Skeletal Radiol (2004) 33:537–540 DOI 10.1007/s00256-004-0758-x CASE REPORT Andrey Bespalchuk Kyoji Okada Jun Nishida Shu Takahashi Yoichi Shimada Eiji Itoi Stress fracture of the second metacarpal bone Received: 5 December 2003 Accepted: 21 January 2004 Published online: 29 June 2004  ISS 2004 A. Bespalchuk · K. Okada ( ) )· S. Takahashi · Y. Shimada · E. Itoi Department of Orthopedic Surgery, Akita University School of Medicine, 1-1-1 Hondo, 010-8543 Akita, Japan e-mail: cshokada@med.akita-u.ac.jp Tel.: +81-18-8846148 Fax: +81-18-8362617 A. Bespalchuk Orthopedic Department, Belarusian State Medical University, 83 Dzerzhinsky Avenue, 220116 Minsk, Republic of Belarus J. Nishida Department of Orthopedic Surgery, Iwate Medical School, Uchimaru 19-1, 020-8505 Morioka, Japan Abstract Stress fractures are usually encountered in athletes; however, only eight such cases involving the metacarpal bones have been reported in the English literature. We report on the rare case of a 15-year-old female tennis player with a stress fracture of the second metacarpal bone. Keywords Stress · Fatigue · Fracture · Metacarpal · MRI Introduction Most stress fractures occur in the lower extremities and are rarely encountered in the upper extremities [1, 2]. To our knowledge, only eight cases of stress fracture of a metacarpal bone have been reported in the English liter- ature [3, 4, 5, 6, 7, 8, 9]. We report on a 15-year-old female with a second metacarpal fatigue fracture after intense tennis practice. Case report A 15-year-old female, right-handed tennis player visited our insti- tution in August 2003 with the complaint of pain over the right hand. She first noticed pain approximately 1 month before the visit. The pain gradually increased in the preceding month. She com- plained of the pain while gripping a racket and during stroking and serving. She had started tennis only 2 months before, and her coach chose the “Western” forehand grip of the racket for her [7]. She practiced for 3 h a day on weekdays and for 5 h a day at weekends. She had neither a history of acute injury nor a special diet. The initial examination showed tenderness over the second metacarpal bone and mild swelling of the radial-dorsal aspect of the right hand. The range of motion was full in all joints. The labora- tory findings were within normal limits. The initial radiographs showed the presence of a periosteal reaction over the base and midshaft of the second metacarpal bone (Fig. 1), which was con- firmed by CT (Fig. 2). On MR imaging, T1-weighted images showed diffuse low-signal change in the bone marrow of the proximal second metacarpal shaft with thickening of the cortical bone, and T2-weighted images showed diffuse high-signal intensity of the bone marrow. In addition, both T1- and T2-weighted images revealed a hairline fracture of the base of the second metacarpal (Fig. 3). A diagnosis of stress fracture of the second metacarpal bone was made. The patient was instructed to avoid tennis for 4 weeks. Repeat radiographs 1 month after the first visit showed thick- ening of periosteal callus (Fig. 4). The pain in the patient’s arm