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Sports and Exercise Medicine iBSc > Bone Stress Injuries > Flashcards

Bone Stress Injuries Flashcards

1
Q

Bone stress injury

A

Gradual injury to the bone
Stress fracture is the end of the spectrum
One of main overuse injuries

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2
Q

Bone stress injury- is … to diagnose

A

Difficult

Mimic other overuse injuries

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3
Q

Injuries in track and field athletes

A

Overuse injuries are majority

From those, 15% are bone stress injuries

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4
Q

Lower limb bone stress injuries location

A

51% tibia > metatarsal > navicular

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5
Q

Location can contribute to

A

Risk of healing
Complications
Surgery
Risk of non-union

High risk BSI lead to delayed diagnosis + treatment, which leads to increase in the above

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6
Q

Low risk areas BSI

A 
Posteromedial border of tibia
Femur
1-4th metatarsals
Ribs
Ulna
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7
Q

High risk areas BSI

A

Anterior tibia
Navicular
Femoral neck
5th metatarsal

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8
Q

BSI more common on which side for track and field runners

A

Left Hand Side

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9
Q

BSI Grade 1

A

Symptoms occur end of training
TUSA (+-)
Endosteal marrow oedema
Return to Play 3-4 weeks

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10
Q

BSI Grade 2

A

Symptoms occur mid of training
TUSA (+-)
Periosteal + endosteal marrow oedema
RTP 5-8 weeks

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11
Q

BSI Grade 3

A

Symptoms occur whole training
TUSA (+)
Periosteal + endosteal marrow oedema + soft tissues oedema
RTP 9-16 weeks

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12
Q

BSI Grade 4

A

Symptoms occur during daily activities
TUSA (+)
Fracture line
RTP 16+ weeks

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13
Q

BSI History

A

Sport
Event
Training intensity
Previous BSI

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14
Q

BSI Symptoms

A

Gradual exercise related leg pain
Progressively worse
No night pain
Intermediate pain

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15
Q

BSI clinical evaluation

A 
Localised pain
Lumbar spine
Hip
One leg hop
One leg extension
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16
Q

BSI Diagnostic test

A

Therapeutic USS- to assess BSI, compare to the other side

Positive is the feeling of pain during TUS assessment

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17
Q

TUSS

A

Therapeutic USS

+ve if feeling of pain during TUS assessment

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18
Q

Gold standard for BSI

A

MRI

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19
Q

BSI MRI- Grade 1

A

Endosteal marrow oedema

TUS +/-

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20
Q

BSI MRI- Grade 2

A

Periosteal and Endosteal marrow oedema

TUS +/-

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21
Q

BSI MRI- Grade 3

A

Grade 2 + soft tissue oedema

TUS +

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22
Q

BSI MRI- Grade 4

A

Fracture line

TUS +

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23
Q

BSI MRI- If nefative

A

Plain XR

No findings in early stages, usually from 4-6 weeks

24
Q

BSI differential diagnosis

A 
MTSS 
CSS
Radiculopathy
Popliteal artery entrapment
Bone contusion
Osteomyelitis
Neoplasm
Lymphoma
Leukemia
25
MTSS
Traction on tibia from tibialis posterior
26
PAE
Pain in uphill training
27
Differential diagnoses diagnosis
Based on clinical symptoms TUSA (gives early assessment) MRI
28
BSI treatment- if MRI +
``` Blood test (calcium VitD) CT (to ensure bone oedema isn't masking a fracture line) ```
29
BSI treatment- if MRI -
BSI grade 1
30
BSI treatment if TUSA - and XR -
DD or treat as BSI grade 1
31
BSI if high risk of non-union
Referral and operative fixation may be considered
32
BSI Management
``` Control pain After at least 1 week pain free: Modify training Functional RTP RTP ```
33
BSI management- Control pain
NWB (5+ days) Swimming, core, stability Local treatment- low intensity pulsed TUS, ESWT?
34
BSI management- modify training
Low intensity TUS, ?ESWT | Deal with modifiable RFs
35
BSI management- Functional RTP
Sport specific | 10% increase every 10 days (intensity, duration)
36
BSI management- RTP
``` Symptom free TUS or threshold markedly increased Grade 1- 4 weeks Grade 2- 8 weeks Grade 3- 10-16 weeks Grade 4- 16+ weeks ```
37
BSI management- modifying training load
Alter G treadmill Underwater running Swimming Core
38
BSI management- medications
Calcium D3 Vit D NEVER NSAIDs as mask symptoms
39
BSI management- physio modalities
Can benefit from local treatment | TUSA, pulsed USS, ESWT, exogen is a portable TUSA
40
BSI management- predisposing factors
``` Biomechanics Running style Footwear Orthoses Nutrition ```
41
RFs for Stress Fractures
Intrinsic | Extrensic
42
RFs for Stress Fractures- intrinsic
``` Leg length discrepancy Female sex Poor nutrition Older age (20+) Smoking FHx ```
43
RFs for Stress Fractures- extrinsic
``` Milage Inadequate rest Running pace Downhill running Surface Footwear ```
44
Stress fractures with low risk of non-union
``` Femoral neck fractures of medial cortex Tibial shaft fractures of the posteromedial cortex Fractures of the distal 2nd to 4th metatarsals Calcaneal fractures Fractures of the fibula Fractures of the pubic ramus Cuboid fractures Cuneiform fractures ```
45
Low risk stress fractures management
Can be managed conservatively | Slowly increase impact loading once ambulation and day to day activity are pain free
46
Stress fractures with high risk of non-union
Femoral neck fractures of superior cortex Tibial shaft fractures of anterior cortex 5th metatarsal, at diaphyseal-metaphyseal junction Navicular fractures Proximal fractures of the 2nd metatarsal Fractures of the talus Fractures of the medial malleolus Sesamoids
47
Fractures in areas of tension
Along the anterior portion of tibia + lateral femoral neck Or in bones with retrograde blood supply such as talus + navicular At risk of delayed union or non-union and often require operative management
48
Prevention of BSI
Periodisation Deal with modifiable RFs Optimum nutrition
49
Periodisation
3 week and then 1 de-load | Allows subsequent metabolic adaptation to occur
50
Optimal nutrition
Especially for female athletes | Minimum of 1500mg of calcium needed/day
51
Femoral stress fractures
Pain in anterior inguinal area Hop test (70%) diagnostic Conservative therapy for compression fractures (TRP 8-16 weeks) Internal fixation for tension type fractures or displaces
52
2nd-4th Metatarsal
20% of all stress fractures of lower extremity | 4-6 weeks limited activities or casting for 4-6 weeks
53
5th metatarsal
6-8 weeks NWB cast | 70% healing (1 in 3 athletes might not respond to treatment)
54
Navicular
Up to 16 weeks RTP 6-8 weeks in boot NWB- if no pain, 86% rate of healing If still pain- then 6-8 weeks booted WB (if still symptomatic) Operate if failed conservative- return to sport 16-20 weeks
55
Tibial stress fractures
40-50% of athletes RFs- ER-hip, width of tibia bone Location- posteromedial-anterior Aircast splinting if more severe symptoms or if not resolved with conservative treatment Casting for mid-shaft fracture until pain-free and radiographic evidence of healing Surgery (intramedullary nailing and/or grafting) if no improvement after 6 months of treatment

Sports and Exercise Medicine iBSc (13 decks)

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