Scapular stress fracture in a professional baseball player: a case report and review of the literature

Scapular Stress Fracture of the Inferior Angle in an Adolescent Swimmer

We present the case of a competitive swimmer who was 14 years, 9 months old and had a 4-month history of posterior shoulder pain. She was initially evaluated by her school's trainer and completed a 2-week rehabilitation program, but pain returned with return to swimming. After feeling a "pop" while swimming with an increase in associated shoulder pain, the patient presented for medical evaluation. Plain radiographs were read as unremarkable. A formal physical therapy program resulted in increased pain, and the patient returned to clinic within 2 weeks with pain out of proportion to examination. Magnetic resonance imaging at this time identified a stress fracture along the inferior angle of the scapula, prompting a complete shutdown of activity for 4 weeks with vitamin D and calcium supplementation. A physical therapy regimen was restarted at 6 weeks with complete resolution of symptoms and return to swimming at 3 months. This case report is important because it highlights a sports-related stress fracture of the inferior angle of the scapula, a finding not currently present in the literature, in a swimmer, a sport not yet associated with scapular stress fractures. [Orthopedics. 202x(xx):xx-xx.].

Unusual Stress Fracture in a CrossFit Athlete: A Case Report

CASE

This is a case of a 28-year-old CrossFit athlete who was observed at the emergency department after a competition with acute right shoulder pain. After investigation, she claimed of some posterior shoulder tightness for the past month, without any trauma associated. After the imaging study, we diagnosed a scapula stress fracture. After 8 weeks of rest, she was pain free and returned to sports.

CONCLUSION

Stress fracture of the scapula should be considered in the differential diagnosis of shoulder pain in overhead activities athletes. This case illustrates an excellent prognosis with conservative treatment and the potencial for full return to sports.

Overlooked Fracture of the Inferior Scapular Angle Treated Conservatively

Isolated fracture of the inferior scapular angle is extremely rare. We present the case of a 20-year-old female with persistent periscapular pain and a winged scapula caused by delayed union of an inferior scapular angle (ISA) fracture. Ten months previously, the patient had a car accident while seated in the left rear passenger seat. The patient visited an orthopedic clinic where a surgeon diagnosed left shoulder contusion without any abnormal radiographic findings. The left arm was kept in a sling for 2 months, as left arm elevation caused severe pain in the upper back. After sling removal, the dull pain around the left scapula continued. The patient presented at our clinic because her mother had noticed the deformity of her back. Radiographs showed a small bony fragment in the ventral side of the ISA. Computed tomography revealed a narrow gap between the ISA and the fragment. The patient's symptoms resolved with conservative treatment that consisted of relative rest for 2 months and subsequent reinforcement exercises of the serratus anterior for 2 months.

Scapular Body Fracture in the Athlete: A Systematic Review

BACKGROUND

Scapular body fractures generally occur as a result of high-energy, direct trauma to the shoulder sustained in automobile accidents. While such mechanisms have been well described, little is known about scapular body fractures sustained during sporting activities.

QUESTIONS/PURPOSES

We sought to systematically review the literature on scapular body fracture sustained during sporting activity, recording rates and mechanisms of injury, management strategies, and return-to-sport times.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of studies conducted between 1985 and 2017. Inclusion criteria were studies examining scapular body fractures sustained during sporting activity, fracture management, and patient outcomes. Exclusion criteria were studies on non-sporting-related fractures and those not reporting fracture management or patient outcomes.

RESULTS

Nine studies encompassing ten cases of scapular body fracture sustained during sporting activity were identified, with acute trauma responsible for 70% of fractures. No patient sustained any associated injuries. Fractures were treated conservatively in 90% of cases, with no reported complications. Mean overall time to return to sport was 2.5 months, while no significant difference in return to sport was appreciated in athletes with acute versus fatigue fractures.

CONCLUSION

Scapular body fractures in athletes occur primarily from muscle contraction against a resisted force in the upper extremity during contact sports. Unlike non-sporting fractures, these fractures usually involve low-energy mechanisms without associated injury and conservative treatment is usually successful.

Understanding and evaluating shoulder pain in the throwing athlete

Shoulder pain in the throwing athlete can present at any age and in any level of sport and can lead to dysfunction. A thorough evaluation of the throwing athlete can often determine the cause of symptoms, which is frequently multifactorial. Although the pathophysiology leading to pain in the shoulder of the throwing athlete is not entirely known, nonoperative modalities remain the mainstay of treatment. In general, surgical intervention should be reserved as a last resort. Effective treatment often requires collaboration among trainers, players, physicians, and therapists to determine an appropriate course of action.

Diagnostic problem solving in male collegiate athletic trainers

CONTEXT

Knowledge and experience may be important factors for understanding expertise based upon a clinician's ability to select and execute an appropriate response as a clinician during injury evaluation.

OBJECTIVE

To describe how collegiate male certified athletic trainers represent injury-evaluation domain knowledge during a situational interview using a think-aloud protocol.

DESIGN

Qualitative.

SETTING

National Collegiate Athletic Association Division I and II colleges in National Athletic Trainers' Association District 3.

PATIENTS OR OTHER PARTICIPANTS

A total of 20 male certified athletic trainers (n = 10 with less than 2 years of experience in the college setting and n = 10 with at least 10 years of experience in the college setting) participated in the study.

