RADIOGRAPHIC EXHIBIT •
Another Sports Fatigue Fracture
•
Stress Fracture of the Coracoid Process of the Scapula 1
Austin R. Sandrock, M.D. 2 An example of stress fracture of the coracoid process of the scapula in a trapshooter is presented. The value of the axillary view of the shoulder is emphasized. INDEX TERMS :
Fractures. stress. Scapula
Radiology 117:274. November 1975
TRESS FRACTURES have been recognized since 1855 when first clinically described by Breifhaupt. The first radiographic description is credited to Stechow in 1897. A his-
S
torical review indicates that most fatigue fractures occur in the lower e xtremities of military recruits (4, 6-8, 11, 12). Ballet dancers , athletes and "week-end athletes" also demonstrate an incidence of stress fractures (1-3,9, 10). This case report is believed to be the first example of a stress fracture of the coracoid process of the scapula re-
Fig. 1. Axillary view shows a transverse fracture involving the midportion of the coracoid process of the right scapula. All other views of the right shoulder were normal.
ported in the radiologic literature. realized and if the individual seeks medical attention, an axillary view will be necessary to make the radiologic diagnosis.
CASE REPORT The patient was seen as an outpatient with the complaint of pain in the right shoulder for two weeks . There was no history of acute injury, but further questioning revealed that the patient was an avid trapshooter. She had participated in this sport for several years with no previous difficulty, shooting between 200-1000 rounds per week . Approximately two weeks prior to her appointment in the clinic, she noted pain in the right shoulder where the butt of the shotgun is positioned. The patient could recall no particular episode of sharp pain at that time. The pain was aggravated by trapshooting which she discontinued several days before her appointment. Physical examination demonstrated point tenderness over the coracoid process. Pain was elic ited by adduction and forward flexion of the right arm against resistance. The patient did have a full range of motion of the right upper extremity . Radiographs of the right shoulder were normal except for the axillary view which demonstrated a fracture of the middle of the coracoid process of the scapula (Fig. 1). A subsequent axillary view of the right shoulder was obtained 3 months later with the pat ient holding her shotgun in the usual position . The stress fracture had healed and the butt of the shotgun was directly anterior to the coracoid process. Treatment required temporary cessation of trapshooting, but she continued her regular daily activities without any specific immobilization.
REFERENCES 1. Burrows HJ: Fatigue infraction of the middle of the tibia in ballet dancers. J Bone Joint Surg [Br) 38:83-94, Feb 1956 2. Devas MB: Stress fractures of the tibia in athletes or shin soreness. J Bone Joint Surg [Br) 40:227-239, May 1958 3. Devas MB, Sweetnam R: Stress fractures of the fibula ; a review of fifty cases in athletes. J Bone Joint Surg [Br) 38:818-829, Nov 1956 4. Elton Re. Abbott HG: An unusual case of multiple stress fractures . Milit Med 130:1207-1210, Dec 1965 5. Evans DL: Fatigue fractures of the ulna. J Bone Joint Surg [Br) 37:618-621, Nov 1955 6. Gilbert RS. Johnson HA: Stress fractures in military recruits-a review of twelve years' experience. Milit Med 131:716721. Aug 1966 7 . Kroening PM, Shelton ML: Stress fractures . Am J RoentgenOI89:1281-1286, Jun 1963 8. Leveton AL: March (fatigue) fractures of the long bones of the lower extremity and pelvis. Am J Surg 71:222-232, Feb 1946 9. Murray DS: Fatigue fractures of the lower tibia and fibula in the same leg; report of a case. J Bone Joint Surg [Br) 39:302-305, May 1957 10. Pentecost RL, Murray RA, Brindley HH: Fatigue, insufficiency , and pathologic fractures . JAMA 187:1001-1004,28 Mar 1964 11. Savoca CJ: Stress fractures: a classification of the earliest radiographic signs . Radiology 100:519-524, Sep 1971 12. Wilson ES, Katz FN: Stress fractures : an analysis of 250 consecutive cases. Radiology 92:481-486,480, Mar 1969
DISCUSSION This case presents another athletic stress fracture which may be more common than is currently appreciated. At present, approximately 71,000 members are registered in two major trapshooter associations. Undoubtedly many other participants of this sport are not registered. The coracoid fatigue fracture was visualized only on the axillary view. If the condition is more common than currently
1 From the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Accepted for publication in July 1975. 2 Present address: Department of Radiology, Maricopa County General Hospital, 2601 E. Roosevelt, Phoenix, Ariz . 85008. dk
274
Another Sports Fatigue Fracture
•
Stress Fracture of the Coracoid Process of the Scapula 1
Austin R. Sandrock, M.D. 2 An example of stress fracture of the coracoid process of the scapula in a trapshooter is presented. The value of the axillary view of the shoulder is emphasized. INDEX TERMS :
Fractures. stress. Scapula
Radiology 117:274. November 1975
TRESS FRACTURES have been recognized since 1855 when first clinically described by Breifhaupt. The first radiographic description is credited to Stechow in 1897. A his-
S
torical review indicates that most fatigue fractures occur in the lower e xtremities of military recruits (4, 6-8, 11, 12). Ballet dancers , athletes and "week-end athletes" also demonstrate an incidence of stress fractures (1-3,9, 10). This case report is believed to be the first example of a stress fracture of the coracoid process of the scapula re-
Fig. 1. Axillary view shows a transverse fracture involving the midportion of the coracoid process of the right scapula. All other views of the right shoulder were normal.
