Comparative role of scintigraphy in sporting injuries in the new millennium Scintigraphy of sporting injuries
Main Article Content
Abstract
Exercise for good health and as a prerequisite for most sporting endeavours is both an aspirational and necessary requirement at a time when obesity plagues much of the well-developed world. It has led to great advances in the science of exercise and a medical specialty devoted to sporting injuries. Epidemiology of sporting injury is crucial in this process in order to prevent injury and to focus attention on dangerous practices in some sports. The bone scan was historically considered a mainstay for the diagnosis of sporting injuries involving stress fractures, acute fractures and some soft tissue injuries. However, the role of scintigraphy has been supplanted by magnetic resonance imaging (MRI) in many of these settings, largely due to its high contrast resolution for soft tissues, spatial resolution of the relevant anatomy and the absence of radiation exposure. Nevertheless, there remains a valuable contribution from scintigraphy with the development of single photon emission computed tomography (SPECT) co-located with x-ray computed tomography (CT) in the same instrument. The place of scintigraphy in the evaluation of sporting injuries needs to be critically evaluated against the competing modalities of CT, MRI and high-resolution ultrasound. It is no longer appropriate or critically acceptable to examine scintigraphy in isolation from the other available imaging modalities.
Keywords:
Trauma, sport, anatomy, stress fracture, scintigraphy
Article Details
How to Cite
VAN DER WALL, Hans et al.
Comparative role of scintigraphy in sporting injuries in the new millennium.
Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4252>. Date accessed: 04 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i8.4252.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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4. Lawrence DW, Hutchison MG, Comper P. Descriptive Epidemiology of Musculoskeletal Injuries and Concussions in the National Football League, 2012-2014. Orthop J Sports Med. 2015; 3:2325967115583653.
5. Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011; 45:553-558.
6. Ekstrand J, Walden M, Hagglund M. Hamstring injuries have increased by 4% annually in men's professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016; 50:731-737.
7. Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train. 2016; 51:410-424.
8. Montalvo AM, Schneider DK, Webster KE, et al. Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification. J Athl Train. 2019; 54:472-482.
9. Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. Am J Sports Med. 2017; 45:426-433.
10. Edwards WB. Modeling Overuse Injuries in Sport as a Mechanical Fatigue Phenomenon. Exerc Sport Sci Rev. 2018; 46:224-231.
11. Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992; 159:245-252.
12. Bhavnagri S, Monammed T-LH. When and how to image a suspected broken rib. Cleve Clin J Med. 2009; 76:310-314.
13. Hutton B, Nuyts J, Zaidi H. Iterative reconstruction methods. In: Zaidi H, ed. Quantitative Analysis in Nuclear Medicine Imaging. New York: Springer, 2006:107-140.
14. Frey E, Tsui B. Collimator-Detector Response Compensation in SPECT. In: Zaidi H, ed. Quantitative Analysis in Nuclear Medicine Imaging. New York: Springer, 2006:141-166.
15. Spitz J, Lauer I, Tittel K, Wiegand H. Scintimetric evaluation of remodeling after bone fractures in man. J Nucl Med. 1993; 34:1403-1409.
16. Best TM. Soft-tissue injuries and muscle tears. Clin Sports Med. 1997; 16:419-434.
17. Morelli V, Smith V. Groin injuries in athletes. Am Fam Physician. 2001; 64:1405-1414.
18. Hoelmich P. Adductor-related groin pain in athletes. Sports Med Arthroscopy Rev. 1997; 5:285-291.
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20. Saunders J, Cusi M, Van der Wall H. What’s Old Is New Again: The Sacroiliac Joint as a Cause of Lateralizing Low Back Pain. Tomography. 2018; 4:72-77.
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22. Saunders J, Hungerford B, Wisbey-Roth T, Cusi M, Van der Wall H. Recurrent Hamstring Injuries in Elite Athletes – A Paradigm Shift to Mechanical Dysfunction of the Sacroiliac Joint as One Causation. Int J Hum Mov Sport Sc. 2019; 7:33-42.
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24. Hoffman J, Phillips W, Blum M, Barohn R, Ramamurthy S. Effect of sympathetic block demonstrated by triple-phase bone scan. J Hand Surg Am. 1993; 18:860-864.
25. Barbier O, Allington N, Rombouts JJ. Reflex sympathetic dystrophy in children: review of a clinical series and description of the particularities in children. Acta Orthop Belg. 1999; 65:91-97.
