“Clinical Question: Stress fractures can be difficult to diagnose due to differential diagnoses and imaging technologies that lack the ability to accurately detect bony changes in the early phases of injury. Proper management is dependent on early diagnosis. Scintigraphy and magnetic resonance imaging (MRI) have been established as the gold standards for diagnosing stress fractures. It has been suggested that tuning forks and therapeutic ultrasound are diagnostically accurate in identifying stress fractures. What is the accuracy of clinical tests when compared to imaging when diagnosing lower limb stress fractures?
“Conclusions: Based on the available literature, it is recommended that radiological imaging be the standard of diagnosing lower limb stress fractures. Using therapeutic ultrasound and tuning forks as tools to diagnose lower limb stress fractures is not adequately supported by the current literature.
“Summary: Stress fractures comprise roughly 10% of all athletic injuries, with 80% to 95% occurring in the lower limb, primarily the tibia.1,2 Due to similar symptoms as other injuries caused by overuse, stress fractures can be difficult to diagnose, so early detection is the key to proper management and treatment.1–3
Radiological imaging (ie, scintigraphy and MRI) has been deemed the gold standard for recognizing stress fractures, with MRI having the highest specificity; however, stress fractures can still be difficult to diagnose even with imaging.1,2 These tools can often be expensive to use and inaccessible to certain patient populations
[The Efficacy of Clinical Tests for Lower Limb Stress Fracture Diagnosis Nicholas J. Spangler, LAT, ATC; Elizabeth R. Neil, MS, LAT, ATC; Kenneth E. Games, PhD, LAT, ATC, February 1, 2019 Athletic Training and Sports Health Care. , https://doi.org/10.3928/19425864-20181031-01] [Healio]
[Schneiders AG, Sullivan SJ, Hendrick PA, et al. The ability of clinical tests to diagnose stress fractures: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2012;42:760–771.]