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What is an Ulnar Stress Fracture?

Ulnar stress fractures occur when repetitive overuse—most often in athletes like pitchers—leads to a slight cracking of the ulna, the lower arm bone on the pinky side. Unlike traumatic fractures that occur suddenly, stress fractures can develop over a long period of time. Symptoms may be indicated by nothing more than chronic pain upon activity. Stress fractures begin as partial and become complete fractures that occur due to repeated stress over time to an area. They are more common in the upper extremity in pitchers.

Characteristics and Clinical Presentation of an Ulnar Stress Fracture

Stress fractures are small cracks on bony structures that often develop as a result of sports that involve repetitive movements. Stress fractures usually develop as a gradual result of overuse. They may often heal with rest, but they can be painful and last for several weeks or months. Patients with an Ulna Stress Fracture may have difficulty using their hand or arm normally. Patients may report hearing a crack in the affected region at the time of completion of the fracture. Usually, it develops silently and slowly over time.

The most common causes of ulnar stress fractures include:

  • Pitching
  • Two handed tennis backhand
  • Weightlifting, pushups, ice dancing.

Getting a Diagnosis for an Ulnar Stress Fracture

Your doctor will do a physical examination first, assessing your reaction to pressure in the affected area. A careful examination may produce tenderness along the upper or midshaft of the ulna with resisted rotation or extension

They may need to confirm the diagnosis using medical imaging techniques, which include magnetic resonance imaging (MRI), X-rays, or a CT scan. These tests generally reveal damage to the bony structure as well as any damage to the soft tissue surrounding the injury.

Treatment Options for an Ulnar Stress Fracture

Unless the bone is completely broken, an Ulnar Stress Fracture will usually respond to rest, icing and splinting. Traumatic and full thickness stress fractures often require surgical repair. Patients may be required to immobilize the arm for a period of time to promote healing if the injury does not require surgical repair.

Stress fractures are easily treated in most cases, but patients experiencing pain following athletic activities should seek medical attention immediately to try to prevent the injury from worsening.

Conservative Treatments

Some stress fractures will heal on their own without surgical intervention if the athlete refrains from physical activity that stresses the affected area.

Patients can promote comfort by elevating the affected area and applying ice whenever possible.

NSAIDs can ease painful transitions until the affected region is healed. Some injuries may require immobilization through the use of splints or casts.

Surgical Treatments

In some cases, stress fractures may warrant surgical intervention if the injury does not heal on its own or if it is severe. Fractures with bone loss or moving fragments are good candidates for surgery to restore stability, minimize pain and maximize function.

Simple fractures where the broken piece hasn’t moved may be treated with a cast for several weeks. Patients are encouraged to begin motion exercises to the arm shortly after immobilization or surgery, to maximally overcome stiffness. Early motion exercises in the arm will promote strength and reduce stiffness from developing in the joints and muscles of the arm.

Preventing an Ulnar Stress Fracture

It is usually possible to prevent some stress fractures. However, athletes who engage in certain sports are more susceptible to injuries of this kind.

Additionally, athletes with certain conditions such as osteoporosis or hypophosphatasia may be at increased risk for injury. Athletes with increased risk of stress fractures should seek modifications to habits and techniques that put them at risk to further injury.

The risk of stress fractures can be reduced by:

  • High-quality equipment and technique.
  • Support with proper coaching and rest.
  • Gradual changes to intensity, frequency, and duration of athletic activities.
  • Attending to pain and avoiding a “no pain, no gain” philosophy while engaging in athletic activities.

Prognosis for an Ulnar Stress Fracture

Most injuries will resolve with conservative treatment methods. Injuries requiring surgical intervention may require an immobilization period through splinting or casting for a period of time depending on severity.

Patients generally enroll in a physical therapy program under their hand surgeon’s supervision to optimize mobility and function. Rehabilitation times will vary depending on severity and individual goals.

If You Believe You Have an Ulnar Stress Fracture, Contact HandSport Surgery Institute.

Please contact us as soon as possible to schedule an appointment with our talented team. People who have been hurt should be evaluated to try to prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.

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