Category: Orthopedics
Keywords: Bone stress reaction, fracture, overuse injury (PubMed Search)
Posted: 7/27/2019 by Brian Corwell, MD
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Bone stress injury (BSI) in Adolescents
A BSI occurs along a pathology continuum that begins with a stress reaction and may progress all the way to a stress fracture.
Difficult to diagnose clinically.
Identifying risk factors as part of the history is very important.
Common sites for BSI are most frequently in the lower extremity and include the tibia, fibula, tarsals and metatarsals, calcaneus, and femur.
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.
BSIs occur more frequently in young athletes than in adults.
Almost 50% of BSIs occur in those younger than 20 years of age
Primary care and sports medicine providers are seeing more of these patients due to many factors.
Year-round training, sports specialization at younger ages and increase in training intensity/duration contribute to the increase incidence in adolescents.
Not surprisingly, participation in organized sports as an adolescent is a known risk factor.
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.
Shin pain lasting more than 4 weeks may represent a unique subset of MSK pain complaints increasing risk of BSI.
A prior history of BSI is a strong predictor of future BSI.
Inquire about night pain, pain with ambulation, and pain affecting performance.
Athletes with BSIs have a significantly lower BMI than controls (<21.0 kg/m2).
Athletes with BSIs sleep significantly less than controls.
Athletes with BSIs have significantly lower dairy intake than controls.
Inquire about components of the female athlete triad (low energy availability, menstrual dysfunction and low bone mineral density)
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.