26. Matin P, Lang G, Carretta R, Simon G. Scintigraphic evaluation of muscle damage following extreme exercise: concise communication. J Nucl Med. 1983; 24:308-311.
27. Van der Wall H, McLaughlin A, Bruce W, Frater CJ, Kannangara S, Murray IP. Scintigraphic patterns of injury in amateur weight lifters. Clin Nucl Med. 1999; 24:915-920.
28. Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res. 2018; 13:309.
29. Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999; 27:393-408.
30. Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005; 10:255-266.
31. Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging. 2013; 4:581-593.
32. Bianchi S, Bortolotto C, Draghi F. Os peroneum imaging: normal appearance and pathological findings. Insights Imaging. 2017; 8:59-68.
33. Collée G, Dijkmans B, Vandenbroucke J, Cats A. Greater Trochanteric Pain Syndrome (Trochanteric Bursitis) in Low Back Pain. Scand J Rheumatol 1991; 20:262-266.
34. Walker P, Kannangara S, Bruce WJ, Michael D, Van der Wall H. Lateral hip pain: does imaging predict response to localized injection? Clin Orthop Relat Res. 2007; 457:144-149.
35. Shbeeb MI, Matteson EL. Trochanteric bursitis (greater trochanter pain syndrome). Mayo Clin Proc. 1996; 71:565-569.
36. Hod N, Fishman S, Horne T. Detection of rhabdomyolysis associated with compartment syndrome by bone scintigraphy. Clin Nucl Med. 2002; 27:885-886.
37. Shadgan B, Menon M, O'Brien PJ, Reid WD. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 2008; 22:581-587.
38. Querellou S, Arnaud L, Williams T, et al. Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures. Clin Nucl Med. 2014; 39:8-13.
39. Avery DM, 3rd, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res. 2016; 11:99.
40. Mandalia V, Henson JH. Traumatic bone bruising--a review article. Eur J Radiol. 2008; 67:54-61.
41. Lynch TC, Crues JV, 3rd, Morgan FW, Sheehan WE, Harter LP, Ryu R. Bone abnormalities of the knee: prevalence and significance at MR imaging. Radiology. 1989; 171:761-766.
42. Miller MD, Osborne JR, Gordon WT, Hinkin DT, Brinker MR. The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries. Am J Sports Med. 1998; 26:15-19.
43. Marks P, Goldenberg J, Vezina W, Chamberlain M, Vellet A, Fowler P. Subchrondral Bone Infractions in Acute Ligamentous Knee Injuries Demonstrated on Bone Scintigraphy and Magnetic Resonance Imaging. J Nucl Med. 1992; 33:516-520.
44. Harrast MA, Colonno D. Stress fractures in runners. Clin Sports Med. 2010; 29:399-416.
45. Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev. 1989; 17:379-422.
46. Devas MB. Stress fractures of the tibia in athletes or shin soreness. J Bone Joint Surg Br. 1958; 40-B:227-239.
47. Slocum DB. The shin splint syndrome. Medical aspects and differential diagnosis. Am J Surg. 1967; 114:875-881.
48. Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012; 31:273-290.
49. Holder LE, Michael RH. The specific scintigraphic pattern of "shin splints in the lower leg": concise communication. J Nucl Med. 1984; 25:865-869.
50. Lieberman CM, Hemingway DL. Scintigraphy of shin splints. Clin Nucl Med. 1980; 5:31.
51. Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. AJR Am J Roentgenol. 2004; 183:635-638.
52. Tins BJ, Garton M, Cassar-Pullicino VN, Tyrrell PN, Lalam R, Singh J. Stress fracture of the pelvis and lower limbs including atypical femoral fractures-a review. Insights Imaging. 2015; 6:97-110.
53. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011; 83:39-46.
54. Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267-2294.
55. Liong SY, Whitehouse RW. Lower extremity and pelvic stress fractures in athletes. Br J Radiol. 2012; 85:1148-1156.
56. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: a one-year study of incidence as related to age,sex and race. Milit Med. 1983; 148:666-667.
57. Cusi M, Tsung J, Nouh F, Wong L, Mansberg R, Van der Wall H. Drummer's fracture of the third metatarsal bone. Clin Nucl Med. 2007; 32:737-738.
