Stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a spinner bowler: a case report and a review of the literature

Abstract

Stress fractures of the ulnar shaft are uncommon injuries, which have been documented in a variety of sports. The location of the fracture is influenced by the activity and mechanism of injury with which it is associated. The combined traditional approach of clinical history, physical examination, plain radiographs and nuclear scintigraphy for unusual stress fracture may be troublesome. This report is the first to describe a stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a bowler due to chronic torsional stress. We discuss the possible mechanism of injury and describe the diagnostic imaging. A review of the literature is also given and compared with the findings and data of this case.

The parry problem

“…The ulna stress fracture does not involve the radius and it is frequently the result of a force bearing down at 90 to the ulna midshaft while the forearm is supinated and flexed at a 90 angle from the elbow to facilitate lifting heavy loads. Alternative stress fracture mechanisms include repetitive flexion and extension at the elbow, increased flexor muscle activity, and torsional stress created during rapid alternating forearm pronation and supination with flexor muscle wrist activity (Hsu et al, 2005). These mechanisms and subsequent injuries may occur during farming activities, for example, hay and manure shovelling (Evans, 1955;Kitchin, 1948;Troell et al, 1941); sports, such as rowing, weight-lifting, golf, tennis, fencing, and bowling (Hamilton, 1984;Hsu et al, 2005;Jones, 2006;Koskinen et al, 1997); and other miscellaneous stressful actions (Morris and Blickenstaff, 1967).…”

Completed Ulnar Shaft Stress Fracture in a Fast-Pitch Softball Pitcher

“…2 Stress fractures of the upper extremities have been previously described in the literature, yet reports of isolated injury to the ulna diaphysis or olecranon are rare and most frequently involve baseball players. [3][4][5][6][7][8] To the authors' knowledge, there has been only 1 case of an ulnar shaft stress fracture in a fast-pitch softball pitcher published in the United States. 3 In that case, the patient's condition was diagnosed early and successfully treated with nonoperative management.…”

Assessing forearm fractures from eight prehistoric California populations

“…The majority of clinical research regarding stress fractures of the upper limb though focuses mostly on athletes (Anderson, 2006;Fines and Stacy, 2002;Hsu et al, 2005;Jones, 2006;Koskinen et al, 1997;Lee, 2004;Maffulli et al, 1992;Reid, 2003;Sinha et al, 1999). In a study conducted by Anderson (2006) that looked at the mechanisms associated with upper limb stress fractures, he described ulnar shaft fractures caused by two forms of stress.…”

“…The factor that contributes to the stress fracture occurs as a result of bending at the midshaft, an area where the bone changes shape rapidly due to normal pressures placed upon the element (Anderson, 2006). Hsu et al (2005) suggested that the spinning motion of the wrist dorsiflexion with forearm supination in backswing to forearm pronation in forward release developed stress at the location of muscle attachment, thus causing the element to fracture. Jones (2006) also concluded through research that stress fractures found in pitchers, tennis players, volleyball players, riflemen, etc., were also located at the point of muscle attachment.…”