PubMed · 16144580
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Ian Shrier. 2005. Stretching perspectives.. https://doi.org/10.1097/01.csmr.0000306215.95056.8a
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The imaging evaluation of a patient who has a clinically suspected stress reaction or fracture should begin with high-resolution radiographs of the area in question. In inconclusive or indeterminate cases, additional imaging should be obtained. CT provides exquisitely fine osseous detail, in multiple planes, often demonstrating the endosteal remodeling or fracture line that is not apparent on conventional radiographs. The sensitivity of nuclear scintigraphy depicts areas of even subtle osseous turnover and stress remodeling. Ultrasonography, used increasingly in the evaluation of the musculoskeletal system, can provide a limited evaluation of the superficial osseous structures, providing an imaging alternative, especially in patients who are MRI-incompatible. MRI, however, provides the most comprehensive evaluation of stress injuries, revealing both functional and morphologic information about the bone.
Stress fractures are common injuries, particularly in endurance athletes. Stress fracture management should take into consideration the injury site (low risk versus high risk), the grade (extent of microdamage accumulation), and the individual's competitive situation. The authors briefly discuss the pathophysiology and diagnostic process of stress fractures and expand on the classification of stress fractures and its impact on return-to-play decision making based on the relative risk of the fracture.
This article is an introduction to the fundamentals of stress fracture management. Extrinsic and intrinsic factors, that may play a role in the development of stress fractures, are discussed and incorporated as possible treatment options. Different treatment modalities including ultrasound and electromagnetic fields are addressed, with an emphasis on literature support.