Using Musculoskeletal Ultrasound to Identify a Tibial Metadiaphysis Stress Fracture: A Case Report

Lower limb stress fractures (SF) can be challenging for physicians to diagnose due to broad clinical presentation and etiology. Bone scintigraphy (bone scan) has been historically accepted as the gold standard for diagnosing these injuries, but studies appear to show an elevated risk of radiation exposure, necessitating judicious use of this imaging modality. Plain radiography is the most cost-accessible choice for imaging osseus structures, but as this case demonstrates, they do not have a high degree of accuracy for diagnosis SF. Magnetic Resonance Imaging (MRI) is an accurate imaging modality for diagnosing SF, but can carry excessive cost. Musculoskeletal ultrasound (MSK US) imaging is an emerging diagnostic imaging technique that can be used in early detection of SF. This case presents a 67-year-old runner, whose distal tibial metadiaphysis stress fracture was initially identified with MSK US and later confirmed with MRI. This case presents a promising option for patients with SF who are at elevated radiation risk from bone scans and who would like to avoid excessive cost and a delay in medical intervention associated with MRI. Further research and possible randomized controlled trials (RCTs) are needed to further assess the specificity and sensitivity of using MSK US to identify SF..