracture, and osteomyelitis are discussed.

Injuries to elite rowers over a 10-yr period

The purpose of this study was to analyze retrospectively all injuries occurring in a population of elite rowers over a 10-yr period to determine their pattern of injury. The medical records of all rowers at the Australian Institute of Sport from 1985 to 1994 inclusive were reviewed and all injuries included. Injuries were categorized according to time, location, cause, and whether acute or chronic. The study found a significant incidence of chest injuries, rib stress fractures, and low back injuries, and a high number of injuries occurring outside specific training. Elite rowers have little risk of major injury, but mild and moderate injuries are common.