Stress Reactions and Fractures
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
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
Compression-type fractures
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