Occult Skeletal Stress Injuries of the Wrist and Vitamin D Deficiency: A Case Series

Stress reactions occur from repetitive loads that weaken the bone and are often associated with nutritional deficiencies and metabolic dysfunction. More commonly, these injuries are reported in the lower extremities, with less literature on stress fractures in the upper extremities. Seven patients presented with chronic, atraumatic wrist pain that did not improve with conservative measures. Magnetic resonance imaging (MRI) demonstrated increased signal on T2, suggestive of carpal stress reaction. Patients had documented low vitamin D levels or levels obtained after MRI confirmation of stress injury. All patients showed improvement in symptoms after targeted vitamin D supplementation and nutritional management; none of the patients required surgical intervention. Stress reactions in the hand and wrist are relatively uncommon. These injuries, and underlying metabolic abnormalities, can be missed easily without a careful history and work-up. Recognizing these injuries and correcting contributing factors can help avoid more catastrophic skeletal stress injuries in the lower extremities, such as the tibia or femoral neck.