Semin Musculoskelet Radiol 2011; 15(3): 183-197
DOI: 10.1055/s-0031-1278419
© Thieme Medical Publishers

Bone Marrow Changes in Stress Injuries

Ana Navas1 , Ara Kassarjian2
  • 1Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  • 2Corades, S.L., Majadahonda, Madrid, Spain
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
03. Juni 2011 (online)

ABSTRACT

Stress injuries and associated bone marrow changes are a common finding in athletes of all levels. Magnetic resonance imaging (MRI) is the imaging modality of choice for detecting characterizing and staging these injuries. However, because bone marrow edema patterns may also be seen in asymptomatic athletes, it is imperative for the sports medicine physician and the radiologist to closely correlate the imaging findings with the clinical signs and symptoms to assess the clinical significance of the imaging findings. This article reviews the pathophysiology, MRI findings, and clinical implications of stress injuries in athletes.

REFERENCES

  • 1 Arendt E A, Griffiths H J. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes.  Clin Sports Med. 1997;  16 (2) 291-306
  • 2 Fredericson M, Bergman A G, Matheson G O. Stress fractures in athletes.  Orthopade. 1997;  26 (11) 961-971
  • 3 Fredericson M, Jennings F, Beaulieu C, Matheson G O. Stress fractures in athletes.  Top Magn Reson Imaging. 2006;  17 (5) 309-325
  • 4 Syed F A, Ng A C. The pathophysiology of the aging skeleton.  Curr Osteoporos Rep. 2010;  8 (4) 235-240
  • 5 Niemeyer P, Weinberg A, Schmitt H, Kreuz P C, Ewerbeck V, Kasten P. Stress fractures in the juvenile skeletal system.  Int J Sports Med. 2006;  27 (3) 242-249
  • 6 Walker R N, Green N E, Spindler K P. Stress fractures in skeletally immature patients.  J Pediatr Orthop. 1996;  16 (5) 578-584
  • 7 de la Cuadra P, Albiñana J. Pediatric stress fractures.  Int Orthop. 2000;  24 (1) 47-49
  • 8 Niemeyer P, Weinberg A, Schmitt H, Kreuz P C, Ewerbeck V, Kasten P. Stress fractures in adolescent competitive athletes with open physis.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 (8) 771-777
  • 9 Anderson M W. Imaging of upper extremity stress fractures in the athlete.  Clin Sports Med. 2006;  25 (3) 489-504, vii
  • 10 Jones G L. Upper extremity stress fractures.  Clin Sports Med. 2006;  25 (1) 159-174, xi
  • 11 Fallon K E, Fricker P A. Stress fracture of the clavicle in a young female gymnast.  Br J Sports Med. 2001;  35 (6) 448-449
  • 12 Waninger K N. Stress fracture of the clavicle in a collegiate diver.  Clin J Sport Med. 1997;  7 (1) 66-68
  • 13 De Villiers R V, Pritchard M, De Beer J, Koenig J. Scapular stress fracture in a professional cricketer and a review of the literature.  S Afr Med J. 2005;  95 (5) 312-317
  • 14 Herickhoff P K, Keyurapan E, Fayad L M, Silberstein C E, McFarland E G. Scapular stress fracture in a professional baseball player: a case report and review of the literature.  Am J Sports Med. 2007;  35 (7) 1193-1196
  • 15 Sandrock A R. Another sports fatigue fracture. Stress fracture of the coracoid process of the scapula.  Radiology. 1975;  117 (2) 274
  • 16 Boyer Jr D W. Trapshooter's shoulder: stress fracture of the coracoid process. Case report.  J Bone Joint Surg Am. 1975;  57 (6) 862
