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Stress Fractures in Sport: Hand

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Fractures in Sport

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Abstract

Stress fractures of the metacarpals and phalanges are extremely rare injuries. They occur almost universally in adolescents. Metacarpal stress fractures are typically associated with racquet or grip sports, and phalangeal fractures typically occur in rock climbers. Symptoms can be subtle, but magnetic resonance imaging usually reveals the injury. Treatment is nonoperative, with high levels of return to sport, and minimal morbidity.

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Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK

    Paul H. C. Stirling & Christopher W. Oliver

Authors
  1. Paul H. C. Stirling
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  2. Christopher W. Oliver
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Editor information

Editors and Affiliations

  1. Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK

    Greg A. J. Robertson

  2. Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK

    Nicola Maffulli

Review

Review

1.1 Questions

A 15-year-old female competitive tennis player presents to your clinic with a 6-month history of dorsal pain the radial border of her dominant hand. Examination reveals tenderness and swelling over the metacarpal shaft. She has recently increased her training intensity in preparation for forthcoming national championships in 3 weeks.

  1. 1.

    You suspect a metacarpal stress fracture. What is the most sensitive imaging modality to diagnose this?

  2. 2.

    Are there any other features, missing from the history, which must be considered in a patient presenting with this clinical picture?

  3. 3.

    How would you treat this injury?

  4. 4.

    How would you counsel the patient?

1.2 Answers

  1. 1.

    MRI is the most sensitive imaging modality. It can also rule out important differentials including neoplasia.

  2. 2.

    A low index of suspicion for neoplasia must be maintained in all patients with insidious and vague bony pain. A focused history asking about weight loss, night sweats, or other neoplastic symptoms should be obtained. Further questions relating to general bone health, such as diet and supplementation, are also valuable. Finally, asking if the patient had recently changed her equipment or racquet grip could provide a target for therapy.

  3. 3.

    The treatment for metacarpal stress fractures is non operative with rest followed by rehabilitation. If the patient has recently changed grip or equipment, changing back to their previous style may accelerate the healing process.

  4. 4.

    The patient can be counseled that these injuries generally heal well in a predictable pattern, and that, according to the literature, there is no reason to expect that they cannot return to sport in the fullness of time.

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Stirling, P.H.C., Oliver, C.W. (2021). Stress Fractures in Sport: Hand. In: Robertson, G.A.J., Maffulli, N. (eds) Fractures in Sport. Springer, Cham. https://doi.org/10.1007/978-3-030-72036-0_23

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  • DOI: https://doi.org/10.1007/978-3-030-72036-0_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-72035-3

  • Online ISBN: 978-3-030-72036-0

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