Article Figures & Data
Figures
- Figure 1.
Eastern and western grip techniques.
- Figure 2.
Racket handle bevel numbering for a right hander. Bevel 3: location of the palm side of the index finger knuckle in an eastern grip technique; Bevel 5: location of the palm side of the index finger knuckle in a western grip technique.
- Figure 3.
Unremarkable (A) posteroanterior and (B) lateral radiographs of the right wrist show no evidence of acute fracture.
- Figure 4.
Magnetic resonance imaging of the right wrist—(A and C) sagittal fat suppressed proton density (PD FS), (E and F) coronal PD FS, and (B and D) sagittal T1 images—showing bone marrow edema on opposing sides of the second carpometacarpal joint, predominantly involving the radial aspect of both trapezoid and base of the second metacarpal bones (yellow arrows). Imaging shows no evidence of periosteal reaction or low T1 fracture line (red arrows show only ill-defined edema), and findings are in keeping with a microtrabecular injury.
Tables
- 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.
- Table 2.
Reports of Nontraumatic Racket Sports–Related Stress Fractures of the Trapezoid and Second Metacarpal Bones
Play Time Study Age, years/Sex Signs and Symptoms Dominant Hand Stress Fracture Location Type of Sport Hours Per Day Increase in Training Intensity Grip Murakami, 198816 16/M Dorsal wrist pain specifically during serving and forehand stroke Point tenderness on base of 2nd metacarpal No swelling Nonpainful full active ROM of the wrist and fingers Yes Base of 2nd metacarpal Tennis 2-3 No NA Waninger and Lombardo, 199517 14/F Hand pain with simple racket gripping Point tenderness over 2nd metacarpal No swelling Nonpainful resisted ROM of the wrist and fingers Yes Base of 2nd metacarpal Tennis NA Yes Western Bespalchuk et al, 200418 15/F Hand pain with simple racket gripping and during stroking and serving Point tenderness over 2nd metacarpal Swelling of radial-dorsal aspect of the hand Nonpainful full active ROM of the wrist and fingers Yes Base and shaft of 2nd metacarpal Tennis 3-5 Yes Western Muramatsu and Kuriyama, 200514 13/F Pain at dorsal aspect of 2nd metacarpal especially during stroking Point tenderness, swelling, and hard mass over 2nd metacarpal Yes Base of 2nd metacarpal Soft tennis 3 Yes Western Fukuda et al, 200819 14/F Dorsal wrist pain especially with extension of index finger Point tenderness over base of 2nd metacarpal Nonpainful full active ROM of the wrist and finger except index finger extension Yes Base of 2nd metacarpal Badminton 3-8 No Western Balius et al, 201020 17/F Mechanical pain at dorsum of hand and inability to wield a racket Induration at 2nd and 3rd metacarpal base (all patients) ROM: NA Yes (all patients) Shaft of 2nd metacarpal Tennis (all patients) NA Yes Western 17/F 2nd metacarpal Semi-western 15/F Shaft of 2nd metacarpal Semi-western 17/M 2nd, 3rd, 4th metacarpal Eastern 15/F Shaft of 2nd metacarpal Semi-western 17/F 2nd metacarpal Western Blomquist et al, 20134 21/F Progressive wrist pain Point tenderness over the dorsal trapezoid with minimal tenderness over the scapholunate interval Full active ROM of the wrist mildly painful at extremes Yes Trapezoid Tennis NA NA NA Duarte et al, 201713 27/M Hand pain especially when serving and forehand stroke Tenderness of the hand on palpation (exact location NA) ROM: NA Yes Shaft of 2nd metacarpal Tennis 1 Yes Eastern Nishikawa et al, 202022 13/F Dorsal hand pain Point tenderness on dorsal aspect of the hand No swelling, ecchymosis, mass, or deformities Nonpainful full active ROM of the wrist and fingers Yes Shaft of 2nd metacarpal Badminton NA NA NA 14/F Base of 2nd metacarpal Soft tennis 14/M Base of 2nd metacarpal Badminton 15/M Base of 2nd metacarpal Tennis 16/M Shaft of 2nd metacarpal Tennis 16/F Base of 2nd metacarpal Tennis 18/F Shaft of 2nd metacarpal Tennis 22/F Shaft of 2nd metacarpal Tennis F, female; M, male; NA, not available; ROM, range of motion.
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