  • 17 Obembe O O, Gaskin C M, Taffoni M J, Anderson M W. Little Leaguer's shoulder (proximal humeral epiphysiolysis): MRI findings in four boys.  Pediatr Radiol. 2007;  37 (9) 885-889
  • 18 Hatem S F, Recht M P, Profitt B. MRI of Little Leaguer's shoulder.  Skeletal Radiol. 2006;  35 (2) 103-106
  • 19 Silva R T, Hartmann L G, Laurino C F. Stress reaction of the humerus in tennis players.  Br J Sports Med. 2007;  41 (11) 824-826
  • 20 Polu K R, Schenck Jr R C, Wirth M A, Greeson J, Cone III R O, Rockwood Jr C A. Stress fracture of the humerus in a collegiate baseball pitcher. A case report.  Am J Sports Med. 1999;  27 (6) 813-816
  • 21 Klingele K E, Kocher M S. Little League elbow: valgus overload injury in the paediatric athlete.  Sports Med. 2002;  32 (15) 1005-1015
  • 22 Nakaji N, Fujioka H, Tanaka J et al.. Stress fracture of the olecranon in an adult baseball player.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 (4) 390-393
  • 23 Mamanee P, Neira C, Martire J R, McFarland E G. Stress lesion of the proximal medial ulna in a throwing athlete. A case report.  Am J Sports Med. 2000;  28 (2) 261-263
  • 24 Schickendantz M S, Ho C P, Koh J. Stress injury of the proximal ulna in professional baseball players.  Am J Sports Med. 2002;  30 (5) 737-741
  • 25 Steunebrink M, de Winter D, Tol J L. Bilateral stress fracture of the ulna in an adult weightlifter: a case report.  Acta Orthop Belg. 2008;  74 (6) 851-855
  • 26 Logan K. Stress fractures in the adolescent athlete.  Pediatr Ann. 2007;  36 (11) 738-739, 742, 744–745
  • 27 Dwek J R, Cardoso F, Chung C B. MR imaging of overuse injuries in the skeletally immature gymnast: spectrum of soft-tissue and osseous lesions in the hand and wrist.  Pediatr Radiol. 2009;  39 (12) 1310-1316
  • 28 Ahluwalia R, Datz F L, Morton K A, Anderson C M, Whiting Jr J H. Bilateral fatigue fractures of the radial shaft in a gymnast.  Clin Nucl Med. 1994;  19 (8) 665-667
  • 29 Koskinen S K, Mattila K T, Alanen A M, Aro H T. Stress fracture of the ulnar diaphysis in a recreational golfer.  Clin J Sport Med. 1997;  7 (1) 63-65
  • 30 Petschnig R, Wurnig C, Rosen A, Baron R. Stress fracture of the ulna in a female table tennis tournament player.  J Sports Med Phys Fitness. 1997;  37 (3) 225-227
  • 31 Guha A R, Marynissen H. Stress fracture of the hook of the hamate.  Br J Sports Med. 2002;  36 (3) 224-225
  • 32 Matzkin E, Singer D I. Scaphoid stress fracture in a 13-year-old gymnast: a case report.  J Hand Surg Am. 2000;  25 (4) 710-713
  • 33 Eng J, Westcott J, Better N. Stress fracture of the first rib in a weightlifter.  Clin Nucl Med. 2008;  33 (5) 371-373
  • 34 Sairyo K, Katoh S, Sasa T et al.. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study.  Am J Sports Med. 2005;  33 (4) 583-590
  • 35 Major N M, Helms C A. Sacral stress fractures in long-distance runners.  AJR Am J Roentgenol. 2000;  174 (3) 727-729
  • 36 Zoga A C, Kavanagh E C, Omar I M et al.. Athletic pubalgia and the “sports hernia”: MR imaging findings.  Radiology. 2008;  247 (3) 797-807
  • 37 DeFranco M J, Recht M, Schils J, Parker R D. Stress fractures of the femur in athletes.  Clin Sports Med. 2006;  25 (1) 89-103, ix
