1/11. 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.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/11. Femoral neck stress fracture: the importance of clinical suspicion and early review.Stress fracture of the femoral neck is rare and often initially missed. A high index of clinical suspicion is required in athletes presenting with a history of insidious onset, exertional groin pain and pain at the extremes of hip motion on examination. Regular review is recommended to prevent progression of the stress fracture to a displaced fracture, as this significantly worsens long term outcome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/11. Bilateral pedicle stress fracture after instrumented posterolateral lumbar fusion: a case report.STUDY DESIGN: A case of bilateral pedicle stress fracture is reported, and the literature is reviewed. OBJECTIVES: To report the rare case of bilateral pedicle stress fracture after instrumented posterolateral fusion, and to investigate the contributing factors. SUMMARY OF BACKGROUND DATA: A 62-year-old man underwent revision spinal surgery for adjacent-segment degeneration. decompression and instrumented posterolateral fusion from L1 to L3 were performed after removal of the previously inserted pedicular screws. In the patient's history, he had undergone L3-L5 instrumented posterolateral fusion for spinal stenosis 6 years previously. At 1 year after the revision surgery, he presented with severe progressive low back pain. Computer-assisted tomogram and bone scan demonstrated bilateral L4 pedicle stress fracture. To the best of the authors' knowledge, only two cases of pedicle stress fracture after lumbar posterolateral fusion have been reported. methods: This study reviewed the reported patient's medical record, his imaging studies, and related literature. The possible factors contributing to bilateral pedicle stress fractures were investigated. RESULTS: In the reported case, the features of radiographic studies confirmed bilateral pedicle stress fracture. The involved vertebra was L4. In all three cases reported so far, including the current case, the site of the pedicle stress fracture was at the junction of the pedicle and vertebral bodies. CONCLUSIONS: Bilateral pedicle stress fracture occurs as a complication of posterolateral lumbar fusion. Pedicle weakening by prior inserted screws and persistent anterior motion after posterolateral fusion are the contributing factors.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/11. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature.STUDY DESIGN: Clinical case report of bilateral stress fractures of the pedicle in a female athlete presenting with back pain. OBJECTIVES: To report this unusual case and surgical treatment and to review the relevant literature. SUMMARY OF BACKGROUND DATA: low back pain is a frequent complaint in athletes, with the majority of cases being related to muscular or soft tissue etiology. spondylolysis, or pars fracture, is the most common injury of the neural arch. Stress fracture of the pedicle is a much less common occurrence. Bilateral pedicle fractures in an otherwise healthy athlete has not been previously reported in the orthopedic literature. methods: A 19-year-old female athlete presented with low back pain limiting sports and daily activities. Radiographic workup revealed bilateral stress fractures of the pedicles of the L5 vertebra. Circumferential fusion of the L5-S1 segment was performed after failure of conservative treatment. Anterior interbody structural allograft and a vertical mesh cage were combined with instrumented posterolateral fusion using segmental pedicle screws and autogenous iliac crest bone graft. RESULTS: The patient achieved complete pain relief, solid fusion, and return to normal function. CONCLUSIONS: In this uncommon case of bilateral stress fractures of the pedicle, circumferential fusion assures full immobilization of the injured motion segment and assures a high probability of successful healing.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/11. Electrical twitch obtaining intramuscular stimulation (ETOIMS) for myofascial pain syndrome in a football player.BACKGROUND: Flare up of acute lower back pain associated with myofascial pain syndrome (MPS) may require various forms of treatment including activity restriction and bracing. Electrical twitch obtaining intramuscular stimulation (ETOIMS) is a promising new treatment. It involves the use of a strong monopolar electromyographic needle electrode for electrical stimulation of deep motor end plate zones in multiple muscles in order to elicit twitches. CASE REPORT: An elite American football player with MPS symptoms failed to respond to standard treatments. He then received ETOIMS which completely alleviated the pain. After establishing pain control, the athlete continued with a further series of treatments to control symptoms of muscle tightness. CONCLUSIONS: ETOIMS has a promising role in pain alleviation, increasing and maintaining range of motion, and in providing satisfactory athletic performance during long term follow up.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/11. Unusual stress fracture of the femoral neck in a young adult not caused by excessive stress: a case report.A 30-year-old man complained of a 10-day history of gradual onset of severe left leg pain. He did not have any history of trauma or excessive training. Routine laboratory data showed no abnormal findings. He was able to perform passive motions of the hip joint without pain, but active motion of the left hip joint was impossible due to anterolateral thigh pain. Plain radiographs of the hip showed no abnormal findings. However, bone scintigraphy indicated trace accumulation in the left femoral neck, and T(1)-weighted magnetic resonance imaging showed a linear low signal on the inferomedial aspect of the femoral neck. Bone mineral density of the lumbar spine was 1.053 g/cm(2), which ruled out osteoporosis. The thigh pain was resolved 2 months after onset with conservative treatment, when plain radiographs showed sclerotic change and a reduction in the intensity of the low signal of T(1)-weighted magnetic resonance imaging. Our diagnosis of unusual stress fracture indicates that the possibility of stress fractures without bone fragility should be kept in mind when young adults complain of atypical pain even without evidence of unusual activities.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/11. Differential diagnosis of a femoral neck/head stress fracture.STUDY DESIGN: Resident's case problem. BACKGROUND: Identifying stress fractures of the hip can be a challenging differential diagnosis. Pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. Hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. diagnosis: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. DISCUSSION: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/11. Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes.BACKGROUND: adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention. PURPOSE: To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities. STUDY DESIGN: Case series; Level of evidence, 4. methods: Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding. RESULTS: Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4-16.6 weeks). patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7-13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1-33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4-28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9-40.4 weeks). CONCLUSION: Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/11. fatigue fracture of the ulna occurring in pitchers of fast-pitch softball.We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/11. Transverse stress fracture of the patella: a case report.PURPOSE: A high index of suspicion is necessary to make the diagnosis of stress fractures in athletes. This is a case report of a soccer player who sustained a transverse stress fracture of the patella. CASE SUMMARY: The soccer player experienced mild discomfort to the patella for 1 month. He then developed severe pain after a twisting motion while playing soccer. Radiological examination showed an undisplaced transverse fracture of the patella. After immobilization in a plaster cast and rehabilitation, he returned to normal activity in 3 months. DISCUSSION: Only six cases have been reported in the literature to date. RELEVANCE: This case illustrates the need to consider a stress fracture when pain in the patella persists.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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