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Radionuclide Bone Scintigraphy
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Kanhaiyalal Agrawal, Gopinath Gnanasegaran
Stress fractures are fractures that occur in normal bone due to repetitive activity or overuse. In contrast, an insufficiency fracture is due to normal stress in a pathological or weak bone. Early diagnosis helps in early recovery and prevention of frank fractures. The bone scan is positive from the very early, or initial, phase of stress reaction and is extremely sensitive. Further, as stress reactions may involve multiple sites, the whole-body assessment helps detect additional areas. The uptake is usually focal intense with a shape ranging from oval to fusiform, depending upon the severity (Figure 11.15). The first two phases on the bone scan typically show increased hyperaemia in a stress fracture. In shin splint or tibial periostitis, there is micro-avulsion of fibres connecting periosteum to bones. Hence, periostitis is seen as linear tracer uptake, typically in the posterior medial aspect of the tibia involving more than a third of the tibia. The first two phases of the scan are usually normal.
Inferior heel pain
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Dishan Singh, Shelain Patel, Karan Malhotra
A stress fracture is an overuse injury, which occurs when the bone is repetitively loaded at an intensity below its ultimately tensile strength. However, microfractures of the trabecular structure still occur, and if these are not allowed to heal, they propagate, producing a fatigue or stress fracture. This fracture line may not travel the whole length of the bone.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Tibial neuropathy at the ankle (tarsal tunnel syndrome): Plantar fasciitis.Stress fractures.Polyneuropathy.
Platelet rich plasma for hallux sesamoid injuries: a case series
Published in The Physician and Sportsmedicine, 2022
Hung M. Le, Andrea Stracciolini, Cynthia J. Stein, Bridget J. Quinn, Sarah S. Jackson
A 17-year-old female Irish step dancer and track & field sprinter presented for PRP treatment for bilateral tibial sesamoids, left greater than right. She developed bilateral tibial sesamoid pain 3 months ago in the setting of increasing her hours of Irish step dancing. MRI showed bilateral tibial sesamoiditis with fragmentation. CT showed healing changes of a stress fracture. She was treated with topical and oral NSAIDs, sesamoid pads, activity modification, physical therapy, bone stimulator, and short pneumatic boot without any relief. She underwent PRP to bilateral tibial sesamoids, left initially followed by the right side 6 weeks after. A two-stage approach was taken as it would have been difficult to immobilize both feet in pneumatic boots simultaneously. The left foot was pain free 4 weeks after PRP injection. The right foot was pain free 2 weeks following the procedure. 6 weeks after the second procedure, she was pain free with biking, walking, and weighted squats. She gradual progressed up to 1 mile run over the next 3 weeks, pain-free. Therefore, full recovery was obtained at 9 weeks following the final procedure, which was performed on the right foot.
Epidemiology of injuries in track and field athletes: a cross-sectional study of specific injuries based on time loss and reduction in sporting level
Published in The Physician and Sportsmedicine, 2022
Christophe Lambert, Noémie Reinert, Linda Stahl, Thomas Pfeiffer, Bernd Wolfarth, Daniel Lachmann, Sven Shafizadeh, Ramona Ritzmann
Track and field cause various injury types with an existing challenge in the recognition, treatment and prevention of these injuries[1]. Track and field disciplines are clustered into four main categories: 1) sprints, middle- and long-distance running, relays, hurdling and steeple chase as track events; 2) pole vault and jumps (long, triple and high), shot put and throwing (javelin, discus and hammer) as field events; 3) road events; and 4) combined events, such as the decathlon for men and heptathlon for women (Official Olympic Games website 2020). Considering the technical attributes and physiological prerequisites, loads and strain to body regions are discipline-specific. Likewise, training intensity and load differ among disciplines [2,3]. Runners experience impact forces equivalent to 5 times the body weight to the foot which can lead to overuse injuries (such as stress fractures) [4]. In contrast, sprint and jump activities are more prone to acute injuries due to supramaximal forces coupled with high strain rates eccentrically loaded on the pre-contracted musculature within the stretch-shortening cycle [5]. Beside this, Caine et al. manifest that high jump and pole vault athletes are more likely to sustain traumatic injuries, whereas throwing disciplines are more likely to encounter overuse or acute injuries to the upper body [6].
Part II: presentation, diagnosis, classification, treatment, and prevention of stress fractures in female athletes
Published in The Physician and Sportsmedicine, 2020
Alexandra Abbott, Mackenzie Bird, Symone M. Brown, Emily Wild, Greg Stewart, Mary K. Mulcahey
Stress fractures can be classified as insufficiency or fatigue stress fractures. The difference relates to their pathological processes [21]. Repetitive bone stress causes osteoclast activity to surpass osteoblast activity, thus weakening the bone. New bone forms to adapt to the initial stress, but if the repeated stress is too frequent, osteoclasts can overwhelm the osteoblastic activity and prevent new growth. Microfractures accumulate, resulting in a fatigue-induced stress fracture [21]. By contrast, insufficiency fractures occur in bones with low bone mineral density (BMD) caused by osteoporosis or other bone diseases [21]. Joy and Campbell summarize the difference succinctly: fatigue fractures occur when abnormal stress is applied to normal bone, whereas insufficiency fractures occur when normal stress is applied to abnormal bone [22]. Fatigue fractures are more likely to occur in young athletes, and insufficiency fractures usually occur in elderly or postmenopausal women [8]. Children and adolescents with anorexia, rickets, scurvy, or osteogenesis imperfecta can also sustain insufficiency fractures [8].