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 breaks:

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

Occur due to repetitive submaximal loading on a bone over time

Risk factors

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

Upper Extremity injuries

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

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)

The most common location is the ischiopubic ramus and sacrum. - The most common cause is running

Lower Extremity Stress Fx

Femoral neck

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

Subjective

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

Types

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

Tension-type femoral neck stress fractures

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

Tension type stress fractures Have the highest risk for complete fracture

Thus, early detection is very important

Compression-type fractures

  • Population
    • Commonly observed in younger athletes
    • Common in runners
  • Involves the inferior-medial femoral neck
  • Rehabilitation: non-surgical management can be attempted if there is no visible fracture line

Femoral shaft

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

Subjective

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

DDX

This pathology is often misdiagnosed as muscle injury.

Testing

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

Rehab

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

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/

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