{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T03:17:34Z","timestamp":1788405454685,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Scapular stress fractures are exceptionally rare in athletes and are notoriously difficult to diagnose due to their subtle presentation and poor sensitivity on initial radiographs. This case report describes the diagnostic challenge of a scapular body stress fracture in an elite boxer who initially presented with wrist pain. Case Presentation: A 19-year-old right-hand-dominant female elite boxer presented with a three-month history of bilateral wrist pain. Initial examination and MRI were consistent with a triangular fibrocartilage complex (TFCC) injury. Despite conservative management, her symptoms persisted, and she subsequently developed mechanical right shoulder pain and a sensation of instability. Physical examination revealed scapular dyskinesis, with a positive push-up test and weakness on punch protraction. Plain radiographs of the scapula were unremarkable. Point-of-care musculoskeletal ultrasound (MSK US) identified a cortical irregularity at the medial scapular border. A subsequent computed tomography (CT) scan obtained at three-month follow-up definitively confirmed a stress fracture at this site. Treatment focused on scapular stabilization via prolotherapy and activity modification, leading to symptomatic resolution and a successful return to sport. Conclusions: This case underscores the importance of evaluating the entire kinetic chain in athletes presenting with focal complaints. It demonstrates the utility of MSK US as an effective initial screening tool for cortical stress fractures and highlights the necessity of CT for definitive confirmation. Clinicians should maintain a high index of suspicion for scapular stress injuries in overhead athletes with unexplained shoulder dysfunction.<\/jats:p>","DOI":"10.3390\/diagnostics15202565","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T05:48:21Z","timestamp":1760420901000},"page":"2565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ultrasonographic Diagnosis and Computed Tomographic Confirmation of a Scapular Body Stress Fracture in an Elite Boxer: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"},{"name":"Incheon Terminal Orthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"International Association of Regenerative Medicine, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"MSKUS, San Diego, CA 92084, USA"},{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King","family":"Lam","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Faculty of Medicine, The University of Hong Kong, Hong Kong"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, New Territory, Hong Kong"},{"name":"The Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-9856","authenticated-orcid":false,"given":"Jihyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seonghwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Korea Association of Cyriax Orthopaedic Medicine, Yangpyeong 12522, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jangkeun","family":"Kye","sequence":"additional","affiliation":[{"name":"Korea Association of Cyriax Orthopaedic Medicine, Yangpyeong 12522, Republic of Korea"},{"name":"Rolfing Spine Posture Institute, Seoul 06236, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeeun","family":"Kim","sequence":"additional","affiliation":[{"name":"Rolfing Spine Posture Institute, Seoul 06236, Republic of Korea"},{"name":"Department of Sports Rehabilitation, Cheongju University, Cheongju 28503, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhan","family":"Kang","sequence":"additional","affiliation":[{"name":"Rolfing Spine Posture Institute, Seoul 06236, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Incheon Terminal Orthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-0918","authenticated-orcid":false,"given":"Daniel","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan 710, Taiwan"},{"name":"A Tempo Regeneration Center for Musicians, Tainan 700, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6722-0268","authenticated-orcid":false,"given":"Teinny","family":"Suryadi","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta 14350, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 12950, Indonesia"},{"name":"Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11510, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0988","authenticated-orcid":false,"given":"Anwar","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-2326","authenticated-orcid":false,"given":"Kenneth","family":"Reeves","sequence":"additional","affiliation":[{"name":"Independent Researcher, Roeland Park, KS 66205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.amepre.2010.12.018","article-title":"Boxing injuries presenting to U.S. emergency departments, 1990\u20132008","volume":"40","author":"Potter","year":"2011","journal-title":"Am. J. Prev. