Table 1.
Reports of Nontraumatic Stress Fractures of the Trapezoid and Second Metacarpal Bones
| Study | Age, years/Sex | Time From Onset of Symptoms to Presentation, days | Stress Fracture Location | Type of Sport | Imaging Modalities for Diagnosis | Treatment Type and Duration | Pain Free After Treatment, weeks |
|---|---|---|---|---|---|---|---|
| Nagumo et al, 20026 | 21/M | 30 | Trapezoid | Baseball (batter) | X-ray: normal Bone scintigraphy: increased uptake in trapezoid bone MRI: stress fracture of trapezoid bone with a dorsal bone fragment | Dorsal surgical approach to remove dorsal fragment and refrain from batting (4 wks) | 208 (4 yrs) |
| Heron et al, 20125 | 22/NA | 365-730 (1-2 yrs) | Trapezoid | Shot put | X-ray: normal Bedside ultrasound: normal Bone scintigraphy: increased uptake in trapezoid bone CT: stress fracture of the trapezoid | Thumb spica splint (8 wks) | N/A |
| Blomquist et al, 20134 | 21/F | 30 | Trapezoid | Tennis | X-ray: normal CT: no definite fracture MRI: marrow edema in the trapezoid with a coronally oriented fracture in the midtrapezoid on the sagittal projection | Avoidance of sport activity, PT, splint immobilization (6 wks) | 4 |
| Murakami, 198816 | 16/M | 7 | Base of 2nd metacarpal | Tennis | X-ray: periosteal reaction at ulnar aspect of base of 2nd metacarpal | Avoidance of sport activity (4 wks) + change of grip technique | 6 |
| Waninger and Lombardo, 199517 | 14/F | 10 | Base of 2nd metacarpal | Tennis | X-ray: periosteal reaction at ulnar aspect of base of 2nd metacarpal Bone scintigraphy: positive for stress fracture | Avoidance of sport activity (2 wks) + PT and change to eastern grip technique | 6 |
| Bespalchuk et al, 200418 | 15/F | 30 | Base and shaft of 2nd metacarpal | Tennis | X-ray: periosteal reaction at base and midshaft of 2nd metacarpal CT: cortical thickening at base and shaft of 2nd metacarpal MRI: stress fracture of base and shaft of 2nd metacarpal | Avoidance of sport activity (4 wks) + change to eastern grip technique | 12 |
| Muramatsu and Kuriyama, 200514 | 13/F | 21 | Base of 2nd metacarpal | Soft tennis | Initial x-ray: normal (done elsewhere) X-ray at 3 wks: fracture line and periosteal reaction at base of 2nd metacarpal MRI: stress fracture of base of 2nd metacarpal | Avoidance of sport activity (5 wks) + change to eastern grip technique | 12 |
| Fukuda et al, 200819 | 14/F | 21 | Base of 2nd metacarpal | Badminton | Initial x-ray: normal (done elsewhere) X-ray at 5 wks: periosteal reaction at ulnar aspect of base of 2nd metacarpal | NSAIDs without limiting activity for 5 wks (failed) followed by avoidance of sport activity (3 wks) | 5 (after sport restriction) |
| Balius et al, 201020 | 17/F | NA | Shaft of 2nd metacarpal | Tennis (all patients) | X-ray: normal (3 patients) X-ray: periosteal reaction and hairline crack in the cortex (3 patients) Bone scintigraphy: positive (performed in 2 patients with positive x-rays) MRI: increased bone marrow signal intensity (all patients) | PT and avoidance of sport activity (6 to 8 wks) for all patients | 6 |
| 17/F | 2nd metacarpal | 7 | |||||
| 15/F | Shaft of 2nd metacarpal | 6 | |||||
| 17/M | 2nd, 3rd, and 4th metacarpal | 10 | |||||
| 15/F | Shaft of 2nd metacarpal | 6 | |||||
| 17/F | 2nd metacarpal | 6 | |||||
| Rolison and Smoot, 201721 | 19/M | 14 | Shaft of 2nd metacarpal | Golf | X-ray: periosteal reaction at ulnar aspect of shaft of 2nd metacarpal MRI: marrow edema in the second metacarpal shaft suggesting stress fracture | Wrist splint, avoidance of sport activity (8 wks) + modified grip technique | 16 |
| Duarte et al, 201713 | 27/M | 28 | Shaft of 2nd metacarpal | Tennis | X-ray: normal MRI: light bone edema in the 2nd metacarpal shaft with periosteal reaction and 2 lines of hyposignal suggesting stress fracture | Cast immobilization (4 wks) + change of grip | 8 |
| Nishikawa et al, 202022 | 13/F | 28 | Shaft of 2nd metacarpal | Badminton | X-ray: periosteal reaction at ulnar aspect of shaft of 2nd metacarpal (1 patient/tennis player) X-ray: positive for stress reaction (1 patient/location and type of sport NA) X-ray: normal (8 patients) MRI: stress fracture of metacarpal bones (in 8 patients with normal x-rays) MRI: not performed for the 2 patients with abnormal x-rays | All patients treated with avoidance of sports activities + change of grip technique in some patients (advised to change from western to eastern) | 4 |
| 14/F | 7 | Base of 2nd metacarpal | Soft tennis | 12 | |||
| 14/M | 21 | Base of 2nd metacarpal | Badminton | 4 | |||
| 15/M | 28 | Base of 2nd metacarpal | Tennis | 3 | |||
| 16/M | 14 | Shaft of 2nd metacarpal | Tennis | 4 | |||
| 16/F | 21 | Base of 2nd metacarpal | Tennis | 10 | |||
| 18/F | 7 | Shaft of 2nd metacarpal | Tennis | 4 | |||
| 18/M | 364 | Shaft of 2nd metacarpal | Boxing | 5 | |||
| 22/F | 7 | Shaft of 2nd metacarpal | Tennis | 4 | |||
| 24/M | 14 | Shaft of 2nd metacarpal | Bowling | 4 |
CT, computed tomography; F, female; M, male; MRI, magnetic resonance imaging; NA, not available; NSAIDs, nonsteroidal anti-inflammatory drugs; PT, physical therapy; x-ray, plain radiograph.