Stress Fractures:

Common for Athletes and Those with

 

Active Lifestyles



Figure 1

Fractures are typically caused by a single traumatic event such as a car accident or fall. Here, bones are exposed to forces so extreme they are unable to support energy that is placed upon them. In contrast, there are fractures caused by a repetitive application of force. These fractures, called stress fractures, occur when muscles become so fatigued they lose their ability to absorb additional shock. These fractures are categorized as overuse injuries and are characterized by tiny cracks in the bone.

Bone is incredibly resilient. Each day, bone broken down by daily living is replaced by the body in a necessary balancing act. However, this balance is disturbed with excessive physical training.

Stress fractures often present in athletes such as tennis players, basketball players, gymnasts and track and field participants. Typical stress fracture causes include improper equipment, increased physical stress, increasing the amount or intensity of an activity too rapidly and the impact of an unfamiliar surface.

Figure 2

Stress fractures are usually categorized one of two ways: a fatigue fracture or an insufficiency fracture. Fatigue fractures are the result of bone being overused or being exposed to repetitive stress beyond its ability to repair itself. In contrast, insufficiency fractures are the result of bone being deficient in minerals or vitamins.

 

A typical cause of an insufficiency fracture is if a bone has been weakened by osteoporosis.

Figure 3

 While stress fractures can occur anywhere on the body, more than 50 percent occur in the lower leg. (Figure 1) (Figure 2). Stress fractures rarely occur in the upper extremities because they are not weight bearing bones, like the tibia and bones that run from the mid-foot to the toes. (Figure 3).

There are certain red flags that may signal stress fractures. These red flags include: pain that increases over time, pain that increases with activity and decreases with rest, pain that persists

Figure 5

Figure 4

even at rest, pain that occurs earlier in each successive workout and swelling. A runner with groin pain and a negative x-ray must have a back scan or an MRI to rule out hip stress fractures.

Early diagnosis of hip fractures is necessary to avoid displacement of the fracture.

The best treatment for stress fractures is rest. After about 6 to 8

weeks, patients should be able to return to their regular activities.
It’s important to do your best to safeguard against stress fractures.
This includes implementing a prevention plan that includes the following:
alternating activities that accomplish the same fitness goals (crosstraining); setting incremental goals when participating in a new sports activity; and maintaining a healthy diet(Figure 4) with
bone strengthening vitamins and minerals such as calcium and vitamin D (Figure 5).
In some situatoins, however, surgery is needed to treat stress fractues.(Figure 6)

Figure 6

Dr. Nabil Ebraheim photo: 12/13/2016

Raynaud’s Phenomenon

Raynaud’s phenomenon is a discoloration of the fingers due to vasospasms and decreased circulation of the fingers. This condition causes the fingers to feel numb and cool and become discolored in response to cold temperatures or stress. This typically occurs more in women.

Fingers may become white due to lack of blood flow. Then as the vessels dilate in order to keep the blood within the tissues, the fingers become blue. Finally, as the blood flow returns, the fingers become red. This condition is usually bilateral.

There are two types Raynaud’s disease and Raynaud’s syndrome. Raynaud’s disease occurs on its own without a cause. Raynaud’s syndrome is caused by a connective tissue disorder such as systemic lupus erythematosus, polymyositis and scleroderma. Raynaud’s phenomenon is the initial presentation for 70% of patients with scleroderma. If you have a patient with Raynaud’s phenomenon, study them for connective tissue disorders.

In chronic cases, the nails may become brittle with ridges, with ulcers of the fingers.

Dr. Nabil Ebraheim photo: 12/5/2016