Stress Reactions and Fractures

Authors
Affiliations

Doctor of Physical Therapy

B.S. in Kinesiology

Doctor of Physical Therapy

B.A. in Neuroscience

Stress injuries

Stress injuries encompass a wide variety of injuries from inflammation to full cortical breaks1:

Stress injuries are a common type of “overuse injury” in athletic populations1

Occur due to repetitive submaximal loading on a bone over time1

Risk factors

  • Athletes are at higher risk of stress injuries1. Especially sports that combine running or jumping with high volume or intensity1.
  • LE injuries occur more often than UE1

Upper Extremity injuries

UE Injuries are much less common than LE stress injuries1. Regardless, when a stress injury occurs in the UE, it generally occurs in the ulna1.

Trunk stress fractures

Pelvis

Stress fx of the pelvis are difficult to diagnose since these present similar to other causes of groin and hip pain (i.e. adductor strain, osteitis pubis, or sacroiliitis)1

The most common location is the ischiopubic ramus and sacrum1. - The most common cause is running1

Lower Extremity Stress Fx

Femoral neck

Femoral neck stress fractures alone make up ~11% of stress injuries in athletes1

Subjective

Generally, patients complain of hip or groin pain which is aggravated with weight bearing and range of motion (especially internal rotation)1

Types

There are 2 types of femoral neck stress fractures: tension-type (or distraction) fractures and compression-type fractures1

Tension-type femoral neck stress fractures1

  • (AKA distraction type)1
  • Involve the superior-lateral aspect of the neck1
Important

Tension type stress fractures Have the highest risk for complete fracture1

Thus, early detection is very important1

Compression-type fractures

  • Population
    • Commonly observed in younger athletes1
    • Common in runners1
  • Involves the inferior-medial femoral neck1
  • Rehabilitation: non-surgical management can be attempted if there is no visible fracture line1

Femoral shaft

Femoral shaft stress fractures are very common, especially in the military1.

Subjective

Generally, patients complain of leg pain that is poorly localized and insidious1

DDX

This pathology is often misdiagnosed as muscle injury1.

Testing

  • An exam is often nonfocal1
  • The “fulcrum test” can be helpful to localize symptoms and rule-in a femoral shaft stress fx1

Rehab

If imaging does not indicate a cortical break, non-surgical rehab can be attempted1

References

1.
Kiel J, Kaiser K. Stress Reaction and Fractures. In: StatPearls. StatPearls Publishing; 2023. Accessed August 30, 2023. http://www.ncbi.nlm.nih.gov/books/NBK507835/

Citation

For attribution, please cite this work as: