STRESS REACTIONS AND STRESS-FRACTURES IN HIGH-PERFORMANCE ATHLETES - CAUSES, DIAGNOSIS AND THERAPY

From 1987 until July 1991 70 athletes with stress reactions or stress fractures were treated in the orthopaedic department of the Hannover M edical School. The average age of the 42 male and 28 female athletes w as 22.6 years. The number of athletes involved in track and field spor ts was 29 (41.4%), in gymnastics 9 (12.9%) and in soccer 5 (7.1%). The most common bone injured was the tibia in 29 (41.4%), followed by the tarsal navicular in 21 (30.0%), the midfoot in 17 (24.3%) and the fib ula in 4 (5.7%) athletes. In three cases double stress fractures were found in adjacent locations; in one case a stress fracture of the oppo site navicular occurred after the initial tarsal navicular stress frac ture had healed, and in another case the tarsal navicular was found to be fractured again. Thirty-seven percent of the athletes claimed sudd en increase in training intensity was the cause; 33% felt that the inc reased sprinting and jump activities were the reason for their complai nts. In some athletes pain started after an ankle sprain. Standard dia gnostic procedure consisted in X-rays in two planes and three-phase bo ne scanning. In tarsal navicular or tibial locations additional tomogr ams were performed. MRI and CT scans were reserved for unclear finding s and to exclude the possibility of a tumorous or inflammatory process . A new grading system was introduced that covers all forms of stress reactions from periostitis to pseudarthrosis. Clinical symptoms, sport disabilities, radiological and bone scan findings were graded from A to D. Using a modified Wilson classification, all radiologically recog nizable stress reactions could be classified. Twelve patients in group A had stress-induced pain, negative X-rays and bone scans, but could continue their sport. Twelve patients in group B with positive X-rays or bone scans had to reduce their sports activities. Forty-two patient s in group C with positive X-rays or bone scans had to discontinue the ir sports activities for up to 12 weeks. Four patients in group D were disabled for more than 3 months because the problem did not respond t o therapy. In groups A - C conservative treatment with antiphlogistics , physical therapy, functional treatment or immobilization was suffici ent. In three therapy-resistant cases with stress fractures of the fem oral neck and tarsal navicular, operative stabilization was performed.