title: Identification of tibial stress fractures using therapeutic continuous ultrasound.
abstract: METHODS
  One-group discriminant analysis.
  
  
  OBJECTIVE
  To determine whether 1 MHz of continuous ultrasound can identify tibial stress fractures in subjects.
  
  
  BACKGROUND
  Stress fractures can lead to loss of function or to more serious nonunion fractures. Early diagnosis is important to reduce the risk of further injury and to assure a safe return to activity. Therapeutic ultrasound has been reported to be an accessible, less expensive alternative in diagnosing stress fractures compared with other diagnostic techniques.
  
  
  METHODS
  Twenty-six subjects (12 men, 20.33 +/- 1.37 years; 14 women, 20.78 +/- 3.8 years) with unilateral tibia pain for less than 2 weeks volunteered to participate in the study. Continuous, 1 MHz ultrasound was applied to the uninvolved and involved tibias at 7 increasing intensities for 30 seconds each. Subjects completed a visual analog scale after the application of each intensity to assess the pain response to ultrasound. Results from the visual analog scale were compared to magnetic resonance imaging (MRI) findings to determine if continuous ultrasound could predict whether subjects had a normal MRI, increased bone remodeling, or advanced bone remodeling consistent with a stress fracture.
  
  
  RESULTS
  Discriminant analysis on the visual analog scale correctly classified subjects into 1 of 3 clinical classification groups in 42.31% of the cases. None of the subjects found to have a stress fracture by MRI were correctly identified by continuous ultrasound. This resulted in a predicted sensitivity of 0% and a predicted specificity of 100%.
  
  
  CONCLUSIONS
  A protocol using visual analog scores after the application of 1 MHz continuous ultrasound is not sensitive for identifying subjects with tibial stress fractures.
authors.affiliation: Department of Physical Therapy, University of Maryland School of Medicine, Baltimore 21201, USA. wromani@physio.umaryland.edu
authors.forename: W A
authors.initials: WA
authors.lastname: Romani
authors.forename: D H
authors.initials: DH
authors.lastname: Perrin
authors.forename: R G
authors.initials: RG
authors.lastname: Dussault
authors.forename: D W
authors.initials: DW
authors.lastname: Ball
authors.forename: D M
authors.initials: DM
authors.lastname: Kahler
mesh_terms: D000293:Adolescent; D000328:Adult; D016723:Bone Remodeling; D016002:Discriminant Analysis; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D012680:Sensitivity and Specificity; D013177:Sports; D013978:Tibial Fractures / Q000175:diagnosis* / Q000628:therapy*; D014464:Ultrasonic Therapy / Q000379:methods*