Stress fracture of bilateral tibial metaphysis due to ceremonial march training: a case report

Stress fractures are caused by repetitive microtraumas that occur during unusual or increased activities. Clinical suspicion is essential for the diagnosis. A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march. Although plain X-rays were normal, scintigraphy and MRI revealed stress fractures at metaphyseal region of both tibias. History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired. Typical history, although pain might be localized to unusual sites, should raise the suspicion of a stress fracture

Shoulder muscle activity in sport climbing in naturally chosen and corrected shoulder positions

Objective: The aim of the study was to determine electromyographic activity of the scapula stabilizing muscles in naturally chosen and corrected shoulder positions in typical static climbing postures. Methods: Six male participants undertook surface electromyography measurement in four climbing postures for two different shoulder positions. The activity of the lower, middle and upper trapezius, serratus anterior, pectoralis major, and sternocleidomastoid was recorded. Electromyographic activity was expressed as the percentage of maximal voluntary contraction (MVC) for each muscle. Results: Climbing postures induced higher activation of middle and lower trapezius in corrected shoulder positions (35.3 ± 11.8 and 61.7 ± 15.4% MVC respectively) than in naturally chosen shoulder positions (18.4 ± 8.9 and 30.1 ± 13.8% MVC respectively). The highest activity of the middle and lower trapezius was found in postures with the arm in external rotation and 90° abduction and in an overhanging posture. Low activation was stated for the other muscles in both shoulder conditions. Conclusion: Results showed that climbers naturally elevate the shoulder during typical static postures. Corrected shoulder positions induce higher activation of the scapula stabilizing muscles than naturally chosen shoulder positions.N/

MR imaging of overuse injuries in the skeletally immature gymnast: spectrum of soft-tissue and osseous lesions in the hand and wrist

In the pediatric gymnast, stress-related physeal injuries have been well described with characteristic imaging findings. However, a spectrum of overuse injuries, some rarely reported in the literature, can be encountered in the gymnast’s hand and wrist. To demonstrate the MR appearance of a spectrum of overuse injuries in the skeletally immature wrist and hand of pediatric gymnasts. A total of 125 MR exams of the hand and wrist in skeletally immature children were performed at our institution during a 2-year period. Clinical histories were reviewed for gymnastics participation. MR studies of that subpopulation were reviewed and abnormalities tabulated. Of the MR studies reviewed, ten gymnasts were identified, all girls age 12–16 years (mean age 14.2 years) who presented with wrist or hand pain. Three of these children had bilateral MR exams. Abnormalities included chronic physeal injuries in three children. Two girls exhibited focal lunate osteochondral defects. Triangular fibrocartilage tears were present in three girls, one of whom had a scapholunate ligament tear. Two girls manifested metacarpal head flattening and necrosis. A variety of soft-tissue and osseous lesions can be encountered in the skeletally immature gymnast. Familiarity with these stress-related injuries is important for accurate diagnosis