A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries

Fukushima, Yaeko; Ray, Jocelyn; Kraus, Emily; Syrop, Isaac P.; Fredericson, Michael

doi:10.1002/jum.14588

Cited by 24 publications

(26 citation statements)

References 71 publications

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“…8,11,[35][36][37] Our study confirmed acromial pathology with ultrasonography, which is a valuable tool in detecting non-displaced fractures, occult cortical fractures, and periosteal reactions that cannot be confirmed by plain radiography. 28,29,32,36,38 Thus, the acromial pathology incidence was higher in our study than in previous reports. Moreover, according to previous studies, the causes of acromial fracture include osteoporosis, ACJ arthritis, acromion morphology and thickness, diabetes, nutritional status, and bone quality.…”

Section: Discussioncontrasting

confidence: 65%

Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

Baek

Kim

Lee

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.

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Section: Discussioncontrasting

confidence: 65%

Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

Baek

Kim

Lee

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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“…56 Early tibial BSI may be detected on fat-saturated T2 and STIR images with bone marrow or periosteal edema as well as cortical abnormalities. 57 Kijowski and colleagues defined several MRI features of tibial BSI: periosteal edema, linear high T2 signal immediately adjacent to the outer cortex; bone marrow edema, low T1 and high T2 within the canal; cortical abnormality (Table 1). 39 MRI may be useful in evaluating other causes of leg pain in athletes, such as chronic exertional compartment syndrome and peripheral neuropathy.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…77 It has the ability to identify presence of hypoechoic calluses and buckling in the bony cortex more than other imaging modalities. 57 Diagnostic ultrasound has a sensitivity of 43-99% and specificity of 13-79%. 27 The sensitivity of MSK US for identifying BSI on the posterior cortex of the tibia is low.…”

Section: Musculoskeletal Ultrasoundmentioning

confidence: 99%

Evaluation and Diagnosis of Tibial Bone Stress Injuries in Adolescents: Imaging and Nomenclature

Nussbaum

Holtzman

Rizzone

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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Tibial bone stress injuries (BSIs) are common injuries experienced by active adolescent athletes. The current literature lacks consensus of BSI nomenclature and appropriate use of imaging modalities. Injury classification, severity, or grade may differ substantially according to imaging modalities used and location of injury. This leads to inconsistency in understanding prevalence of injury, communication of diagnosis and management, and can cause confusion for patients and their entourages. As such, the purpose of this Current Concept Review was to identify existing classification of atraumatic tibial pain/BSI, propose unifying nomenclature, and review imaging tools available to clinicians caring for young athletes. Limited literature was identified pertaining to adolescent aged athletes. Thus, we expanded our search to included adult literature and identified 32 publications for atraumatic tibial pain. Multiple grading scales and various imaging modalities were used in the literature highlighting a lack of consensus of terminology and imaging for formalizing diagnosis of BSI. Tibial BSI is common in athletes and has large discrepancies in reported incidence. Unified terminology and recommended imaging modalities for the adolescent athlete with these injuries would improve patient care and professional communication. We propose using “Bone Stress Injury” (BSI) to describe overuse injury of the tibia with associated physical examination findings. When needed for guidance of management, imaging can be used to confirm the diagnosis of BSI. Radiography is recommended as the first imaging modality, and MRI should be considered to confirm diagnosis and determine grade of injury.

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“…Overuse injuries (bone fractures, musculoskeletal injuries), occurring when involved structures fail to adapt to increased mechanical stress [1][2][3][4][5], mostly affect resistance athletes, athletes involved in pre-season preparation, and military populations [3,[5][6][7][8][9][10][11][12][13][14][15]. In the army, most injuries occur both during the training of new recruits and in special training contexts (incidence up to �7% for men and 21% for women [16]) [3,10,11,13,[15][16][17]. The implications in terms of patient morbidity, recurrence, reduced military performance, and dropout rates do represent a relevant public health problem and a demand for efficient surveillance, prevention and treatment plans [3,11,15].…”

Section: Introductionmentioning

confidence: 99%

Experimental study protocol of the project “MOtor function and VItamin D: Toolkit for motor performance and risk Assessment (MOVIDA)”

et al. 2021

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Musculoskeletal injuries, a public health priority also in the military context, are ascribed to several risk factors, including: increased reaction forces; low/reduced muscle strength, endurance, body mass, Vitamin D level, and bone density; inadequate lifestyles and environment. The MOVIDA Project–funded by the Italian Ministry of Defence—aims at developing a transportable toolkit (assessment instrumentation, assessment protocols and reference/risk thresholds) which integrates motor function assessment with biological, environmental and behavioural factors to help characterizing the risk of stress fracture, stress injury or muscle fatigue due to mechanical overload. The MOVIDA study has been designed following the STROBE guidelines for observational cross-sectional studies addressing healthy adults, both militaries and civilians, with varying levels of physical fitness (sedentary people, recreational athletes, and competitive athletes). The protocol of the study has been designed and validated and is hereby reported. It allows to collect and analyse anamnestic, diagnostic and lifestyle-related data, environmental parameters, and functional parameters measured through portable and wearable instrumentation during adapted 6 minutes walking test. The t-test, one and two-way ANOVA with post-hoc corrections, and ANCOVA tests will be used to investigate relevant differences among the groups with respect to biomechanical parameters; non-parametric statistics will be rather used for non-normal continuous variables and for quantitative discrete variables. Generalized linear models will be used to account for risk and confounding factors.

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A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries

Cited by 24 publications

References 71 publications

Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

Evaluation and Diagnosis of Tibial Bone Stress Injuries in Adolescents: Imaging and Nomenclature

Experimental study protocol of the project “MOtor function and VItamin D: Toolkit for motor performance and risk Assessment (MOVIDA)”

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