17- Overuse Injuries

Question 1

How do stress fractures occur?

Answer 1

Overuse

Question 2

Who are 3 individuals highly susceptible to stress fractures?

Answer 2

runners, females, soldiers

Question 3

What is a population that is at a low risk for stress fractures?

Answer 3

African americans

Question 4

What are the pathological changes that cause stress fractures to occur?

Answer 4

increased bone remodeling = increase osteoclastic activity –> larger cavities in osteon –> more osteoblastic activity over time

Question 5

What are the 3 stages of a stress fracture?

Answer 5

1. Crack initiation - creates a weak point
2. Crack propogation
3. Gross failure of the bone

(like the spidering of a crack on your windshield that occurs)

Question 6

What does the Hx usually show for a stress Fx?

Answer 6

increased activity over 4 weeks prior to onset, increas in pain

Question 7

What does the Physical exam show for a stress Fx?

Answer 7

pain upon palpation, local swelling, normal ROM

Question 8

What does the nutritional exam show for a stress Fx?

Answer 8

decreased body fat, Ca deficiency, Vit D deficiency

Question 9

What is the differential Dx for a stress Fx?

Answer 9

bone pain from overuse, periostitis, chronic extertional compartment syndrome

Question 10

Are stress Fx’s easy to see on radioggraphs?

Answer 10

No

Question 11

Bones such as the calcaneus can be seen with stress Fx’s because of what morphology of the bone?

Answer 11

they have a high trabecullar regions

Question 12

What is a sign of endosteal or periosteal healing that can be seen via radiographs for stress Fx’s?

Answer 12

Callus formations

Question 13

What type of sensitive exam can Dx a stress Fx by measuring metabolic activity of the bone?

Answer 13

Bone scan

Question 14

A 3-phase bone scan is useful to differentiate what disorder from a stress Fx?

Answer 14

periostitis

Question 15

How do stress Fx’s uptake the isotope differently in a 3-phase bone scan periostitis?

Answer 15

both take up the 1st and 2nd phases but only stress F’x take up the 3rd phase

Question 16

What is the Tx’s for stress Fx’s?

Answer 16

A)Treatment for overuse is underuse
B) Patients should decrease or discontinue inciting activities for 4-12 weeks and maintain other activities to prevent disuse osteoporosis
C) Athletes may cross-train to maintain aerobic fitness
D) Ice + analgesics help to relieve pain
E) Crutches and casting used occasionally
F) Gradual reintroduction to activity essential
G) Optional surgical treatment

Question 17

What are the 3 components to the female athlete triad?

Answer 17

I) Disordered eating
II) Abnormal or absent menses
III) osteoporosis