58. Donahue SW, Sharkey NA. Strains in the metatarsals during the stance phase of gait: Implications for stress fractures. J Bone Joint Surg. 1999; 81-A:1236-1244.
59. Hulkko A, Orava S. Stress fractures in athletes. Int J Sports Med. 1987; 8:221-226.
60. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007; 37:73-94.
61. O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010; 38:392-404.
62. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985; 5:165-185.
63. Carli A, Leblanc E, Amitai A, Hamdy RC. The Evaluation and Treatment of Pediatric Tarsal Coalitions: A Critical Analysis Review. JBJS Rev. 2014; 2
64. Iwamoto J, Takeda T. Stress fractures in athletes: review of 196 cases. J Orthop Sci. 2003; 8:273-278.
65. Devas MB. Stress fractures in athletes. J R Coll Gen Pract. 1970; 19:34-38.
66. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987; 15:46-58.
67. Blankenbaker DG, De Smet AA. Hip injuries in athletes. Radiol Clin North Am. 2010; 48:1155-1178.
68. Clement DB, Ammann W, Taunton JE, et al. Exercise-induced stress injuries to the femur. Int J Sports Med. 1993; 14:347-352.
69. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008; 24:1407-1421.
70. Johnson AW, Weiss CB, Jr., Stento K, Wheeler DL. Stress fractures of the sacrum. An atypical cause of low back pain in the female athlete. Am J Sports Med. 2001; 29:498-508.
71. Major NM, Helms CA. Sacral stress fractures in long-distance runners. AJR Am J Roentgenol. 2000; 174:727-729.
72. Verrall GM, Henry L, Fazzalari NL, Slavotinek JP, Oakeshott RD. Bone biopsy of the parasymphyseal pubic bone region in athletes with chronic groin injury demonstrates new woven bone formation consistent with a diagnosis of pubic bone stress injury. Am J Sports Med. 2008; 36:2425-2431.
73. Lapp JM. Pelvic stress fracture: assessment and risk factors. J Manipulative Physiol Ther. 2000; 23:52-55.
74. Mizel MS, Michelson JD. Nonsurgical treatment of monarticular nontraumatic synovitis of the second metatarsophalangeal joint. Foot Ankle Int. 1997; 18:424-426.
75. Connolly LP, Connolly SA. Rib stress fractures. Clin Nucl Med. 2004; 29:614-616.
2. Palmer-Green D. Epidemiology of Sports Injuries and Illnesses. In: Whyte G, Loosemore M, Williams C, eds. ABC of Sports and Exercise Medicine. London: John Wiley & Sons, 2015
3. Klein C, Henke T, Platen P. Injuries in football (soccer) - a systematic review of epidemiology and aetiological aspects. Ger J Exerc Sport Res. 2018; 48:309-322.
4. Lawrence DW, Hutchison MG, Comper P. Descriptive Epidemiology of Musculoskeletal Injuries and Concussions in the National Football League, 2012-2014. Orthop J Sports Med. 2015; 3:2325967115583653.
5. Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011; 45:553-558.
6. Ekstrand J, Walden M, Hagglund M. Hamstring injuries have increased by 4% annually in men's professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016; 50:731-737.
7. Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of Injury Incidences in Male Professional Adult and Elite Youth Soccer Players: A Systematic Review. J Athl Train. 2016; 51:410-424.
8. Montalvo AM, Schneider DK, Webster KE, et al. Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification. J Athl Train. 2019; 54:472-482.
9. Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. Am J Sports Med. 2017; 45:426-433.
10. Edwards WB. Modeling Overuse Injuries in Sport as a Mechanical Fatigue Phenomenon. Exerc Sport Sci Rev. 2018; 46:224-231.
11. Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992; 159:245-252.
12. Bhavnagri S, Monammed T-LH. When and how to image a suspected broken rib. Cleve Clin J Med. 2009; 76:310-314.
13. Hutton B, Nuyts J, Zaidi H. Iterative reconstruction methods. In: Zaidi H, ed. Quantitative Analysis in Nuclear Medicine Imaging. New York: Springer, 2006:107-140.
14. Frey E, Tsui B. Collimator-Detector Response Compensation in SPECT. In: Zaidi H, ed. Quantitative Analysis in Nuclear Medicine Imaging. New York: Springer, 2006:141-166.
