This review looked at therapeutic US and the tuning fork.Ĭopyright © The Student Physical Therapist LLC 2023 Clinical tests that are currently used and accepted include therapeutic US, the tuning fork test, superficial palpation, and palpable thickening or swelling of periosteum. Additionally, the single photon-emission CT scan is receiving a lot of attention for it's accuracy in diagnosing stress fractures, but further research is needed.Īs therapists (excluding the military), we do not have the power to order the gold standard tests mentioned above, so we must rely on our own diagnostic tests to help us interpret our patient's clinical presentation. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. Currently, a triple phase technium-99 bone scan (scintigraphy) is the most accurate method of diagnosing stress fractures with a sensitivity of 100% and specificity of 76%. Additionally, it is important to know the gold standard for ruling in stress fractures. As Schneiders et al, points out "clinically lower-limb stress fractures can be difficult to diagnose, due to a wide range of potential differential diagnoses." This differential diagnosis process should include (but not be limited to) compartment syndrome, muscular strain, tendinitis, tendinosis, infection, and nerve entrapment. The review discusses when, why, and how these tests should be implemented. This research article, The Ability of Clinical Tests to Diagnose Stress Fractures: A systematic Review and Meta-analysis, assesses the reliability of both therapeutic ultrasound and the tuning fork test. Due to the high amount of impact force, 80-90% of all stress fractures occur in the lower extremities, most commonly seen in the running population. Knowing the high prevalence of stress fractures, it is important to also understand the diagnostic accuracy of the clinical tests one uses to rule-in or rule-less likely a stress fracture. Stress fractures account for approximately 10% of all athletic injuries.
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