Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

Jonathan C. Baker, Jennifer L. Demertzis

Research output: Contribution to journalArticle

Abstract

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture.

Original languageEnglish
Pages (from-to)833-837
Number of pages5
JournalSkeletal Radiology
Volume45
Issue number6
DOIs
StatePublished - Jun 1 2016

Keywords

  • MRI
  • Manubrium
  • Sternum
  • Stress fracture

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