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Diagnosis of Stress Fractures in Athletes

T. D. Noakes, MBChB, MD
JAMA. 1985;254(24):3422-3423. doi:10.1001/jama.1985.03360240034016.
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To the Editor.—  The title of the article by Dr Devereaux and colleagues,1 "Diagnosis of Stress Fractures in Athletes," is misleading because the clinical criteria used by these authors to diagnose stress fracture are in doubt.I suspect that most clinicians would consider a diagnosis of stress fracture of the tibia or fibula only if the athlete was no longer able to run on the affected limb and if palpation of the affected bone elicited exquisite tenderness localized only to bone. By failing to fulfill both of these criteria, the authors have included patients who suffer from "shin splints" (posterior tibial stress syndrome) in their series of "stress fractures."Because the authors did not make this clinical distinction, their conclusion that scintography is specific for stress fractures may be in error. We have recently observed abnormal scintigrams in the bones of asymptomatic runners immediately after completing a 90-km ultramarathon


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