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s00113-015-0014-y","article-title":"[Hand injuries from combat sports]","volume":"118","author":"Hanna","year":"2015","journal-title":"Unfallchirurg"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jung, J.W., and Kim, Y.K. (2021). Scapular Dyskinesis in Elite Boxers with Neck Disability and Shoulder Malfunction. Medicina, 57.","DOI":"10.3390\/medicina57121347"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1142\/S2424835520500290","article-title":"Management of Little Finger Metacarpal Fractures: A Meta-Analysis of the Current Evidence","volume":"25","author":"Chong","year":"2020","journal-title":"J. Hand Surg. Asian Pac. Vol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.ptsp.2015.02.003","article-title":"Shoulder function and scapular position in boxers","volume":"16","author":"Lenetsky","year":"2015","journal-title":"Phys. Ther. Sport"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cornelia, Z., Steiner, I., Robert, B., Fiala, R., and Krifter, R.M. (2021). Shoulder Injuries in Boxing: A systematic Review. Res. Sq.","DOI":"10.21203\/rs.3.rs-457153\/v1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.17816\/PTORS676981","article-title":"Stress fractures in upper extremities of athletes: A review","volume":"13","author":"Agranovich","year":"2025","journal-title":"PTORS"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"765","DOI":"10.20945\/2359-3997000000562","article-title":"Stress fractures","volume":"66","author":"Costa","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s40798-024-00769-7","article-title":"Upper Extremity Stress Fractures","volume":"10","author":"Koslosky","year":"2024","journal-title":"Sports Med.\u2014Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S1058-2746(95)80025-5","article-title":"Scapular fracture in a professional boxer","volume":"4","author":"Wyrsch","year":"1995","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_11","first-page":"52","article-title":"Ultrasound in bone fracture diagnosis\u2014A comparative meta-analysis and systematic review","volume":"27","author":"Matschiner","year":"2025","journal-title":"Med. Ultrason."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1007\/s00402-024-05396-1","article-title":"Fracture sonography-review of literature and current recommendations","volume":"144","author":"Ackermann","year":"2024","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1136\/bjsm.2003.009225","article-title":"Isolated first rib fracture in athletes","volume":"38","author":"Sakellaridis","year":"2004","journal-title":"Br. J. Sports Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s13256-024-04458-7","article-title":"Treatment of a fractured humerus and partially torn supraspinatus tendon in a professional boxer with liquid platelet-rich fibrin and heat-coagulated albumin gel: A case report","volume":"18","author":"Ogeus","year":"2024","journal-title":"J. Med. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0749-8063(98)70065-9","article-title":"The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation","volume":"14","author":"Burkhart","year":"1998","journal-title":"Arthroscopy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"663","DOI":"10.2165\/00007256-200939080-00004","article-title":"Shoulder muscle activity and function in common shoulder rehabilitation exercises","volume":"39","author":"Escamilla","year":"2009","journal-title":"Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1136\/bjsm.2009.058834","article-title":"Current concepts: Scapular dyskinesis","volume":"44","author":"Kibler","year":"2010","journal-title":"Br. J. Sports Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.26603\/001c.31727","article-title":"Current Views of Scapular Dyskinesis and its Possible Clinical Relevance","volume":"17","author":"Sciascia","year":"2022","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s12178-019-09591-1","article-title":"Evaluation and Management of Scapular Dyskinesis in Overhead Athletes","volume":"12","author":"Kibler","year":"2019","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5435\/00124635-200303000-00008","article-title":"Scapular dyskinesis and its relation to shoulder pain","volume":"11","author":"Kibler","year":"2003","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"23259671241275087","DOI":"10.1177\/23259671241275087","article-title":"Prolotherapy in the Treatment of Sports-Related Tendinopathies: A Systematic Review of Randomized Controlled Trials","volume":"12","author":"Capotosto","year":"2024","journal-title":"Orthop. J. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Champagne, N., Eadie, L., Regan, L., and Wilson, P. (2019). The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: A systematic review and subgroup meta-analysis. BMC Emerg. Med., 19.","DOI":"10.1186\/s12873-019-0226-5"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1002\/msc.1643","article-title":"Ultrasound-guided versus landmark-guided subacromial corticosteroid injections for rotator cuff related shoulder pain: A systematic review of randomised controlled trials","volume":"20","author":"Adamson","year":"2022","journal-title":"Musculoskelet. Care"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ma, Q., Jiao, Q., Wang, S., Dong, L., Wang, Y., Chen, M., Wang, S., Ying, H., and Zhao, L. (2020). Prevalence and Clinical Significance of Occult Fractures in the Extremities in Children. Front. Pediatr., 8.","DOI":"10.3389\/fped.2020.00393"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.jemermed.2021.11.025","article-title":"Use of Point-of-Care Ultrasound to Identify Occult Fractures of the Tibia in the Pediatric Emergency Department: A Case Series","volume":"62","author":"Scheier","year":"2022","journal-title":"J. