Roentgenologic diagnosis of stress fractures and stress reactions

We examined 26 athletes with continued pain after strenuous exercise. We found stress fractures in 15 patients, all of whom had positive roentgenographic studies. Seven of these 15 also had bone scans, all of which were positive. Five patients had stress reactions, all of which showed positive results on bone scan and negative roentgenographic results. Five had occult stress reactions manifested by pain, with normal roentgenographic and scintigraphic results, and one had minor pain not requiring radiologic studies. Stress reaction is contrasted with stress fracture by demonstrating the role of bone imaging in the diagnostic continuum of stress reaction to stress fracture.