Differential Diagnosis of Leg Pain in the Athlete

Abstract

Leg pain in the athlete is common and has many different etiologies. The most common causes include muscle or tendon injury, medial tibial stress syndrome, stress fracture, and exertional compartment syndrome. Less common causes of leg pain include lumbosacral radiculopathy, lumbosacral spinal stenosis, focal nerve entrapment, vascular claudication from atherosclerosis, popliteal artery entrapment syndrome, and venous insufficiency. This article reviews the essential history and physical examination findings and the various causes of leg pain to help the clinician pinpoint the diagnosis and facilitate the athlete's return to sport participation.

The Ability of Clinical Tests to Diagnose Stress Fractures: A Systematic Review and Meta-analysis

“…8,41 MRI has been shown to have comparable sensitivity 3,41 and superior specificity to scintigraphy for assessment of bone pathology. 41 Although MRI is less invasive and provides greater anatomic detail than scintigraphy, 16,35 it is more costly. 3,43 Of further concern is the accessibility of these procedures to many patients.…”

“…Although plain radiographs are commonly used as initial reference standards, they have limited usefulness due to their inability to detect bony changes during the early development of a stress fracture, 3,8,13,15,16,28,29,35,40,41,43 and computed tomography is not frequently used due to low diagnostic sensitivity.…”

“…Clinically, lower-limb stress fractures can be difficult to diagnose, due to a wide range of potential differential diagnoses 16 that include compartment syndrome, soft tissue injuries, infection, and other overuse conditions such as medial tibial stress syndrome and periostitis. 43, 44 The diagnosis of a stress fracture is contingent on a detailed clinical examination 14 that incorporates the patient history 35,41,43 and contributing risk factors, 5,24,32,33,40 as well as a thorough physical examination, 35,41,43 and is most often confirmed with radiological imaging.…”

“…5 Radiological imaging for stress fractures has traditionally included roentgenograms (plain radiographs), 18 scintigraphy (bone scan), magnetic resonance imaging (MRI), and computed tomography. Although plain radiographs are commonly used as initial reference standards, they have limited usefulness due to their inability to detect bony changes during the early development of a stress fracture, 3,8,13,15,16,28,29,35,40,41,43 and computed tomography is not frequently used due to low diagnostic sensitivity. 8,41 The gold standard for stress fracture T T STUDY DESIGN: Systematic literature review and meta-analysis.…”

Fraturas por estresse: definição, diagnóstico e tratamento

“…20,36 O paciente apresenta-se com aumento da sensibilidade no local da lesão, dor e edema após aumento abrupto e/ou repetitivo da atividade física sem intervalos suficientes de descanso para recuperação fisioló-gica tecidual. 6 Inicialmente a dor é reduzida e aliviada com o repouso e permite a atividade física sem prejuízo.…”