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However, in professional athletes, these fractures can significantly impact function, training and return-to-play decisions. This narrative review examines the anatomy of transverse processes, mechanisms of injury, clinical presentation, imaging modalities, management strategies, rehabilitation principles and return-to-play considerations. A comprehensive review of the literature was conducted, incorporating case studies, sports medicine reports and trauma data to provide an evidence-based approach to TPF diagnosis and management in professional athletes. TPFs in athletes typically result from high-energy direct trauma, excessive rotational forces or muscular avulsion. While inherently stable, they may be associated with concomitant injuries, necessitating a thorough clinical and radiologic evaluation. Despite emerging imaging techniques (e.g. magnetic resonance imaging [MRI] three-dimensional [3D] T1 volumetric interpolated breath-hold examination [VIBE]), computed tomography (CT) imaging remains the gold standard for diagnosis, with MRI useful for detecting soft tissue pathology. Treatment is predominantly non-operative, focusing on multimodal pain control, early mobilization and structured rehabilitation to restore spinal function while preventing complications. Return-to-play is individualized, with most athletes resuming full activity within 3\u20136\u00a0weeks for isolated TPFs, though multi-level fractures or associated injuries may prolong recovery. TPFs require careful assessment and management to ensure optimal recovery and a safe return-to-play. A multidisciplinary approach involving orthopaedic surgeons, musculoskeletal radiologists, sports physicians, physiotherapists, sport scientists and coaching staff is essential to balance expedient recovery without long-term sequelae. Understanding sport-specific demands and implementing tailored rehabilitation protocols can allow athletes to make a complete recovery with minimal risk of recurrence.<\/jats:p>","DOI":"10.1007\/s40279-026-02471-y","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T10:10:30Z","timestamp":1781518230000},"page":"2457-2476","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transverse Process Fractures in Athletes: Mechanisms, Management and Return-to-Play Considerations"],"prefix":"10.1007","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8570-7704","authenticated-orcid":false,"given":"Arnav","family":"Barve","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake M.","family":"McDonnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"McCartney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubrie","family":"Sowa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Carmody","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Darwish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Butler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"2471_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/B978-0-323-07954-9.00002-5","volume-title":"Clinical anatomy of the spine, spinal cord, and ans","author":"GD Cramer","year":"2014","unstructured":"Cramer GD. 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