15. Spitz J, Lauer I, Tittel K, Wiegand H. Scintimetric evaluation of remodeling after bone fractures in man. J Nucl Med. 1993; 34:1403-1409.
16. Best TM. Soft-tissue injuries and muscle tears. Clin Sports Med. 1997; 16:419-434.
17. Morelli V, Smith V. Groin injuries in athletes. Am Fam Physician. 2001; 64:1405-1414.
18. Hoelmich P. Adductor-related groin pain in athletes. Sports Med Arthroscopy Rev. 1997; 5:285-291.
19. Cusi M, Saunders J, Van Der Wall H. Functional Imaging Of The Sacro-iliac Joint In Health And Mechanical Injury. Med Sci Sports Exerc. 2016; 48:1087-1088).
20. Saunders J, Cusi M, Van der Wall H. What’s Old Is New Again: The Sacroiliac Joint as a Cause of Lateralizing Low Back Pain. Tomography. 2018; 4:72-77.
21. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012; 221:537-567.
22. Saunders J, Hungerford B, Wisbey-Roth T, Cusi M, Van der Wall H. Recurrent Hamstring Injuries in Elite Athletes – A Paradigm Shift to Mechanical Dysfunction of the Sacroiliac Joint as One Causation. Int J Hum Mov Sport Sc. 2019; 7:33-42.
23. Schwartzman RJ, McLellan TL. Reflex sympathetic dystrophy. A review. Arch Neurol. 1987; 44:555-561.
24. Hoffman J, Phillips W, Blum M, Barohn R, Ramamurthy S. Effect of sympathetic block demonstrated by triple-phase bone scan. J Hand Surg Am. 1993; 18:860-864.
25. Barbier O, Allington N, Rombouts JJ. Reflex sympathetic dystrophy in children: review of a clinical series and description of the particularities in children. Acta Orthop Belg. 1999; 65:91-97.
26. Matin P, Lang G, Carretta R, Simon G. Scintigraphic evaluation of muscle damage following extreme exercise: concise communication. J Nucl Med. 1983; 24:308-311.
27. Van der Wall H, McLaughlin A, Bruce W, Frater CJ, Kannangara S, Murray IP. Scintigraphic patterns of injury in amateur weight lifters. Clin Nucl Med. 1999; 24:915-920.
28. Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res. 2018; 13:309.
29. Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999; 27:393-408.
30. Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005; 10:255-266.
31. Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging. 2013; 4:581-593.
32. Bianchi S, Bortolotto C, Draghi F. Os peroneum imaging: normal appearance and pathological findings. Insights Imaging. 2017; 8:59-68.
33. Collée G, Dijkmans B, Vandenbroucke J, Cats A. Greater Trochanteric Pain Syndrome (Trochanteric Bursitis) in Low Back Pain. Scand J Rheumatol 1991; 20:262-266.
34. Walker P, Kannangara S, Bruce WJ, Michael D, Van der Wall H. Lateral hip pain: does imaging predict response to localized injection? Clin Orthop Relat Res. 2007; 457:144-149.
35. Shbeeb MI, Matteson EL. Trochanteric bursitis (greater trochanter pain syndrome). Mayo Clin Proc. 1996; 71:565-569.
36. Hod N, Fishman S, Horne T. Detection of rhabdomyolysis associated with compartment syndrome by bone scintigraphy. Clin Nucl Med. 2002; 27:885-886.
37. Shadgan B, Menon M, O'Brien PJ, Reid WD. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 2008; 22:581-587.
38. Querellou S, Arnaud L, Williams T, et al. Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures. Clin Nucl Med. 2014; 39:8-13.
39. Avery DM, 3rd, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res. 2016; 11:99.
40. Mandalia V, Henson JH. Traumatic bone bruising--a review article. Eur J Radiol. 2008; 67:54-61.
41. Lynch TC, Crues JV, 3rd, Morgan FW, Sheehan WE, Harter LP, Ryu R. Bone abnormalities of the knee: prevalence and significance at MR imaging. Radiology. 1989; 171:761-766.
42. Miller MD, Osborne JR, Gordon WT, Hinkin DT, Brinker MR. The natural history of bone bruises. A prospective study of magnetic resonance imaging-detected trabecular microfractures in patients with isolated medial collateral ligament injuries. Am J Sports Med. 1998; 26:15-19.
