Stress fractures in upper extremities of athletes: a review

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Abstract

Stress (overuse) fractures of the upper extremities are a relatively uncommon condition typically observed in athletes. Due to their gradual onset, typically mild clinical symptoms, and sometimes unremarkable imaging findings, such injuries are frequently overlooked. The article aims to present data on the pathogenesis, clinical presentation, diagnostics, and treatment strategies of COVID-19. A scientific data search was conducted in the PubMed (MEDLINE) database and via the Google search engine from 1975 to 2024 using combinations of the operators OR and the following keywords: стрессовые переломы (stress fractures), нагрузочные переломы (overuse fractures), верхние конечности (upper extremities), and спортсмены (athletes). A total of 70 sources were selected, including 22 published within the past decade. Stress (overuse) fractures are reported in approximately 40% of athletes, with 80%–95% occurring in the lower extremities and only 5%–20% occurring in the upper extremities. Stress fractures result from repetitive mechanical loading of the bone and are compounded by fatigue of the surrounding muscles, leading to an increase in the rate of bone resorption by osteoclasts to exceed the rate of new bone formation by osteoblasts. Magnetic resonance imaging is the primary diagnostic modality. In most cases, bone healing occurs with load restriction and activity modification (avoidance of repetitive trauma-inducing movements). Surgical intervention is often required in stage III gymnast wrist fractures, avulsion fractures of the medial epicondyle with displacement ≥10 mm, complete or partial tears of the ulnar collateral ligament of the elbow, olecranon fractures, and carpal bone fractures. Although relatively rare, upper extremity stress fractures can cause significant problems and hinder athletic progression. A thorough medical history, physical examination, and analysis of the mechanism of injury will allow clinicians to raise suspicion of this condition. Load restriction, elimination of provoking factors, gradual increase in training intensity, and improvement of sports technique, in most cases, allowed the patient to avoid surgical treatment and return to sports activities.

About the authors

Olga E. Agranovich

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN-code: 4393-3694

MD, PhD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

Ekaterina V. Petrova

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN-code: 2492-1260

MD, PhD, Cand. Sci. (Medicine)

Russian Federation

Svetlana I. Trofimova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: trofimova_sv@mail.ru
ORCID iD: 0000-0003-2690-7842
SPIN-code: 5833-6770

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN-code: 2068-2102

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Alina M. Khodorovskaya

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: alinamyh@gmail.com
ORCID iD: 0000-0002-2772-6747
SPIN-code: 3348-8038

MD

Russian Federation, Saint Petersburg

Evgeny D. Blagovechtchenski

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: eblagovechensky@hse.ru
ORCID iD: 0000-0002-0955-6633
SPIN-code: 2811-5723

PhD, Cand. Sci. (Biology)

Russian Federation, Saint Petersburg

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