Correlate With Point Tenderness

Correlate with point tenderness is a phrase used on X-rays of bones.  This phrase is used when an abnormality is seen of the bone that is not clearly a fracture but not normal either.  Breaks in the bone or fractures hurt.  That’s why if you touch the area questioned on the X-ray, and it hurts, it likely represents a fracture.  Since the radiologist only issues the report based on the images, he has to ask the clinical doctor to do the physical exam.

Correlate with point tenderness is most commonly used for X-rays of the extremities.  X-rays sometimes show various lucent or dark areas of the bone.  Sometimes this is only seen on one of the X-rays.  Usually multiple projections are obtained of the bones to get the best look.  While these lucent small areas are often not fractures, it can be tough to tell sometimes.

Other times, there may be a clear fracture but it’s not clear if it’s new or old.  It is sometimes tough to tell whether a remote fracture is really old.  The idea being that the old fracture that happened a long time ago will not hurt.  Usually older fractures will show signs of healing on X-ray.

Normal variations of bones can be confused for fractures.  A normal variation of bone is chronic and will not hurt.  Examples of this include extra ossicles or small bones which are chronic.  Normal separation of bones like a sesamoid bone of the great toe or variations of the way the patella or knee cap looks.  At times, this can be confusing purely on x ray.

The same is true for abnormalities of any other bone like the ribs.  Rib X-rays can have many spots which can mimic fracture. Correlating with point tenderness will clear up any confusion.  Ribs hurt when they are broken!   Same with other bones like the skull where normal sutures or grooves for blood vessels can mimic a fracture.

Therefore, correlate with point tenderness is sometimes used by the radiologist to help with the imaging finding.  Broken bones hurt whereas those that are something else usually do not.   Sometimes it’s not possible to tell from the X-ray, so additional testing with other tests may be needed like CT or MRI.


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