Stress Fractures

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Diagnosing Stress Fractures

Stress fractures are one of the most common sports related injuries that are usually managed by family practitioners. It is a result of repetitive use of a muscle group that exceeds the natural ability of the bone to repair itself. The lower extremities are frequently affected by sports involving running and jumping. Activities such as baseball and tennis involve repetitive usage of the arms and can cause stress fractures of the upper extremities.

Lower extremity stress fractures present as localized, dull pain with no evidence of trauma that worsens during exercise or weight bearing. The tibia is the most common site of injury and accounts for 50% of stress fractures. Localized edema and thickening of the periosteum can occur and is prevalent to the middle and distal third of the tibia. Point tenderness to palpation to the injury site is hallmark for stress fractures. Metatarsal fractures make up 25% of stress fractures and are usually located to the distal second and third metatarsal. These injuries are common among military recruits and those who are not physically conditioned for the workout routine they are participating in.

Many presumed diagnosis are made by clinical exam. Radiological studies will help the clinician to make a definitive diagnosis. Plain radiographs should be obtained, but evidence of a fracture may never appear or may not appear for two to ten weeks after symptom onset. Repeat radiographs will reveal a fracture during the recovery phase 50% of the time. Bone scans and magnetic resonance imaging scans are more expensive than plain radiographs but are much more accurate in identifying stress fractures.

Although stress fractures are very common among young athletes, clinicians are imprecise at making the correct diagnosis. Proper diagnosis are important to prevent further injury and possible nonunion of the affected bone. My patient care populations are ...