What is a stress fracture?
Chronic overloading of a bone at a rate that exceeds the bone’s ability to respond to the load and repair results in microtrauma that can progress to a fracture. Athletes who are pushing their limits may suffer from fatigue fractures, (abnormal stress on normal bone) while those with osteoporosis or other form of diminished bone health, may get fragility fractures doing everyday tasks (normal load on abnormal bone)
What do these injuries feel like?
Patients seek medical care because of pain they cannot explain with a traumatic event. The pain is usually in the lower extremities but can be in the chest or arms if you use those extremities a lot (paddlers, hikers, those with crutches or wheelchairs).
What is the best test to detect a stress injury?
- MRI is the best test your doctor can order when the question is stress fracture or not. No contrast injection is required for this test. By looking for the earliest changes of bone overload, an MRI is both able to detect an injury very soon after the onset of pain (1-3 days) and differentiate between fractures and other causes of pain. While more time consuming and expensive, early fracture detection with MRI results in earlier diagnosis, faster recovery, and may prevent a stress injury from progressing from one that can heal with rest to one that requires surgery for treatment.
- Although the first test your doctor may order is an x-ray, this kind of imaging is limited early on. In the first 2 weeks, x-rays are only able to detect between 15-30 percent of injuries. Once a stress fracture begins to heal with new bone, x-rays get better, detecting between 30-70 percent of injuries when viewed by trained readers.
- Bone scans will detect most stress fractures within 3 days of onset of pain but cannot distinguish between fracture and other causes of bone turnover like arthritis, infection, or a tumor. In this 2-part study, an IV injection of radiotracer travels to areas of bone turnover and then images several hours later are obtained, looking for a “hot spot”.
Your MSK imaging and intervention doctors at ARA Health Specialists are experts at interpreting imaging of all parts of the body in both athletes and others for whom stress fracture is suspected. We communicate the result of your exam directly back to your primary care provider or orthopedic specialist, after hours if needed, to get the ball rolling ASAP on your recovery.