Imaging of stress fractures

Stress injuries are a common cause of pain and morbidity in both professional and recreational athletes. The early diagnosis of such injuries is imperative to halt the progression of disease, which may result in a complete fracture. Stress fractures occur when unusual stresses are applied to normal bones that have not remodeled themselves enough to handle increased stress. This condition usually occurs in the setting of newly undertaken, vigorous athletic activity to which the patient-and the skeleton-has not accommodated. Clinically, the diagnosis of stress injuries may be difficult because the condition may mimic other musculoskeletal complaints such as tendon or muscle injuries, and therefore, imaging of these injuries is central to obtaining a rapid diagnosis. Conventional radiographs are the mainstay of imaging patients with musculoskeletal complaints; however, radiographic findings can sometimes lag behind the clinical presentation and therefore may compound a delay in diagnosis. Advanced cross-sectional imaging techniques, including MRI, CT, ultrasonography, and nuclear scintigraphy, can confirm the diagnosis of stress injuries earlier and, therefore, contribute to initiating appropriate treatment sooner.