Ulnar shaft stress fractures in fast-pitch softball pitchers: a case series and proposed mechanism of injury
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CASE REPORT
Ulnar shaft stress fractures in fast-pitch softball pitchers: a case series and proposed mechanism of injury Jens T. Verhey 1
&
Erik Verhey 2 & David Holland 3 & Jonathan C. Baker 4 & Jeremiah R. Long 5
Received: 18 July 2020 / Revised: 17 September 2020 / Accepted: 20 September 2020 # ISS 2020
Abstract Background Stress fractures of the upper extremities in athletes are important injuries for radiologists to appreciate despite being far less common than stress fractures of the lower extremities. Among upper extremity stress fractures, those involving the olecranon have been well described in overhead pitching athletes. Isolated stress fractures of the ulnar shaft however are less commonly reported in the literature and considered to be rare. We have observed a correlation between young patients with ulnar shaft stress fractures and the activity of fast-pitch softball pitching. Case Reports In this series, we present the imaging findings in four cases of ulnar shaft stress fractures in softball pitchers who presented with insidious onset forearm pain. Furthermore, a review of the literature focusing on softball pitching mechanics is provided to offer a potential underlying mechanism for the occurrence and location of these injuries. Conclusion An awareness of the imaging appearance of ulnar shaft stress fractures along with an understanding of its proposed mechanism will facilitate accurate and timely imaging diagnosis of this injury by the radiologist. Keywords Stress fracture . Fatigue fracture . Ulna fractures . Upper extremity . Female . Baseball
Introduction Given the current popularity of organized sports for children and adolescents, awareness and recognition of skeletal stress injuries are important for sports medicine physicians and radiologists alike. Early diagnosis and appropriate treatment of stress fractures is necessary to avoid complications such as fracture completion, displacement, and delayed healing [1, 2]. Stress fractures are far more common in the lower extremity, and most often affect the tibia, metatarsals, and fibula [3]. Stress fractures of the upper extremity are rare, accounting for only 1.2–9.2% of all stress fractures in athletes, with the ulna * Jens T. Verhey [email protected] Erik Verhey [email protected] David Holland [email protected]
representing the most commonly affected bone [4]. The diagnosis of a stress fracture can sometimes be made by radiographs, but when radiographs are negative or equivocal, additional imaging with magnetic resonance imaging (MRI), computed tomography (CT), or bone scintigraphy is often needed for definitive diagnosis. Ulnar stress fractures involving the olecranon process are known to occur in overhead throwing athletes [5]. Ulnar stress fractures involving the shaft on the other hand have been reported in a variety of different sporting endeavors and activities including volleyball, weight lifting, tennis, softball (removed space), break dancing, excessive push-ups, bowling, 1
Mayo Clinic Alix School of Medicine, 13400 East
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