Upper Extremity Stress Fractures

Abstract

Upper extremity (UE) stress fractures are less common than lower extremity stress fractures and account for 2.8% of all stress fractures among high school athletes (Changstrom et al. Am J Sports Med 43:26–33, 2015). Early diagnosis hinges on understanding the etiology and having an index of suspicion. Repetitive stress and loading of upper extremity bones at the point of muscular attachments can lead to stress fractures (Crasto JA, Jain S, Jones GL. Upper extremity stress fractures. In: Stress Fractures in Athletes: Diagnosis and Management: Springer International Publishing; 2015. p. 205–22). Stress fractures can often be missed on X-ray radiographs initially (Greaney et al. Radiology [Internet] 146:339–46, 1983; Nielsen et al. Acta Orthop Scand [Internet] 62:531–4, 1991). Radionuclide scanning has been shown to be extremely sensitive in detecting early-stage osseous stress injury. Most upper extremity stress fractures can be managed non-operatively with rest and activity modification when diagnosed early in the process, with a rapid return to sport. A specific sport-related rehabilitation program targeting correct technique use may also help the athlete recover from this injury and help prevent future injuries. More chronic injuries may require surgical intervention to achieve a satisfactory outcome.