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M84.4 Stress Fracture – Causes, Symptoms & Treatment
M84.4 is the ICD-10 code for stress fracture, a bone break caused by repetitive mechanical loading rather than a single traumatic event.
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M84.4 is the ICD-10 code for stress fracture, a bone break caused by repetitive mechanical loading rather than a single traumatic event.
What is M84.4 – Stress Fracture?
The ICD-10 code M84.4 refers to a stress fracture, also known as a fatigue fracture. Unlike a traumatic fracture caused by a single forceful impact, a stress fracture develops gradually due to repetitive mechanical stress on a bone. Over time, this repeated loading causes microscopic cracks that can progress to a complete fracture if the underlying cause is not addressed.
Causes
Stress fractures typically result from overuse or repetitive strain. Common contributing factors include:
- Sudden increases in training intensity or volume (common in runners, military recruits, and dancers)
- Repetitive, monotonous physical activity in sports or occupational settings
- Changes in training surface or footwear
- Osteoporosis or low bone density, where even normal activity can cause fractures (also called insufficiency fractures)
- Nutritional deficiencies such as low calcium or vitamin D intake
Symptoms
Symptoms of a stress fracture usually develop gradually and include:
- Localized, sharp or aching pain that worsens with activity and improves with rest
- Swelling and point tenderness over the affected bone
- Occasional skin changes such as redness or mild bruising
- In advanced cases, pain at rest or during the night
Commonly affected bones include the metatarsals (foot), tibia (shinbone), fibula, femur (thigh bone), and vertebrae.
Diagnosis
Diagnosis is based on a combination of clinical and imaging findings:
- Medical history: Assessment of activity levels, training habits, and symptom onset
- Physical examination: Point tenderness, swelling, and functional assessment
- Imaging: X-rays (often normal in early stages), MRI (gold standard for early detection of bone marrow edema and microfractures), or bone scintigraphy
- Laboratory tests: To rule out metabolic bone disorders (e.g., calcium, vitamin D, bone turnover markers)
Treatment
Treatment depends on the location and severity of the fracture:
Conservative Treatment
- Activity modification or complete rest of the affected limb
- Use of splints, casts, or offloading orthoses
- Physiotherapy to strengthen surrounding muscles and improve biomechanics
- Pain relief with analgesics such as ibuprofen or paracetamol
- Correction of nutritional deficiencies (calcium, vitamin D)
Surgical Treatment
- High-risk stress fractures (e.g., femoral neck, anterior tibia) may require surgical fixation using screws or intramedullary nails to prevent complete displacement
Prevention
- Gradual progression of training load and intensity
- Appropriate footwear and training surfaces
- Adequate dietary intake of calcium and vitamin D
- Regular bone density screening in at-risk populations
References
- Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(10):749-765.
- Nattiv A et al. American College of Sports Medicine position stand: The female athlete triad. Medicine & Science in Sports & Exercise. 2007;39(10):1867-1882.
- World Health Organization (WHO). ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva: WHO. Code M84.4.
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