Differential Diagnosis of a Sacral Stress Fracture

Jill M. Thein-Nissenbaum, William G. Boissonnault

Determining whether a patient’s symptoms are associated with a condition for which physical therapy intervention is indicated is one of the important questions physical therapists attempt to answer during an initial patient visit. This resident’s case problem involves a 34-year-old homemaker and long-distance runner referred for physical therapy with a diagnosis of right sacral pain. This case illustrates that the answer to this question may not be clear until subsequent patient visits occur. Sacral stress fractures, although relatively uncommon, are a potential source of back pain, which is a common complaint in patients seeking physical therapy outpatient services. Because bony lesions can be associated with serious medical conditions, such as cancers and fractures, early detection and an accurate diagnosis is paramount to appropriate care. An important element in screening for such conditions is recognizing patients with the relevant risk factors. The presence of the risk factors associated with insufficiency and fatigue fractures, as described in this case, should alert the therapist to scrutinize symptoms and signs suggestive of a bony lesion thoroughly. As described, there is an unfortunate degree of overlap of symptoms and signs for many of the conditions causing back pain and those of sacral stress fractures. Another important element of this screening process is establishing a prognosis that carries expectations of patient progression, both from a subjective and a physical examination standpoint. If these expectations are not met, the therapist must reconsider the original diagnosis, and, as in this case, insure that the patient is referred for physician follow-up and the recommended appropriate diagnostic workup. J Ortho Sports Phys Ther. 2002;32(12):613-621.

Determining whether a patient’s symptoms are associated with a condition for which physical therapy intervention is indicated is one of the important questions physical therapists attempt to answer during an initial patient visit. This resident’s case problem involves a 34-year-old homemaker and long-distance runner referred for physical therapy with a diagnosis of right sacral pain.

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