![]() If that fails, surgical management such as an intramedullary rod or flexible plate is indicated. They are at a greater risk of nonunion and full cortical break and require aggressive conservative therapy. These patients may have the “dreaded black line” on x-ray. ![]() Anterior cortex tibial stress fractures are less common than the posteromedial ones and are found in jumping and leaping athletes. Stress injuries will present with pain during activities of daily living, while MTSS is generally limited to exertional activity. Typically, the patient will be tender over the medial posterior edge of the tibia often made worse with a motor exam. Medial tibial stress syndrome (MTSS), also known as shin splints or tibial periostitis, can be difficult to distinguish from medial tibial stress fractures. ![]() Tibial stress injuries are the most common location of stress reactions and fractures. Transverse fractures are at higher risk for displacement and immobilization is recommended. The patella is a rare location for a stress fracture and can be oriented either transverse or vertical. If there is no evidence of a cortical break on imaging, a non-surgical approach can be attempted. An exam is often nonfocal, although the “fulcrum test” test can be used by providers to localize the affected pain and suggest the diagnosis. Patients typically complain of poorly localized, insidious leg pain often mistaken for muscle injury. Stress fractures of the femoral shaft are well documented in the literature, and in one study among military recruits, they represented 22.5% of all stress fractures. A trial of non-surgical management can be attempted for patients without a visible fracture line on radiographs in compression type injuries. Compression-type fractures are seen in younger athletes and involve the inferior-medial femoral neck. Tension-type femoral neck stress fractures involve the superior-lateral aspect of the neck and are at highest risk for complete fracture thus, these should be detected early. There are 2 types of femoral neck stress fractures: tension-type (or distraction) fractures and compression-type fractures. The patient complains of hip or groin pain which is worse with weight bearing and range of motion especially internal rotation. These injuries are seen most commonly in runners.įemoral neck stress fractures make up approximately 11% of stress injuries in athletes. The most common location is the ischiopubic ramus and sacrum. Stress fractures of the pelvis can be vague clinically and mimic other causes of groin and hip pain, for example, adductor strain, osteitis pubis, or sacroiliitis. Stress fractures in ribs 4 through 9 are seen in competitive rowers, and posteromedial rib stress fractures can be seen in golfers. First rib fractures are the most common, and these are seen in pitchers, basketball players, weightlifters, and ballet dancers. Rib stress fractures are an uncommon site of stress injuries. Similar to the lower extremity injuries, upper extremity stress injuries are the result of overuse and fatigue. Upper extremity stress injuries are much less common than lower extremity stress injuries, but when they do occur, they are most commonly seen in the ulna. Most commonly, they are found in the lower extremities and are specific to the sport in which the athlete participates. Stress injuries are often seen in running and jumping athletes and are associated with increased volume or intensity of training workload. They are relatively common overuse injuries in athletes that are caused by repetitive submaximal loading on a bone over time. ![]() Stress injuries represent a spectrum of injuries ranging from periostitis, caused by inflammation of the periosteum, to a complete stress fracture that includes a full cortical break. ![]()
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