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/8756479321996314","article-title":"Radiography Versus Sonography in the Detection of Acute Fractures: A Case Series","volume":"37","author":"Yu","year":"2021","journal-title":"J. Diagn. Med. Sonogr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1177\/0363546506298278","article-title":"Scapular stress fracture in a professional baseball player: A case report and review of the literature","volume":"35","author":"Herickhoff","year":"2007","journal-title":"Am. J. Sports Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/RCT.0b013e318280575d","article-title":"Stress fracture of the scapula in a professional baseball pitcher: Case report and review of the literature","volume":"37","author":"Levine","year":"2013","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_29","first-page":"312","article-title":"Scapular stress fracture in a professional cricketer and a review of the literature","volume":"95","author":"Pritchard","year":"2005","journal-title":"S. Afr. Med. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e249","DOI":"10.3928\/01477447-20220907-01","article-title":"Scapular Stress Fracture of the Inferior Angle in an Adolescent Swimmer","volume":"46","author":"Reed","year":"2023","journal-title":"Orthopedics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1177\/1941738112463346","article-title":"Scapular stress fracture in water polo: A case report","volume":"4","author":"Donaldson","year":"2012","journal-title":"Sports Health"},{"key":"ref_32","first-page":"e79993","article-title":"Acromion and Clavicle Stress Fractures After Reverse Total Shoulder Arthroplasty Reflect Failure to Address Osteoporosis: A Case Report and Literature Review","volume":"17","author":"Cronin","year":"2025","journal-title":"Cureus"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Elmenawi, K.A., Sperling, J.W., Sanchez-Sotelo, J., and Barlow, J.D. (2025). Risk Factors for Acromial and Scapular Fractures Following Reverse Shoulder Arthroplasty: A Meta-analysis of Over 100,000 Shoulders. JSES Rev. Rep. Tech.","DOI":"10.1016\/j.xrrt.2025.08.015"},{"key":"ref_34","first-page":"228","article-title":"A stress fracture of the scapular body in a child","volume":"15","author":"Hart","year":"1995","journal-title":"Iowa Orthop. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s12178-007-9002-3","article-title":"Advances and utility of diagnostic ultrasound in musculoskeletal medicine","volume":"1","author":"Lento","year":"2008","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1055\/s-2007-1000408","article-title":"[Ultrasound findings after shoulder dislocation]","volume":"18","author":"Weishaupt","year":"1997","journal-title":"Ultraschall Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20150372","DOI":"10.1259\/bjr.20150372","article-title":"Ultrasound-guided interventional procedures around the shoulder","volume":"89","author":"Messina","year":"2016","journal-title":"Br. J. Radiol."},{"key":"ref_38","unstructured":"Cowan, P.T., Mudreac, A., and Varacallo, M.A. (2025). Anatomy, Back, Scapula. StatPearls, StatPearls Publishing."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Kacprzak, J., Mosler, D., Tsos, A., and W\u0105sik, J. (2025). Biomechanics of Punching\u2014The Impact of Effective Mass and Force Transfer on Strike Performance. Appl. Sci., 15.","DOI":"10.3390\/app15074008"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.jelekin.2011.07.001","article-title":"Differential activation of parts of the serratus anterior muscle during push-up variations on stable and unstable bases of support","volume":"21","author":"Park","year":"2011","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.25122\/jml-2023-0087","article-title":"Role of kinetic chain in sports performance and injury risk: A narrative review","volume":"16","author":"Almansoof","year":"2023","journal-title":"J. Med. Life"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1249\/JSR.0000000000000084","article-title":"Stress fracture of second rib and scapular spine in a female softball player","volume":"13","author":"Marcano","year":"2014","journal-title":"Curr. Sports Med. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Pepper, M., Akuthota, V., and McCarty, E.C. (2006). The pathophysiology of stress fractures. Clin. Sports Med., 25.","DOI":"10.1016\/j.csm.2005.08.010"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/03635465980260022801","article-title":"The role of the scapula in athletic shoulder function","volume":"26","author":"Kibler","year":"1998","journal-title":"Am. J. Sports Med."},{"key":"ref_45","first-page":"170","article-title":"Serratus anterior palsy secondary to long thoracic nerve dysfunction","volume":"5","year":"2025","journal-title":"JSES Rev. Rep. Tech."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/00130911-200312000-00008","article-title":"Anatomy and biomechanics of the elbow joint","volume":"7","author":"Fornalski","year":"2003","journal-title":"Tech. Hand Up. Extrem. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/20\/2565\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:37:10Z","timestamp":1761057430000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/20\/2565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,11]]},"references-count":46,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["diagnostics15202565"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15202565","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,11]]}}}