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Tuning fork, ultrasound diagnosis of stress fractures is unreliable

PainSci » bibliography » Schneiders et al 2012
Tags: treatment, diagnosis, devices, shin pain, fun, leg, limbs, pain problems, overuse injury, injury, running, exercise, self-treatment

Three articles on PainSci cite Schneiders 2012: 1. Shin Splints Treatment, The Complete Guide2. The Complete Guide to Muscle Strains3. Is Diagnosis for Pain Problems Reliable?

PainSci commentary on Schneiders 2012: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This science attacks something I care deeply about: tuning fork diagnosis of stress fractures. Yeah, you read that right. Supposedly a humming tuning fork applied to a stress fracture will make it ache. This analysis of studies since the 1950’s tried to determine if either ultrasound or tuning forks are actually useful in finding lower-limb stress fractures. Neither technique was found to be accurate; “it is recommended that radiological imaging should continue to be used” instead.

Fortunately (for the sake of the elegant quirkiness of the tuning fork idea), they aren’t saying that a tuning fork actually can’t work … just that’s it not reliable for confirmation, which kind of a “well, duh” conclusion. I don’t suppose I ever thought it was a slam dunk diagnosis, just an easy and quirky clue generator.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

STUDY DESIGN: Systematic literature review and meta-analysis.

OBJECTIVES: To evaluate the diagnostic accuracy of clinical tests to identify stress fractures in the lower limb.

BACKGROUND: Stress fractures are a bone-related overuse injury primarily occurring in the lower limb and commonly affecting running athletes and military personnel. Physical examination procedures and clinical tests are suggested for diagnosing stress fractures; however, data on the diagnostic accuracy of these tests have not been investigated through a systematic review of the literature.

METHODS: A systematic review was conducted in 8 electronic databases to identify diagnostic accuracy studies, published between January 1950 and June 2011, that evaluated clinical tests against a radiological diagnosis of lower-limb stress fracture. Retrieved articles were evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool, and a meta-analysis was performed where appropriate.

RESULTS: Nine articles investigating 2 clinical procedures, therapeutic ultrasound (n = 7) and tuning fork testing (n = 2), met the study inclusion criteria. Meta-analysis was used to statistically analyze the data extracted from the ultrasound articles and demonstrated a pooled sensitivity of 64% (95% confidence interval [CI]: 55%, 73%), specificity of 63% (95% CI: 54%, 71%), positive likelihood ratio of 2.1 (95% CI: 1.1, 3.5), and negative likelihood ratio of 0.3 (95% CI: 0.1, 0.9). Tuning fork test data could not be pooled; however, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio ranged from 35% to 92%, 19% to 83%, 0.6 to 3.0, and 0.4 to 1.6, respectively.

CONCLUSION: The results of this systematic review do not support the specific use of ultrasound or tuning forks as standalone diagnostic tests for lower-limb stress fractures. As the overall diagnostic accuracy of the tests investigated is not strong, based on the calculated likelihood ratios, it is recommended that radiological imaging should continue to be used for the confirmation and diagnosis of stress fractures of the lower limb.

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