Wrist  > Stress Fractures

What are Stress Fractures?

A stress fracture is a disruption in the normal architecture of the bone. It differs from an acute fracture in that the mechanism is due to repetitive, cyclic loading, with forces being lower than the force necessary to produce an acute fracture. For example, running is more likely to lead to stress fractures than getting hit by something. It is commonly an overuse injury and the most common site is somewhere in the lower extremities.

Stress fractures turn up most often in activities that require repetitive impact, primarily running and jumping sports. Running creates forces two to three times the body weight on the lower extremities. Running a marathon subjects your feet and shins to tons and tons of force. Foot fractures are most common in track and field athletes. Theoretically, any situation that overloads one part of your body can cause a stress fracture. In other sports, stress fractures can occur in the upper extremities; gymnasts often suffer wrist and forearm stress fractures.

It is not always easy to diagnose this condition. X-rays of suspected stress fractures are commonly negative for many weeks, which can be confusing. If a stress fracture is suspected, a bone scan is done, wherein radioactive material is injected into the blood stream and accumulates at the suspected fracture site. This allows confirmation of a stress fracture long before an X-ray would reveal changes. Unlike a visible crack in the bone, a stress fracture disrupts the bone at a microscopic level. Since overuse causes the injury, rest is the most common treatment. The second level of treatment is non-weightbearing (crutches), and the third, immobilization, such as casting or splinting. It varies from site to site or bone to bone. Generally, stress fractures require a period of around six weeks of rest. As with other bone and muscle injuries, symptoms can be relieved with ice and anti-inflammatory medication such as naproxen, ibuprofen, or aspirin. In the case of stress fractures of the tibia (shinbone) that do not heal, a rod is sometimes inserted in the center of the bone to provide stability. It acts as an internal splint and prevents recurrence. Electrical stimulation and ultrasound bone-growth stimulators are also used to help bones heal. If the cause was metabolic, as in the case of bone weakness due to Vitamin D deficiency, then a change of diet is necessary.

Healing carpal tunnel syndrome usually requires resting your wrists and forearm muscles. Wrist splints are helpful at forcing the joint to be straight. You can try sleeping with them on, and even wearing them while doing the suspect activity. Heat may relieve the pain in your wrist, while cold may reduce inflammation. Try both to see which relieves your symptoms most effectively. Many patients relieve pain by using a heating pad before activities that involve their wrist and then icing for about twenty minutes afterward. For a more severe case, a doctor may prescribe anti-inflammatory medication and diuretics (water pills), which can reduce some of the fluid that accumulates in the wrist tissues. Another option is the injection of corticosteroids (strong ant-inflammatories) in the tunnel. If the condition does not respond to conservative treatment, surgery may be necessary. Surgery is generally prescribed if carpal tunnel syndrome pain is limiting your activities. Most people can return to work a week after surgery, but athletes and people who use tools may have to take up to six weeks off.

Here's what recreational athletes need to remember to avoid stress fractures:

   Workout level - do not suddenly change the intensity and duration of activities, for the simple reason that your body is not accustomed to the change in stresses

   Running surfaces - Hard concrete increases the likelihood of stress fractures ­ asphalt is significantly softer, and grass is significantly softer, subjecting your feet to one-fifth the impact force of running on concrete

   Footwear - Studies have indicated that you should change your shoes every 500 miles because the density of the material in the midsole (the part of the shoe between the sole and the upper) becomes more dense, which decreases cushioning and increases the risk of injury

   Muscle strength - muscles help absorb shock, so strengthening muscles helps prevent injuries from impact

It has been demonstrated that there are certain intrinsic factors that can lead to stress fractures. I was involved in a study that showed that distance runners are at risk if they have a problem with hyperpronation (the excessive turning-in of the foot). Other studies have identified a more rigid, high arch as a factor. In women, osteoporosis can contribute when there is a clear loss of calcium and a weakening of bone. In younger women, eating disorders can cause metabolic problems and a subsequent weakening of the bone. It is important to understand that stress fractures can be associated with sudden increases in intensity of exercise. When the pain persists during normal activity, or if you have any clinical signs like swelling, redness, and tenderness that seem more significant than your normal soreness, promptly seek medical attention. Arthur J. Ting, M.D. is team physician for the San Jose Sharks and a member of Professional Team Physicians.