Diagnosing Stress Fractures

Unlike a broken bone, which is caused by a single traumatic injury, stress fractures develop gradually as the result of repeated trauma, or “stress.” Over time, bones may become fatigued by the stress of the foot hitting the ground in sports like running, tennis, or basketball, Without rest, tiny cracks called stress fractures can form on the surface of bones.

Symptoms may not appear right away. The first sign might be a dull pain that you notice while performing a high-impact activity. As the injury worsens, pain usually increases. Swelling or tenderness may occur near the fracture. The pain of a stress fracture can interfere with movement, especially if the injury is in the leg or foot. If you continue to exercise despite the pain, a stress fracture can become a chronic problem that may take years to heal.

Orthopedic sports medicine specialists at NYU Langone Orthopedic Center understand that a stress fracture can be a frustrating setback. Our experts can diagnose a stress fracture in its early stages, which can help you recover as quickly as possible.

Medical History

To diagnose a stress fracture, your doctor asks about the location of the pain, when it occurs, and how long you’ve noticed it. He or she also asks whether you have any other medical conditions and what medications you take. Telling your doctor about the athletic activities you participate in can help him or her diagnose a stress fracture.

Physical Exam

A stress fracture may cause visible changes to the skin and muscle near the injury. The skin may swell slightly and feel warm to the touch. Your doctor may apply light, direct pressure to the area and the nearby muscle to see if it is painful. Your doctor may also ask you to walk a few steps to determine how the injury affects the way you move.

Imaging Tests

If your symptoms suggest you have a stress fracture, doctors typically recommend imaging tests to confirm the diagnosis. All of these painless tests are conducted at NYU Langone Orthopedic Center and take less than an hour to complete.

X-rays

X-rays use electromagnetic radiation to create detailed images of bones. Doctors often use X-rays to diagnose fractures, but many early stress fractures are too small to appear on an X-ray. If an X-ray looks normal but symptoms suggest the presence of a stress fracture, your doctor may recommend another imaging test, such as an MRI scan.

MRI Scans

An MRI scan can reveal a stress fracture up to two weeks before it’s visible on an X-ray. This test uses magnetic fields and radio waves to create two- and three-dimensional images of structures inside the body. A computer combines these images to produce a highly detailed picture of bones and soft tissues such as muscles and tendons. This technology enables your doctor to identify tiny breaks in a bone.

A doctor may also use an MRI scan to rule out other causes of pain, such as a sprain or strain.

Bone Scans

Most of the time, a doctor uses MRI scans to diagnose stress fractures. If he or she suspects a stress fracture has occurred in a part of the body that’s difficult to detect on an MRI scan, such as the ribs, he or she may recommend a bone scan. This test can reveal areas of bone that are being repaired, which usually indicate that an injury such as a stress fracture has occurred.

To conduct this test, a doctor injects a small amount of a radioactive substance, called a tracer, into your bloodstream. Over the course of a few hours, this tracer moves throughout your body and accumulates in spots of significant bone repair. If the tracer accumulates in the bone where you are experiencing pain and other symptoms of a stress fracture, your doctor may diagnose a stress fracture or recommend further testing.

CT Scans

If you cannot have an MRI scan because you have a pacemaker or other implanted device that should not be exposed to a magnetic field, your doctor may order a CT scan to diagnose a stress fracture. A CT scan uses a series of X-rays combined by a computer to produce a detailed three-dimensional image of bones. It allows a doctor to evaluate a possible injury from a variety of angles.