Tibial stress reaction in runners: Correction of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system to define a progression of injury from shin splints to stress fracture

Fredericson, Michael; Bergman, Anne G.; Hoffman, Kenneth L.; Dillingham, M S

doi:10.1016/0003-9993(94)90699-8

Cited by 118 publications

(257 citation statements)

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“…Chronic stress of a normally mineralised bone may result in a spectrum of MRI findings ranging from periosteal oedema over severe marrow lesions to a hypo-intense fracture line in cancellous or cortical bone. This continuum of MRI findings has been described by Fredericson et al (1995).…”

Section: Discussionmentioning

confidence: 92%

Use of standing low‐field magnetic resonance imaging to diagnose middle phalanx bone marrow lesions in horses

Olive¹,

Mair

Charles

2009

Equine Veterinary Education

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Summary Bone marrow lesions (BMLs) (also known as ‘bone bruises’, ‘bone oedema’, ‘bone contusions’ and ‘occult fractures’) within the middle phalanx were diagnosed by standing low field magnetic resonance imaging (MRI) in 7 horses. The lesions were characterised by low signal intensity on T1‐ and T2*‐weighted gradient echo sequences, mildly increased signal intensity on T2 fast spin echo sequences, and high signal intensity on short tau inversion recovery (STIR) sequences. Four distinct patterns of abnormal signal were identified: BML associated with osteoarthritis of either the proximal or distal interphalangeal joints; BML associated with soft tissue injury; BML associated with acute trauma; and BML unassociated with any other injury or lameness (assumed to represent bone response to biomechanical stress). Repeat MRI was undertaken in 4 cases. In most cases the BML resolved with rest and time, although lameness was persistent in 2 horses (one of which had an associated osteoarthritis of the proximal interphalangeal joint).

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Section: Discussionmentioning

confidence: 92%

Use of standing low‐field magnetic resonance imaging to diagnose middle phalanx bone marrow lesions in horses

Olive¹,

Mair

Charles

2009

Equine Veterinary Education

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“…A good correlation between BMO signal pattern and increased radionuclide uptake on delayed-phase scintigraphic images has been demonstrated in stress injuries in human patients (Boegard 1998). In human sports medicine MRI has been shown to have a greater sensitivity and specificity for the detection of stress fractures (Gaeta et al 2005) than scintigraphy (Boden and Osbahr 2000) and is the diagnostic modality of choice for many orthopaedic stress injuries (Fredricson et al 1995).…”

Section: Discussionmentioning

confidence: 99%

Clinical and imaging features of suspected prodromal fracture of the proximal phalanx in three Thoroughbred racehorses

Ramzan

Powell

2010

Equine Veterinary Journal

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Sagittal fracture of the proximal phalanx (P1) is an important musculoskeletal injury of the performance horse. Although widely considered to be monotonic in nature, there is emerging evidence that some P1 fractures may have stress-injury aetiology. Three cases are described in which imaging features found were suggestive of prodromal bone injury. All cases returned to full performance use after a period of rest. The authors conclude that it is possible that some P1 fractures in the Thoroughbred racehorse may develop through stress/fatigue injury pathways. It is proposed that intervention prior to overt fracture may be possible in some cases.

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“…Since the 1980s, MRI has been used to identify early and low-grade bone stress injuries, revealing the periosteal or marrow edema that precedes cortical fracture; over the past 2 decades, it has become the reference standard for the diagnosis of these injuries. [31][32][33] In the diagnosis and management of bone stress injuries, MRI is considered a more comprehensive and preferred method compared to bone scintigraphy, 16 although the latter imaging modality yields fewer false-negative results. In 2005, Gaeta and colleagues 34 concluded that the results of MRI were superior to those of both CT and bone scintigraphy in the evaluation of bone stress injuries of the tibia.…”

Section: Magnetic Resonance Imaging Studiesmentioning

confidence: 99%

“…24 An MRI grading system for bone stress injuries was developed in the 1990s. 33,[37][38][39][40][41] Fredericson and colleagues 33 described an MRI grading scale for tibial bone stress injuries in 1995 that was further modified for all bone stress injuries by Arendt and Griffiths 32 in 1997 and Nattiv and colleagues 42 in 2013. Such grading scales are used to categorize injuries and aid in clinical management.…”

Section: Magnetic Resonance Imaging Studiesmentioning

confidence: 99%

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

Fukushima

Ray

Kraus

et al. 2018

J of Ultrasound Medicine

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Bone stress injuries are common in military personnel and athletes. The delayed diagnosis of a bone stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of bone stress injuries is a central part of management. Currently, the reference standard for detecting bone stress injuries is magnetic resonance imaging. However, the expanding use of point-of-care ultrasonography (US) may enable the early detection of bone stress injuries in the clinical setting. In this article, we review the US detection of bone stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.

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Tibial stress reaction in runners: Correction of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system to define a progression of injury from shin splints to stress fracture

Cited by 118 publications

References 0 publications

Use of standing low‐field magnetic resonance imaging to diagnose middle phalanx bone marrow lesions in horses

Use of standing low‐field magnetic resonance imaging to diagnose middle phalanx bone marrow lesions in horses

Clinical and imaging features of suspected prodromal fracture of the proximal phalanx in three Thoroughbred racehorses

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

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