DATA COLLECTION AND ANALYSIS

We collected data using a situational interview and questionnaire. Data were transcribed, reduced to meaningful units, and analyzed using verbal analysis procedures. Member checks, triangulation of data, field journaling, and peer-debriefing techniques were used to ensure trustworthiness of the data. Knowledge concepts were enumerated to describe differences between experts and novices.

RESULTS

Compared with novices, experts had more knowledge concepts of patient history and predictions and fewer concepts of situation appraisal.

CONCLUSIONS

Expertise in athletic training shares traits with other areas in health care. Athletic training education and professional development may benefit from our understanding which cognitive processes differentiate expert practice. Future investigators should attempt to describe other settings and study diagnostic problem solving in a natural environment.

[Stress fracture of the scapular spine associated with rotator cuff dysfunction: Report of 3 cases and review of the literature]

Scapular spine stress fractures have been scarcely reported in the literature. Their pathomechanics, clinical course and treatment are not well established. We review 3 cases in 2 patients that were associated with cuff dysfunction. On follow-up, none of these fractures progressed to healing. Two of them needed osteosynthesis and bone grafting, and the third one became a painless non-union. The authors propose the combination of 3 factors as a reason for this lesion: a functionally impaired cuff, a greater activation of the muscles with origin and insertion in the spine-acromion and a fragile bone. As we believe that these fractures are unstable, and non-union would be expected, their surgical management is recommended.

Stress fractures of the ribs and upper extremities: causation, evaluation, and management

Stress fractures are common troublesome injuries in athletes and non-athletes. Historically, stress fractures have been thought to predominate in the lower extremities secondary to the repetitive stresses of impact loading. Stress injuries of the ribs and upper extremities are much less common and often unrecognized. Consequently, these injuries are often omitted from the differential diagnosis of rib or upper extremity pain. Given the infrequency of this diagnosis, few case reports or case series have reported on their precipitating activities and common locations. Appropriate evaluation for these injuries requires a thorough history and physical examination. Radiographs may be negative early, requiring bone scintigraphy or MRI to confirm the diagnosis. Nonoperative and operative treatment recommendations are made based on location, injury classification, and causative activity. An understanding of the most common locations of upper extremity stress fractures and their associated causative activities is essential for prompt diagnosis and optimal treatment.

Scapular stress fracture in water polo: a case report

Water polo is an intense sport with extreme physical contact and repetitive shoulder motion that predisposes to injury. The continuous scapular motion and recruitment of the scapular stabilizers to maintain buoyancy expose water polo athletes to the risk of scapular stress fracture. Suspicion should arise when evaluating water polo athletes presenting with shoulder pain.

Stress fracture of the scapula in a professional baseball pitcher: case report and review of the literature

We report a case of a 26-year-old, right-handed professional baseball pitcher who presented with gradually worsening right shoulder pain. Initial magnetic resonance imaging and computed tomography demonstrated a stress fracture involving the posterior aspect of the scapula at the junction between the scapular neck and body. After a period of rest, follow-up magnetic resonance imaging and computed tomography performed 3 1/2 weeks later demonstrated ongoing healing of the stress fracture.

Spontaneous scapular spine fracture related to rotator cuff pathology: a report of two cases

Spontaneous fractures of the scapula are rare, especially those involving the scapular spine. There are only a few case reports addressing this topic. Two cases are presented of spontaneous scapular spine fractures in patients with cuff-tear arthropathy. Treatment was conservative, resulting in a stiff shoulder in both patients. The combination of oral steroids and cuff-tear arthropathy seems to have caused a spontaneous scapular spine fracture in these patients. Considering the risk of operative intervention in the elderly patient conservative treatment seems a reasonable alternative.

Stress fractures of the metacarpal bones in adolescent tennis players: a case series

BACKGROUND

There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal.

PURPOSE

The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players-the carpal boss.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player.

RESULTS

Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip.

CONCLUSION

Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.

Delayed union of a scapular fracture-an unusual cause of persistent shoulder pain

INTRODUCTION

Scapular fractures in athletes are rare, although they have been reported in football and baseball players. Most scapular fractures heal with nonoperative management; delayed union is rarely a problem.

CASE SUMMARY

A 15-yr-old male fell onto his posterior shoulder after he had been pushed into the boards and then fell to the ice during a hockey check. He was diagnosed with a rotator cuff injury at an outside facility. Initial radiographs were negative. The patient was not immobilized, and he continued to play hockey despite intermittent pain. Seven months later, he presented to our sports medicine clinic, complaining of an aching pain at the base of his left shoulder. Examination revealed point tenderness along the base of the scapula, restriction of shoulder abduction, rhomboid weakness, scapular winging, and anterior impingement-type shoulder pain. A new radiograph, obtained at our sports medicine clinic, was nondiagnostic. Magnetic resonance imaging revealed increased signal on T2, with bone edema at the lateral margin of the scapular neck. A computed tomography scan revealed an unhealed, left-transverse, subglenoid scapular fracture. The fracture was nondisplaced. The patient was treated with transcutaneous electrical stimulation for 6 months and a physical therapy regimen focusing on periscapular strengthening. A final computed tomography scan, 6 months after initial presentation to our clinic, revealed healing of the fracture. Examination was normal. The patient was asymptomatic and was able to fully return to sports without any complications.

CONCLUSIONS

Although scapular fractures in athletes are rare, they may occur, particularly in "contact sports" that share the energies of injury seen in high-speed motor vehicle collisions. Early identification and proper management are integral to decrease symptoms and to avoid protracted disability, particularly in athletes.