Bone stress fractures and injuries of the upper limb in athletes

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.

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.

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.

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.