> Stress Fractures
What are Stress Fractures?
A hip stress fracture is a disruption
in the normal structure of your upper thighbone or hipbone.
It differs from an acute fracture because it is due
to repetitive stress from forces lower than the force
necessary to produce an acute fracture. Stress fractures
usually begin as small areas of damaged bone that gradually
worsen as you continue to strain you hip joint. The
severity of bone damage in your hip can vary. Your femoral
neck, which is the shaft of bone that branches off at
the top of your thighbone and connects to the hip joint,
is the most common area affected by stress fractures
in the hip. The front of the upper hipbone, called the
iliac crest, less frequently suffers stress fractures.
Stress fractures are commonly caused
by the cumulative effect of repeated minor stress on
your hip joint. Stress fractures typically develop over
a varying period of weeks or months, depending on factors
like the strength of your bones and your level of activity.
Sports that involve repetitive, stressful hip motions,
like long distance running, or high speed changes of
direction, such as ice hockey, put athletes at the highest
risk of hip stress fractures. Hip stress fractures often
occuer in long distance female runners who have amenorrhea
or anorexia. Stress fractures often develop because
of training errors. This means increasing the intensity
or duration of your workouts faster than your body can
handle. For example, people who are out of shape may
be at particular risk of developing hip stress fractures
when aggressively beginning a new running workout. Running
on hard surfaces or uneven roads may also put abnormal
strain on your hip joint that can lead to stress fractures.
Losing bone strength can put some people are at risk
of stress fractures during repetitive or stressful workouts.
Your hipbones tend to weaken with age. Post–menopausal
women seem particularly at risk of stress fractures.
Low calcium intake may also be related to weaker hipbones.
Abnormal biomechanics in your legs can increase the
risk of hip stress fractures. Twisting or bending of
your shinbone or thighbone may awkwardly transmit weight
into your hip joint. High rigid arches or flat feet
also may alter the mechanics of your running stride
and put you at risk for hip stress fractures. Running
in old, worn–out sneakers may accentuate any abnormalities
in your foot or leg anatomy.
If stress fractures are left untreated
in your hip, you may be at risk of suffering a debilitating
acute fracture in the future. This is particularly true
for patients over age 65. Untreated stress fractures
may also lead to a dangerous condition called avascular
necrosis. Another group at risk of suffering hip stress
fractures are female runners who are misdiagnosed and
told they have suffered groin pulls by trainers, coaches,
or physicians. Conditions that lead to weaker bone structure,
like osteoarthritis and osteoporosis, also increase
the risk of stress fractures turning into acute fractures.
Most hip stress fractures in younger patients can be
treated in six to eight weeks without surgery by resting
and using crutches until X–rays or bone scans
show the bones in your hip joint have healed. When a
femoral neck stress fracture is clearly visible on an
X–ray, the bone usually has suffered significant
damage and your physician may monitor your hip closely.
You may need to have your femoral neck surgically aligned
(open reduction) and reinforced (internal fixation)
with pins or screws. If the stress fracture is located
on the upper part of the femoral neck, it typically
is a tension injury and requires surgery to stabilize
the fracture. If the fracture is on the lower part of
the femoral neck, it typically is a compression injury
and surgery usually is not recommended. Patients over
age 65 may have surgery prescribed earlier to stabilize
their bones if the risk of acute fracture is high.
There are usually three parts to an
orthopedic evaluation: medical history, physical examination,
and tests your physician may order.
Your physician may ask you about the
following information to help make the diagnosis:
age and history of other medical conditions.
nature of your pain – when it began; how long
it lasts; its location and severity; whether it radiates;
and any factors, like running or climbing stairs, that
relieve or increase the pain.
physical and athletic goals – information that
will help determine what treatment might be best for
you in achieving those goals.
you have fever, chills, weight loss, or other symptoms
you have recently increased the duration or intensity
of your workouts or training.
Your physician usually feels around
your hip area, looking for painful spots, as your leg
is moved in different directions. However, hip stress
fractures may not cause any tenderness to the touch.
You may be asked to take a "hop test" that
requires you to hop on one leg so your physician can
see how quickly the pain occurs.
To make the final diagnosis, your
physician usually needs to take a closer look at your
hipbone and thighbone. A bone scan, where a harmless
radioactive dye is injected into your hip joint, typically
is the clearest way to differentiate a stress fracture
from soft tissue damage. You may also be given X–rays
(magnetic resonance imaging) scans, but stress fractures
are harder to see in these images, especially in the
early stages when your bone has not been badly damaged.