43. Marks P, Goldenberg J, Vezina W, Chamberlain M, Vellet A, Fowler P. Subchrondral Bone Infractions in Acute Ligamentous Knee Injuries Demonstrated on Bone Scintigraphy and Magnetic Resonance Imaging. J Nucl Med. 1992; 33:516-520.
44. Harrast MA, Colonno D. Stress fractures in runners. Clin Sports Med. 2010; 29:399-416.
45. Jones BH, Harris JM, Vinh TN, Rubin C. Exercise-induced stress fractures and stress reactions of bone: epidemiology, etiology, and classification. Exerc Sport Sci Rev. 1989; 17:379-422.
46. Devas MB. Stress fractures of the tibia in athletes or shin soreness. J Bone Joint Surg Br. 1958; 40-B:227-239.
47. Slocum DB. The shin splint syndrome. Medical aspects and differential diagnosis. Am J Surg. 1967; 114:875-881.
48. Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012; 31:273-290.
49. Holder LE, Michael RH. The specific scintigraphic pattern of "shin splints in the lower leg": concise communication. J Nucl Med. 1984; 25:865-869.
50. Lieberman CM, Hemingway DL. Scintigraphy of shin splints. Clin Nucl Med. 1980; 5:31.
51. Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. AJR Am J Roentgenol. 2004; 183:635-638.
52. Tins BJ, Garton M, Cassar-Pullicino VN, Tyrrell PN, Lalam R, Singh J. Stress fracture of the pelvis and lower limbs including atypical femoral fractures-a review. Insights Imaging. 2015; 6:97-110.
53. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011; 83:39-46.
54. Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267-2294.
55. Liong SY, Whitehouse RW. Lower extremity and pelvic stress fractures in athletes. Br J Radiol. 2012; 85:1148-1156.
56. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: a one-year study of incidence as related to age,sex and race. Milit Med. 1983; 148:666-667.
57. Cusi M, Tsung J, Nouh F, Wong L, Mansberg R, Van der Wall H. Drummer's fracture of the third metatarsal bone. Clin Nucl Med. 2007; 32:737-738.
58. Donahue SW, Sharkey NA. Strains in the metatarsals during the stance phase of gait: Implications for stress fractures. J Bone Joint Surg. 1999; 81-A:1236-1244.
59. Hulkko A, Orava S. Stress fractures in athletes. Int J Sports Med. 1987; 8:221-226.
60. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007; 37:73-94.
61. O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010; 38:392-404.
62. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985; 5:165-185.
63. Carli A, Leblanc E, Amitai A, Hamdy RC. The Evaluation and Treatment of Pediatric Tarsal Coalitions: A Critical Analysis Review. JBJS Rev. 2014; 2
64. Iwamoto J, Takeda T. Stress fractures in athletes: review of 196 cases. J Orthop Sci. 2003; 8:273-278.
65. Devas MB. Stress fractures in athletes. J R Coll Gen Pract. 1970; 19:34-38.
66. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987; 15:46-58.
67. Blankenbaker DG, De Smet AA. Hip injuries in athletes. Radiol Clin North Am. 2010; 48:1155-1178.
68. Clement DB, Ammann W, Taunton JE, et al. Exercise-induced stress injuries to the femur. Int J Sports Med. 1993; 14:347-352.
69. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008; 24:1407-1421.
70. Johnson AW, Weiss CB, Jr., Stento K, Wheeler DL. Stress fractures of the sacrum. An atypical cause of low back pain in the female athlete. Am J Sports Med. 2001; 29:498-508.
71. Major NM, Helms CA. Sacral stress fractures in long-distance runners. AJR Am J Roentgenol. 2000; 174:727-729.
72. Verrall GM, Henry L, Fazzalari NL, Slavotinek JP, Oakeshott RD. Bone biopsy of the parasymphyseal pubic bone region in athletes with chronic groin injury demonstrates new woven bone formation consistent with a diagnosis of pubic bone stress injury. Am J Sports Med. 2008; 36:2425-2431.
73. Lapp JM. Pelvic stress fracture: assessment and risk factors. J Manipulative Physiol Ther. 2000; 23:52-55.
74. Mizel MS, Michelson JD. Nonsurgical treatment of monarticular nontraumatic synovitis of the second metatarsophalangeal joint. Foot Ankle Int. 1997; 18:424-426.
75. Connolly LP, Connolly SA. Rib stress fractures. Clin Nucl Med. 2004; 29:614-616.