VALIDATION OF TUNING FORK TEST IN STRESS FRACTURES AND ITS COMPARISON WITH RADIONUCLIDE BONE SCAN

Authors

  • Syeda Tatheer Fatima
  • Asif Jeilani
  • Mazhar -ud- Duha
  • Nadeem Zia Abbasi
  • Amjad Aziz Khan
  • Kamran Khan
  • Abdul Samad Sheikh
  • Furqan Ali
  • Khalid Hussain Memon

Abstract

Background: Stress fractures are quite common both in athletes and military recruits. The purpose ofthe study was to evaluate the efficacy of tuning fork in stress fractures by comparing it with three phasebone scan. Methods: The current study examined 55 subjects whose age ranged 18–28 years. X-rays ofall the subjects were unremarkable. After history and clinical examination tuning fork test (TFT) wasperformed on each case by placing 128 Hertz vibrating tuning fork on the site of pain (underlying bonysurface) of tibia or fibula. Each case was scanned using triple phase bone scintigraphy. Results: Fiftyfive patients had a total of 67 stress fractures, out of which 53 were picked up by TFT. Sensitivity of TFTwas found to be 79% and specificity of 63%. Positive and negative predictive values were 88% and 46%respectively. Conclusion: Tuning fork test is a simple and easy approach of diagnosing stress fractureswhich can be performed even by athletics and military trainers. Management should be initiated inpatients who have history of stress related below-knee pain and positive tuning fork test without waitingfor bone scintigraphy. For complicated cases the bone scan is the gold standard for diagnosis.Keywords: stress fracture, bone scan, tuning fork test

References

Rosenthal MD, Mc Millian DJ. Comprehensive evaluation and

management of stress fractures in military trainees. In: Lenhart

MK, Lounsbury DE, North RB Jr. Eds. Recruit Medicine, Text

book of Military Medicine. Washington DC: Surgeon General at

TMM Publications; 2006.p. 176–89. Available at:

httpwww.bordeninstitute.army.mil/publishedvolumes/recruitme

dicine/RM-ch11.pdf

Otter MW, Qin YX, Rubin CT, McLeod KJ. Does bone

perfusion/reperfusion initiate bone remodelling and stress

fracture syndrome? Med Hypothesis 1999;53:363–8.

Simpson PJ, Lucchesi BR. Free radicals and myocardial ischemia

and reperfusion. J Lab Clin Med 1987;110:13–30.

Jordaan G, Schwellmus MP. The incidence of overuse injuries in

military recruits during basic military training. Mil Med

;159:421–6.

Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures of 295

trainees: a one-year study of incidence as related to age, sex, and

race. Mil Med 1983;148:666–7.

Almeida SA, Williams KM, Shaffer RA, Brodine SK.

Epidemiological patterns of musculoskeletal injuries and physical

training. Med Sci Sports Exerc 1999;31:1176–82.

Protzman RR. Physiologic performance of women compared to

men. Observations of cadets at the United States Military

Academy. Am J Sports Med 1979;7:191–4.

Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison

TR. The effect of foot structure and range of motion on

musculoskeletal overuse injuries. Am J Sports Med

;27:585–93.

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Published

2012-12-01