From the Research
The best clinical exam special test to diagnose a stress fracture is the hop test, which involves having the patient stand on the suspected injured limb and hop several times, as it is a simple and effective way to assess for pain and discomfort associated with stress fractures. This test is particularly useful for lower extremity stress fractures, especially in the tibia, metatarsals, and femoral neck. The hop test works by applying compressive forces through the bone, which exacerbates pain at the fracture site. Other helpful clinical tests include the fulcrum test for femoral stress fractures (applying pressure to the femur while leveraging it) and the tuning fork test (placing a vibrating tuning fork on the suspected fracture site to elicit pain) 1, 2, 3, 4, 5.
Key Points to Consider
- The hop test is a useful clinical exam special test for diagnosing stress fractures, especially in the lower extremities.
- Imaging studies, such as MRI or bone scan, are typically needed to confirm the diagnosis of a stress fracture.
- The patient's history, including recent changes in activity level, training surfaces, or footwear, should also be considered alongside these clinical tests.
- It's essential to start gently and progress cautiously when performing these tests to avoid worsening the potential fracture.
Imaging Studies
Imaging studies, such as MRI or bone scan, are crucial in confirming the diagnosis of a stress fracture. According to the most recent study 5, magnetic resonance imaging (MRI) is the gold standard for diagnosing stress fractures, and computed tomography (CT) should be included if the MRI findings are unclear. New techniques, such as dual energy computed tomography (DECT) and magnetic resonance bone imaging (MR bone), may also be used in the future to aid in diagnosis.
Clinical Considerations
When diagnosing stress fractures, it's essential to consider the patient's history, including recent changes in activity level, training surfaces, or footwear. This information can help identify potential risk factors for stress fractures and guide the diagnosis and treatment plan. Additionally, the patient's symptoms, such as pain and discomfort, should be carefully evaluated to determine the best course of action. As noted in 2, individuals with stress fractures present with focal tenderness and local pain that is aggravated by physical activity and reduced by rest.
Treatment and Prevention
Treatment of stress fractures typically involves activity modification, including the use of nonweight-bearing crutches if needed for pain relief, as well as analgesics to relieve pain. Pneumatic bracing can also be used to facilitate healing. As mentioned in 3, surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention strategies, such as modifications to physical training programs, use of shock-absorbing insoles, and vitamin D and calcium supplementation, can also be effective in reducing the risk of stress fractures 2.