The Superiority of Magnetic Resonance Imaging in Differentiating the Cause of Hip Pain in Endurance Athletes

Shin, Alexander Y.; Morin, William D.; Gorman, Jason J.; Jones, Steven B.; Lapinsky, Anthony

doi:10.1177/036354659602400209

Cited by 177 publications

(86 citation statements)

References 10 publications

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“…When bone stress injuries become more severe, the pain can progress and become constant. Owing to the often insidious onset of symptoms, clinical diagnosis of these injuries may be difficult and nonspecific [27]. We observed similar findings because, regardless of the strong suspicion by the experienced orthopaedic surgeon, there were no specific findings in the clinical examination on which a bone stress injury diagnosis could have been based.…”

Section: Discussionsupporting

confidence: 60%

Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study

Niva¹,

Mattila

Kiuru³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although bone stress injuries are common in male military trainees, it is not known how common they are in female trainees. It also is unclear whether asymptomatic bone stress injuries heal if intensive training is continued. We prospectively followed 10 female trainees of a military Reserve Officer Course. The subjects underwent clinical and MRI examinations of the pelvis, thighs, and lower legs at the beginning, once during, and at the end of their 3-month course. We identified two to five injuries in every female trainee, all of whom already had the injuries at the beginning of the officer course. None of these injuries increased their severity despite vigorous training. Two-thirds were asymptomatic and low grade. Femoral and tibial shafts were the most common locations. Higher-grade injuries were more likely symptomatic, but regardless of the MRI findings, female trainees expressed only mild to moderate symptoms. Asymptomatic, low-grade bone stress injuries of the femoral and tibial shaft are common in female recruits undergoing heavy physical training. Because these injuries seem to remain constant or even disappear despite continued heavy physical activity, we do not recommend routine screening of asymptomatic trainees. As some bone stress fractures may have severe consequences (eg, in the femoral neck), symptomatic bone stress injuries should be examined and treated.

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Section: Discussionsupporting

confidence: 60%

Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study

Niva¹,

Mattila

Kiuru³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Like bone scintigraphy, MRI can detect the reactive hyperemia and periosteal new bone formation of an evolving stress or insufficiency fracture (151)(152)(153)(154)(155) (Fig. 5C).…”

Section: Atypical Subtrochanteric and Femoral Shaft Fractures: Clinicmentioning

confidence: 99%

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

998

679

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Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem. Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures. Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs. Research directions should include development of animal models, increased surveillance, and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management. ß

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“…A stress fracture is treated more aggressively, entails a longer convalescence, and is likely symptomatic for longer. MR imaging is hl~gtit-y sensitive for a spectrum of osseous injuries (7)(8)(9). The MR imaging finding of a lowsignal-intensity line in the marrow space, extending to the cortex, has been described as a hallmark of stress fracture, distinguishing it from an occult trabecular injury or "bone bruise" (10).…”

Section: Radiographic Findingsmentioning

confidence: 99%

Stress injuries of bone: Analysis of MR imaging staging criteria

Yao¹,

Johnson²,

Gentili³

et al. 1998

Academic Radiology

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Rationale and Objectives. The aut_horS exaw~ed the prognostic value of magnetic resonance (MR) imaging in stress injuries of bone.Materials and Methods, Clinical follow-up data were collected in 35 patients who underwent MR hnaging because of st~spected stress fractures. MR findings were correlated with total duxation of sYm4~toms; the time to retm'n to sports activity, and findings'at follow-up radiog-• raphy~ :Results. The MR imaging finding of a "fracture" or "fatigue" line or a cortical signal intensity abnormality was predictive of a longer symptomatic period, whereas muscle edema was predictive of a shorter symptomatic w~riod. A published ~-ading system could be used in only 24 patients;, the ]VIR imaging grade of injury did not show correlation with clinical outcome, ' ~-, Conclusion. The MR imaging finding Of either a medullar~ line or a cortical abnormality %~ to indicate a ,more severe stress iiijury of bone: A pre-ciously,put~ , lished MR imaging grading system for stress injuries' of' the tibia was nOVprognostic in this more heterogeneous . patient group.

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The Superiority of Magnetic Resonance Imaging in Differentiating the Cause of Hip Pain in Endurance Athletes

Cited by 177 publications

References 10 publications

Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study

Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Stress injuries of bone: Analysis of MR imaging staging criteria

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