Bone scan for stress fracture

Diagnosis of stress fractures and correlation of scintigraphy and MRI

bone scan for stress fracture

It can take several weeks and sometimes longer than a month for evidence of stress fractures to show on X-rays. Bone scan. A few hours.

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Objectives Radionuclide scintigraphy in the early diagnosis of stress fracture has been well established compared to plain radiography. In the recent years MRI has also evolved as a very useful modality in the early diagnosis of stress lesions of bone. This study was undertaken to correlate the efficacy of bone scintigraphy and MRI in the diagnosis of stress injuries of bone in those patients whose initial plain radiographs were negative for stress injuries and to recommend the best approach for early detection of stress injuries of bone. Methods 50 consequent cases of suspected stress injuries, in the age group of years, referred from various defence units in Bangalore area to Radiology and Nuclear medicine department were included in the study. All the cases that had negative findings of stress injury on X-rays were subjected to Scintigraphy and MRI.

Symptoms may not appear right away.
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Patient information: See related handout on stress fractures , written by the authors of this article. Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome shin splints can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema.

Stress fractures refer to fractures occurring in bone due to a mismatch of bone strength and chronic mechanical stress placed upon the bone. Fractures can either be:. Radiographs have limited sensitivity for an acute stress fracture, although repeat delayed radiograph may show changes of healing. MRI is the most sensitive modality for diagnosis of stress fracture and is important tool to distinguish high and low risk fractures to help clinicians for management plans 5,6. A pathological fracture , although a type of insufficiency fracture, is a term in general reserved to fractures occurring at the site of a focal bony abnormality. Some authors use the term stress fracture synonymously with fatigue fracture , and thus some caution with the term is suggested.

Tibial stress fractures account for half of all stress fractures and are especially common in athletes who are involved in repetitive impact sports that are often of high intensity 1. Runners and younger participants in jumping sports are particularly prone to these injuries due to repetitive submaximal stress on the posterior medial cortex of the tibia. Stress fractures often occur after a change in training regime, surface or footwear. The use of imaging to visibly demonstrate early stress lesions can be helpful in convincing athletes to seek immediate rehabilitation, rather than to persist through the pain. The differential diagnosis between shin splints also known as medial tibial stress syndrome MTSS and a true stress fracture is often difficult. MTSS can be thought of as a less advanced version of tibial stress fracture, involving pain at the posterior medial border during exercise with diffuse periostitis, but no cortical break 2.



Imaging of lower extremity stress fracture injuries.

Stress reactions and stress fractures in the lower extremities occur frequently in military and athletic populations. - Lower extremity stress fractures among athletes and military recruits cause significant morbidity, fiscal costs, and time lost from sport or training. Diagnosis relied heavily on bone scans, often very early in clinical course and often in preference to magnetic resonance imaging MRI , highlighting the need for an evidence-based algorithm for stress injury diagnosis and initial management.

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A stress fracture is an overuse injury. Bone is constantly attempting to remodel and repair itself, especially when extraordinary stress is applied. When enough stress is placed on the bone, it causes an imbalance between osteoclastic and osteblastic activity and a stress fracture may appear. Muscle fatigue can also play a role in the occurrence of stress fractures. For every mile a runner runs, more than tons of force must be absorbed by the legs.

Doctors can sometimes diagnose a stress fracture from a medical history and a physical exam, but imaging tests are often needed. To reduce the bone's weight-bearing load until healing occurs, you might need to wear a walking boot or brace or use crutches.

Nuclear scintigraphy (bone scan) is a highly sensitive scan has limited specificity for stress fractures.
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