title: Stress reaction of the humerus in tennis players.
abstract: BACKGROUND
  Overuse injuries are a frequent occurrence among competitive athletes. When analysing the incidence of overuse injuries in tennis players, it has been determined that a significant number of these injures occur in the upper limb area. In this study, we describe five cases of a stress-induced injury to the middle and distal humerus occurring mainly due to repetitive serving.
  
  
  METHODS
  Athletes studied were competitive tennis players and elite junior players, two of whom played at international level. Four of the five were male. In all cases, diagnosis was confirmed by magnetic resonance imaging examination. The treatment of middle and distal humeral stress reactions consisted of physical therapy, which focused on analgesia and muscle strengthening. In addition, we analysed each tennis player's strokes in order to identify modifications that would decrease the amount of stress that the upper limbs were subjected to during the service motion.
  
  
  RESULTS
  The players in our study missed on average 3 weeks of play and at follow-up after 1 year were able to play symptom free.
  
  
  CONCLUSIONS
  Our study highlights the need for coaches, physicians and players to be aware of distal humeral pain and understand treatment options in order to prevent further injury, including stress fractures.
authors.affiliation: NEO-Sports Medicine Research Center, Orthopedics and Sports Medicine, Sao Paulo, Brazil. rgtsilva@uol.com.br
authors.forename: Rogerio Teixeira
authors.initials: RT
authors.lastname: Silva
authors.forename: Luis Guilherme
authors.initials: LG
authors.lastname: Hartmann
authors.forename: Cristiano Frota de Souza
authors.initials: CF
authors.lastname: Laurino
mesh_terms: D000293:Adolescent; D000328:Adult; D000698:Analgesia; D001265:Athletic Injuries / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D003163:Competitive Behavior; D012090:Cumulative Trauma Disorders / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000293:injuries* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000209:etiology; D020127:Recovery of Function; D013715:Tennis / Q000293:injuries*; D016896:Treatment Outcome