How is a stress fracture diagnosed?

Your doctor may need to do several tests to see if you have a stress fracture and the severity of the fracture. These tests can include:

  • Physical examination: During your first visit, your doctor will do a physical exam and discuss your risk factors for developing a stress fracture. When discussing risk factors, you will be asked about:
    • Your medical history.
    • Your work.
    • Your activities.
    • Any medications you might be taking.
  • X-Rays: Your doctor may order an X-Ray to look for a fracture. However, a stress fracture can be difficult to see on an X-Ray because the bone often appears normal and the small cracks can’t be seen on the image. X-rays actually miss about ⅔ of stress fractures. X-Rays may not help diagnose a stress fracture unless it has started to heal. When the bone starts to heal, it creates a callus, or lump, that can be seen on X-Rays. With a high index of suspicion for a stress fracture, your doctor may recommend an imaging test that is more sensitive than an X-Ray and will pick up a stress reaction even before it may become a stress fracture. These tests can include:
    • Magnetic resonance imaging (MRI).
    • Bone Scan.
  • Bone scan: A bone scan may be used to see stress fractures that cannot be seen on an X-Ray. During a bone scan, a tracer (a radioactive substance) is injected into your bloodstream. The tracer collects in the bone and settles in the areas where the bone is being repaired. The area that is affected by a stress fracture will appear darker on the bone scan that an uninjured area.
  • Magnetic resonance imaging (MRI): When your doctor needs very detailed images of the injury, an MRI may be used. Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio waves and a computer to produce very clear images of the human body. An MRI is preferred in many cases because:
    • There is no radiation exposure.
    • It takes less time than other imaging tests.
    • It is better at diagnosing different types of bone and or soft tissue problem.

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