ported in the radiologic literature. realized and if the individual seeks medical attention, an axillary view will be necessary to make the radiologic diagnosis.
CASE REPORT The patient was seen as an outpatient with the complaint of pain in the right shoulder for two weeks . There was no history of acute injury, but further questioning revealed that the patient was an avid trapshooter. She had participated in this sport for several years with no previous difficulty, shooting between 200-1000 rounds per week . Approximately two weeks prior to her appointment in the clinic, she noted pain in the right shoulder where the butt of the shotgun is positioned. The patient could recall no particular episode of sharp pain at that time. The pain was aggravated by trapshooting which she discontinued several days before her appointment. Physical examination demonstrated point tenderness over the coracoid process. Pain was elic ited by adduction and forward flexion of the right arm against resistance. The patient did have a full range of motion of the right upper extremity . Radiographs of the right shoulder were normal except for the axillary view which demonstrated a fracture of the middle of the coracoid process of the scapula (Fig. 1). A subsequent axillary view of the right shoulder was obtained 3 months later with the pat ient holding her shotgun in the usual position . The stress fracture had healed and the butt of the shotgun was directly anterior to the coracoid process. Treatment required temporary cessation of trapshooting, but she continued her regular daily activities without any specific immobilization.
REFERENCES 1. Burrows HJ: Fatigue infraction of the middle of the tibia in ballet dancers. J Bone Joint Surg [Br) 38:83-94, Feb 1956 2. Devas MB: Stress fractures of the tibia in athletes or shin soreness. J Bone Joint Surg [Br) 40:227-239, May 1958 3. Devas MB, Sweetnam R: Stress fractures of the fibula ; a review of fifty cases in athletes. J Bone Joint Surg [Br) 38:818-829, Nov 1956 4. Elton Re. Abbott HG: An unusual case of multiple stress fractures . Milit Med 130:1207-1210, Dec 1965 5. Evans DL: Fatigue fractures of the ulna. J Bone Joint Surg [Br) 37:618-621, Nov 1955 6. Gilbert RS. Johnson HA: Stress fractures in military recruits-a review of twelve years' experience. Milit Med 131:716721. Aug 1966 7 . Kroening PM, Shelton ML: Stress fractures . Am J RoentgenOI89:1281-1286, Jun 1963 8. Leveton AL: March (fatigue) fractures of the long bones of the lower extremity and pelvis. Am J Surg 71:222-232, Feb 1946 9. Murray DS: Fatigue fractures of the lower tibia and fibula in the same leg; report of a case. J Bone Joint Surg [Br) 39:302-305, May 1957 10. Pentecost RL, Murray RA, Brindley HH: Fatigue, insufficiency , and pathologic fractures . JAMA 187:1001-1004,28 Mar 1964 11. Savoca CJ: Stress fractures: a classification of the earliest radiographic signs . Radiology 100:519-524, Sep 1971 12. Wilson ES, Katz FN: Stress fractures : an analysis of 250 consecutive cases. Radiology 92:481-486,480, Mar 1969
DISCUSSION This case presents another athletic stress fracture which may be more common than is currently appreciated. At present, approximately 71,000 members are registered in two major trapshooter associations. Undoubtedly many other participants of this sport are not registered. The coracoid fatigue fracture was visualized only on the axillary view. If the condition is more common than currently
1 From the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Accepted for publication in July 1975. 2 Present address: Department of Radiology, Maricopa County General Hospital, 2601 E. Roosevelt, Phoenix, Ariz . 85008. dk
274
