MRI of Stress Reaction of the Distal Humerus in Elite Tennis Players

Abstract

Stress injury to the distal humerus is a cause of chronic arm pain among elite tennis players and may be exacerbated during full competition. The degree of marrow edema on STIR MRI may be predictive of time to return to competition.

Pedicle Marrow Signal Hyperintensity on Short Tau Inversion Recovery- and T2-Weighted Images: Prevalence and Relationship to Clinical Symptoms

“…[1][2][3] There is a large amount of literature on a similar marrow signal intensity pattern in joints outside the spine where symptoms and abnormal marrow signal intensity in long bones correlate with clinical symptoms and trauma or response to stress. [10][11][12][13][14] Likewise, the association of type 1 pedicle marrow signal intensity changes with pars and pedicle fractures and degenerative facet changes suggests they are related to biomechanical stress created by abnormal spinal segment motion. This or a similar mechanism may be at play in the vertebral bodies A, Right parasagittal T1-, T2-, and STIR-weighted images that demonstrate a discrete fracture line through the pedicles of L4 bilaterally without pedicle marrow signal intensity changes (long arrow) and a less obvious fracture line on T1 images through the L5 pedicle with concomitant type 1 pedicle marrow changes (short arrows).…”

Stress Reaction of the Humerus in a High School Baseball Player

“…2 As a result, mag- Stress Reaction of the Humerus in a High School Baseball Player netic resonance imaging was obtained, which showed a hyperintense bone marrow signal in the distal humerus on fluidsensitive sequences (FIGURE 2), which was consistent with a stress reaction of the distal humerus.…”

Stress reaction of the humerus in tennis players

“…Recently published studies have reported chronic injuries in this region 1 – 4. As a consequence of these injuries, the athlete is required to spend weeks or even months recovering and is unable to participate in on-court activities.…”

“…Furthermore, most of the studies examining tennis-related bone stress injuries concentrate on injuries to the trunk and lower limbs 5 6. In fact, only three articles were retrieved that reported stress reactions involving the humerus in tennis players 3 4 7…”

“…It has been well documented that the elbow, as well as the middle and distal humerus, are prone to overuse injuries 4 7. Injuries to this portion of the arm occur primarily during the acceleration phase of the service motion, when the arm moves into internal rotation 8.…”