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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

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The physical therapist I'm seeing thinks I might have a stress fracture in the thigh bone (right at the top near the groin). To find out for sure I would probably have to have an MRI. The closest place to where I live in Wyoming to get a test like that is a 45-minute drive (one way). Do I really need to get this test?

It has always been assumed that the tests physical therapists use to check for a stress fracture are good indicators that there is a problem. These tests have included the use of a tuning fork or therapeutic ultrasound over the fracture site and pressure or force through the leg. But a recent study conducted by physical therapists from New Zealand suggest otherwise. Local tenderness over the bone in question, pain with weight-bearing or load through the leg, and a thickening or swelling over the bone do suggest the need for further evaluation with imaging studies. The use of therapeutic ultrasound to diagnose stress fractures is not enough by itself. Pain can be reproduced by applying ultrasound over the fracture site occurs as a result of heat produced at the fracture site. But as studies show, the results are too imprecise to be depended on for diagnosis. The use of a tuning fork to create vibration that reproduces the pain is problematic. Different forks have different frequencies. Studies have not been done to establish any kind of standard or reference for normal versus abnormal. The overall accuracy of this test in diagnosing a bone fracture just isn't good enough at this time. More high-quality studies are needed to clarify the role of tuning fork vibrations in identifying stress reactions of the bone. Evidence to date suggests that radiologic imaging is still the best way to confirm the true presence of a stress fracture in the bone. MRIs or bone scans are the most sensitive and accurate tests for bone pathology. Early detection is important to avoid further injury and long delays in rehabilitation (and return to sports for competitive athletes). For now, there is no clinically proven test that can be applied by the physical therapist to determine conclusively the presence of a stress fracture. But when all the signs point to a potential problem and the therapist advises further imaging studies, it is probably a good idea to take the drive and find out for sure. Accurate diagnosis allows for more specific treatment and faster recovery.


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