Title: Bone stress injury (BSI) in Adolescents<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p>
<span style="font-size:16px;"><strong>Bone stress injury (BSI) in Adolescents</strong></span></p>
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A BSI occurs along a pathology continuum that begins with a <em>stress</em> reaction and may progress all the way to a <em>stress</em> fracture.</p>
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Difficult to diagnose clinically.</p>
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Identifying risk factors as part of the history is very important.</p>
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Common sites for BSI are most frequently in the lower extremity and include the tibia, fibula, tarsals and metatarsals, calcaneus, and femur.</p>
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When considering this in an ED setting, image the involved area and if there is no fracture, advise discontinuing the activity until time of PCP/sports medicine follow up. For those with rest pain, pain with minimal weight bearing or in whom a fracture was suspected but not present, consider providing a walking boot or crutches.</p>
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BSIs occur more frequently in young athletes than in adults. </p>
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Almost 50% of BSIs occur in those younger than 20 years of age</p>
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Primary care and sports medicine providers are seeing more of these patients due to many factors.</p>
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Year-round training, sports specialization at younger ages and increase in training intensity/duration contribute to the increase incidence in adolescents.</p>
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Not surprisingly, participation in organized sports as an adolescent is a known risk factor.</p>
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Just as a change in sporting level from high school to college is a known risk factor for BSI, young “gifted” athletes who are promoted to competing with the varsity team may be at similar risk.</p>
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Shin pain lasting more than 4 weeks may represent a unique subset of MSK pain complaints increasing risk of BSI.</p>
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A prior history of BSI is a strong predictor of future BSI.</p>
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Inquire about night pain, pain with ambulation, and pain affecting performance.</p>
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Athletes with BSIs have a significantly lower BMI than controls (<21.0 kg/m2).</p>
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Athletes with BSIs sleep significantly less than controls.</p>
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Athletes with BSIs have significantly lower dairy intake than controls.</p>
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Inquire about components of the <strong>female athlete triad</strong> (low energy availability, menstrual dysfunction and low bone mineral density)</p>
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<fieldset><legend>References</legend>
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<span style="color: rgb(0, 0, 0); font-family: arial, helvetica, clean, sans-serif; font-size: 1.4em;">Nussbaum et al., 2019. Identifying Factors That Contribute to Adolescent Bony Stress Injury in Secondary School Athletes: A Comparative Analysis With a Healthy Athletic Control Group. Sports Health.</span></p>
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