![]() ![]() Increased uptake is also seen in tumors, infection, inflammation, or trauma. A negative radiograph warrants a follow-up radiograph after about a week or should initiate further imaging.īone scan has extremely high sensitivity but with a very low specificity in detecting stress fractures. Although, the occult stress fractures may not be identified on the initial radiograph due to low sensitivity,it is crucial to rule out other diseases, such as infections, or tumors. Radiographs should always be the first line of investigations in patients with bone pain. It is essential to detect and treat fatigue and insufficiency fractures at the earliest, to prevent morbidity and hindrance in normal physical activity which may result due to delay in diagnosis. The role of imaging in the diagnosis of stress fractures is indispensable. A discord between tissue tolerance and an externally applied load results from an imbalance in the interaction between bone remodeling and notable risk factors. Contrarily, lamellar bone is maturely characterized by stress-oriented organized collagen. Woven bone is immature, identified by randomly orientated matrix of collagen. Bone comprises woven and lamellar bone, at the microscopic level. Bone is constantly metabolizing, maintaining a balance between osteoclastogenesis and osteoblastogenesis. BONE STRUCTURE AND PATHOPHYSIOLOGY OF STRESS FRACTURESīasic knowledge of the physiology, architecture, and metabolism of bone is essential to understand the pathophysiology of stress fractures. ![]() We aim to stimulate readers’ thinking by illustrating MR findings, in stress fractures and their possible differentials at various sites, to reduce misinterpretation of MR scans and facilitate patient management. Furthermore, insufficient and inappropriate clinical history prevents reaching a correct diagnosis and delays appropriate management. Lack of imaging standards and poor scan quality can result in misinterpretation of marrow edema on MRI, in the absence of corresponding plain radiograph or computed tomography (CT) scan, as early tumor or osteomyelitis. ĭue to technological advancement, it is common to see magnetic resonance imaging (MRI) being used as first line of investigation for patients with bone pain. These are commonly encountered either in unconditioned individuals who abruptly engage in a strenuous sports activity or in trained conditioned athletes who had acutely intensified the training regimen. ![]() Fatigue fractures occur due to the reaction of normal bone to abnormal repetitive stress. Insufficiency fractures result due to normal stress on abnormal bone in patients with osteoporosis, osteomalacia, Paget’s disease, fibrous dysplasia, osteogenesis imperfecta, radiation, hyperparathyroidism, anorexia, etc. These are divided into two types: Insufficiency and fatigue fractures. Stress fractures are fractures that occur due to a mismatch between bone strength and long-term mechanical stress. ![]()
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