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M84.3 Stress Fracture – Causes, Symptoms & Treatment
M84.3 is the ICD-10 code for stress fractures, also called fatigue fractures. They result from repeated mechanical overload and are common in athletes.
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M84.3 is the ICD-10 code for stress fractures, also called fatigue fractures. They result from repeated mechanical overload and are common in athletes.
What is M84.3?
The ICD-10 code M84.3 refers to stress fractures, also known as fatigue fractures or insufficiency fractures. Unlike conventional bone fractures caused by a single traumatic event, stress fractures develop gradually over time due to repetitive mechanical loading. The bone cannot repair itself quickly enough, and microscopic cracks accumulate until a fracture becomes visible.
Causes
Stress fractures occur when the mechanical load on a bone exceeds its capacity for adaptation and regeneration. Common causes include:
- Intense physical activity: Especially running, dancing, gymnastics, or military training with sudden increases in training intensity
- Rapid changes in training: Too-quick increases in duration, intensity, or frequency of exercise
- Inadequate footwear: Lack of cushioning or support increases the risk of injury
- Bone diseases: Osteoporosis or other conditions that reduce bone density
- Nutritional deficiencies: Insufficient calcium and vitamin D weakens bone structure
- Anatomical factors: Flat feet, leg length discrepancies, or other biomechanical abnormalities
Symptoms
Symptoms of a stress fracture typically develop gradually and worsen with continued activity:
- Localized, point-specific pain at the affected bone
- Pain that increases with physical activity and subsides with rest
- Swelling and tenderness over the affected area
- In advanced cases, pain may also occur at rest
The most commonly affected bones are the metatarsals (foot bones), tibia (shinbone), fibula (calf bone), and the femur (thigh bone).
Diagnosis
Diagnosing a stress fracture involves several steps:
- Medical history and physical examination: Assessment of sporting activity, training history, and the nature of the pain
- X-ray: Early stress fractures are often not visible on X-ray; changes may only appear after 2–4 weeks
- MRI (Magnetic Resonance Imaging): The gold standard for early detection of stress fractures, even when X-rays are negative
- Bone scintigraphy: Detects increased bone remodeling but is less specific than MRI
- CT (Computed Tomography): Used for unclear findings or to assess the extent of the fracture in detail
Treatment
Treatment depends on the location, severity, and underlying cause of the stress fracture:
Conservative Treatment
- Rest from loading: Reduction or complete avoidance of weight-bearing activities for 4–8 weeks
- Immobilization: Using orthoses, a plaster cast, or crutches if necessary
- Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief (use only as directed by a physician)
- Physiotherapy: Strengthening and stretching exercises to prevent recurrence
- Nutritional adjustment: Ensuring adequate intake of calcium and vitamin D
Surgical Treatment
In rare cases, particularly for high-risk fractures (e.g., femoral neck, navicular bone) or when healing fails to progress, surgical fixation using screws or nails may be necessary.
Prognosis and Prevention
Most stress fractures heal completely with consistent offloading. Preventive measures include:
- Gradual increases in training intensity
- Appropriate, well-cushioned footwear
- Regular recovery phases within training programs
- Adequate intake of calcium and vitamin D
- Regular bone density measurements for at-risk groups (e.g., older women, competitive athletes)
References
- Tenforde AS, Kraus E, Fredericson M. Bone Stress Injuries. Physical Medicine and Rehabilitation Clinics of North America, 2016;27(1):53–76. PMID: 26616177.
- Warden SJ, Davis IS, Fredericson M. Management and Prevention of Bone Stress Injuries in Long-Distance Runners. Journal of Orthopaedic and Sports Physical Therapy, 2014;44(10):749–765. PMID: 25155475.
- World Health Organization (WHO): ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision – Chapter XIII Diseases of the Musculoskeletal System and Connective Tissue, 2019.
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