OCAD MSK

History

75F bilateral midfoot pain

Figure 1 for case stress reaction — Figure 1

Figure 2 for case stress reaction — Figure 2

Figure 3 for case stress reaction — Figure 3

Discussion

The short axis images show dark T1/ bright PDFS marrow signal and subtle periosteal edema, but there is no fracture or cortical defect. I thought this might be Grade 3 stress reaction (using Mike Fredericsons schema for Tibial Stress reaction. But the long axis and Sag images show severe TMT DJD, with degenerative subchondral cysts at the head of C2 and superimposed BME. My question is whether this is degenerative marrow edema and if you consider that separate from stress reaction (is this in the spectrum of stress fracture? can it progress to s tress fracture?), or if it is actually a degenerative cyst dissecting into the shaft, or if you believe this is Gr 3 stress reaction, which I would consider (in a runner) to indicate impending fracture. These changes are bilateral and symmetric, by the way.

Diagnosis

stress reaction

Hilary Umans, MD

Courtesy

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