The best stress fracture test

Описание: 💥 Bone Stress Injury Clinical Pearl💥

Over a decade ago, I was evaluating a young, gifted runner dealing with a "hip flexor strain."

As we went through the objective portion of the evaluation, things didn't add up.
There was no specific injury mechanism, and they struggled to tolerate any weight-bearing assessments.

The thing I remember the most is they had a significant increase in symptoms when they took the weight off their affected leg. I referred them out to a local physician, worried about a potential stress fracture.

MRI would come back as a stress fracture in the medial aspect of the femoral neck.

I've seen this "pain with offloading" in dozens of patients who eventually get diagnosed with a BSI in the femur, pelvis, or sacrum. I have no research to support this pattern, just significant clinical experience with runners exhibiting the same presentation.

Why does this pattern happen? I have my ideas, but the most essential idea to remember is if this pattern presents itself, you need more information.

The high-risk nature of this region means if I see this pattern today, I'll advise them to get on crutches and refer them out for potential imaging.

Be on the lookout for this presentation when working with runners, and I'll see ya next week.
#thinkingcapthursday