Similarly, the process of bony remodelling and stress fracture in athletes is recognized as occurring along a clinical continuum with pain or radiographic changes presenting identifiable markers along the continuum. Since radioisotopic imaging and MR can detect changes in bone at the phase of accelerated remodelling, these investigations can show stress-induced bony changes early in the continuum. Stress fractures may occur in virtually any bone in the body. A full list of sites of stress fractures and the likely associated sports or activities is shown in Table 2.3. There will often be a history of a recent change in training or taking up a new activity.
Stress fracture is primarily a clinical diagnosis.
Clinical suspicion may be confirmed by performing an X-ray. Thus, further investigation is often indicated in the patient in whom stress fracture is suspected but X-ray is normal. 2.8 X-ray showing periosteal new bone formation indicative of a stress fracture Fig. Thus, it bone scan remains a very valuable investigation. The bone scan, however, is a non-specific investigation, and therefore, other bony pathologies such as tumours and osteomyelitis may cause similar pictures.