  • 38 Hutchinson P H, Stieber J, Flynn J, Ganley T. Complete and incomplete femoral stress fractures in the adolescent athlete.  Orthopedics. 2008;  31 (6) 604
  • 39 Song W S, Yoo J J, Koo K H, Yoon K S, Kim Y M, Kim H J. Subchondral fatigue fracture of the femoral head in military recruits.  J Bone Joint Surg Am. 2004;  86-A (9) 1917-1924
  • 40 Koenig S J, Toth A P, Bosco J A. Stress fractures and stress reactions of the diaphyseal femur in collegiate athletes: an analysis of 25 cases.  Am J Orthop. 2008;  37 (9) 476-480
  • 41 Sillanpää P J, Paakkala A, Paakkala T, Mäenpää H, Toivanen J. Displaced longitudinal stress fracture of the patella: a case report.  J Bone Joint Surg Am. 2010;  92 (13) 2344-2347
  • 42 Coady C M, Micheli L J. Stress fractures in the pediatric athlete.  Clin Sports Med. 1997;  16 (2) 225-238
  • 43 Moen M H, Tol J L, Weir A, Steunebrink M, De Winter T C. Medial tibial stress syndrome: a critical review.  Sports Med. 2009;  39 (7) 523-546
  • 44 Craig D I. Current developments concerning medial tibial stress syndrome.  Phys Sportsmed. 2009;  37 (4) 39-44
  • 45 Umans H R, Kaye J J. Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging.  Skeletal Radiol. 1996;  25 (4) 319-324
  • 46 Sherbondy P S, Sebastianelli W J. Stress fractures of the medial malleolus and distal fibula.  Clin Sports Med. 2006;  25 (1) 129-137, x
  • 47 Woods M, Kijowski R, Sanford M, Choi J, De Smet A. Magnetic resonance imaging findings in patients with fibular stress injuries.  Skeletal Radiol. 2008;  37 (9) 835-841
  • 48 Rossi F, Dragoni S. Talar body fatigue stress fractures: three cases observed in elite female gymnasts.  Skeletal Radiol. 2005;  34 (7) 389-394
  • 49 Jones M H, Amendola A S. Navicular stress fractures.  Clin Sports Med. 2006;  25 (1) 151-158, x–xi
  • 50 Sormaala M J, Niva M H, Kiuru M J, Mattila V M, Pihlajamäki H K. Stress injuries of the calcaneus detected with magnetic resonance imaging in military recruits.  J Bone Joint Surg Am. 2006;  88 (10) 2237-2242
  • 51 Sairyo K, Katoh S, Sasa T et al.. Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study.  Am J Sports Med. 2005;  33 (4) 583-590
  • 52 Peace K A, Hillier J C, Hulme A, Healy J C. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases.  Clin Radiol. 2004;  59 (11) 1025-1033
  • 53 Zanetti M, Steiner C L, Seifert B, Hodler J. Clinical outcome of edema-like bone marrow abnormalities of the foot.  Radiology. 2002;  222 (1) 184-188
  • 54 Reinus W R, Fischer K C, Ritter J H. Painful transient tibial edema.  Radiology. 1994;  192 (1) 195-199
  • 55 Grasel R P, Schweitzer M E, Kovalovich A M et al.. MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome.  AJR Am J Roentgenol. 1999;  173 (3) 699-701
  • 56 Bergman A G, Fredericson M, Ho C, Matheson G O. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners.  AJR Am J Roentgenol. 2004;  183 (3) 635-638
  • 57 Weishaupt D, Schweitzer M E. MR imaging of the foot and ankle: patterns of bone marrow signal abnormalities.  Eur Radiol. 2002;  12 (2) 416-426
  • 58 Kornaat P R, de Jonge M C, Maas M. Bone marrow edema-like signal in the athlete.  Eur J Radiol. 2008;  67 (1) 49-53

Ana NavasM.D. 

Department of Radiology C2-S, Leiden University Medical Center (LUMC)

P.O. Box 9600, 2300 RC Leiden, The Netherlands

eMail: A.Navas_Canete@lumc.nl