International Orthopaedics - 2026-08-08 - Journal Article; Review
Bone stress fractures and injuries of the upper limb in athletes.
Bojovic M, Hagert E
Topics
Key Takeaway
Upper-limb bone stress injuries span the entire extremity from scapula to phalanges, with MRI being the most sensitive early diagnostic tool when plain radiographs are normal in athletes with subtle, non-specific symptoms.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This narrative review synthesizes current literature on upper-limb bone stress injuries in athletes, covering mechanisms, anatomical patterns, imaging strategies, and return-to-sport decision-making across all upper-extremity segments. MRI is identified as the primary modality for early detection when radiographs are negative, and management is predominantly non-operative with load modification and structured rehabilitation. Surgery is reserved for displaced fractures, nonunion, or functionally limiting injuries.
Key Limitation
As a non-systematic narrative review without defined inclusion criteria or quality assessment, the evidence synthesis is subject to author selection bias and cannot support evidence-based treatment recommendations.
Original Abstract
PURPOSE
Bone stress injuries of the upper limb are less common than those of the lower limb, but they can cause substantial diagnostic delay in athletes because symptoms are often subtle and non-specific. This narrative review summarizes clinically relevant mechanisms, risk factors, diagnostic challenges, anatomical patterns, management strategies, and return-to-sport considerations.
METHODS
This narrative review was developed from a targeted, non-systematic review of the current literature and clinical experience, with emphasis on sports that expose the shoulder, arm, forearm, wrist, and hand to repetitive loading. Particular attention was given to imaging features, regional presentations, and practical decision-making in athletic populations.
RESULTS
Upper-limb bone stress injuries occur when repetitive loading exceeds the capacity for skeletal adaptation, progressing from marrow oedema and periosteal reaction to cortical disruption if loading continues. Plain radiographs may be normal early, whereas magnetic resonance imaging is most useful for detecting early stress reactions. Injuries may affect the scapula, clavicle, humerus, ulna, radius, carpal bones, metacarpals, and phalanges. Management usually involves load modification, immobilization when appropriate, structured rehabilitation, and correction of biomechanical or training-related contributors. Surgery is reserved for selected displaced, non-union, or functionally limiting injuries.
CONCLUSION
Recognition of upper-limb bone stress injuries requires a high index of suspicion. Individualized, multidisciplinary care is essential to prevent progression, guide safe return to sport, and reduce recurrence.