Medial tibial stress fracture diagnosis and treatment guidelines

Milgrom, Charles; Zloczower, Elchanan; Fleischmann, Chen; Spitzer, Elad; Landau, Regev; Bader, Tarif; Finestone, Aharon S.

doi:10.1016/j.jsams.2020.11.015

Cited by 21 publications

(11 citation statements)

References 20 publications

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“…The purpose of this study was to quantify the internal forces and moments acting on the tibia during running as a function of grade. To this end, a combination of experimental and modeling techniques were used to calculate 3-dimensional forces and moments acting at the distal 1/3 rd of the tibia, a common site of stress fracture [27].…”

Section: Accepted Manuscript N O T C O P Y E D I T E Dmentioning

confidence: 99%

Internal Tibial Forces and Moments During Graded Running

Baggaley

Derrick

Vernillo

et al. 2021

Journal of Biomechanical Engineering

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The stress experienced by the tibia has contributions from the forces and moments acting on the tibia. We sought to quantify the influence of running grade on internal tibial forces and moments. Seventeen participants ran at 3.33 m/s on an instrumented treadmill at 0°, ±5°, and ±10° while motion data were captured. Ankle joint contact force was estimated from an anthropometrically-scaled musculoskeletal model using inverse dynamics-based static optimization. Internal tibial forces and moments were quantified at the distal 1/3rd of the tibia, by ensuring static equilibrium with all applied forces and moments. Downhill running conditions resulted in lower peak internal axial force (range of mean differences: -9 to -16%, p<0.001), lower peak internal anteroposterior force (-14 to -21%, p<0.001), and lower peak internal mediolateral force (-14 to -15%, p<0.001), compared to 0° and +5°. Furthermore, downhill conditions resulted in lower peak internal mediolateral moment (-11 to -21%, p<0.001), lower peak internal anteroposterior moment (-13 to -14%, p<0.001), and lower peak internal torsional moment (-9 to -21%, p<0.001), compared to 0°, +5°, and +10°. The +10° condition resulted in lower peak internal axial force (-7 to -9%, p<0.001) and lower peak internal mediolateral force (-9%, p=0.004), compared to 0° and +5°. These findings suggest that downhill running may be associated with lower tibial stresses than either level or uphill running.

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Section: Accepted Manuscript N O T C O P Y E D I T E Dmentioning

confidence: 99%

Internal Tibial Forces and Moments During Graded Running

Baggaley

Derrick

Vernillo

et al. 2021

Journal of Biomechanical Engineering

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“…A summary of the types of manuscripts included in this review is shown in Table 3. Noncomparative studies including opinion pieces/narrative reviews accounted for 45.4% of the included manuscripts [4, 6, 33–84], case reports (22%) [7, 85–109], and case series studies (17%) [110–129]. Five percent of the included manuscripts were systematic reviews [5, 130–134].…”

Section: Resultsmentioning

confidence: 99%

“…Other specific tests have been used and reported to be useful in this review, for example, the hop test or fulcrum test. However, the hop test was found to be 100% sensitive and 45% specific for diagnosing medial tibial stress fracture, whereas the fulcrum test was not proposed to be statistically specific and sensitive for the diagnosis of medial tibial stress fracture [38, 110]. Therefore, the history, palpation and imaging modalities are consistent, and core elements are needed to detect stress fracture [38, 110, 163, 164].…”

Section: Discussionmentioning

confidence: 99%

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review

Bosnina,

Padhiar,

Miller

et al. 2023

Journal of Foot and Ankle Research

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BackgroundNumerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions.MethodsThree online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions.ResultsOne hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF,n = 31), popliteal artery entrapment syndrome (PAES,n = 22), superficial peroneal nerve entrapment syndrome (SPNES,n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS,n = 5), myofascial tears (n = 3), and McArdle’s syndrome (n = 2).ConclusionInitial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation.

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“…There is focal tenderness and swelling around the fracture site. An inability to hop on a symptomatic leg for 10 repetitions without excessive pain constitutes a positive hop test and is strongly suggestive of a stress fracture [15]. Initial plain radiographs may not be sensitive enough to diagnose a stress fracture.…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Popliteal Artery Entrapment Syndrome in Light of an Atypical Clinical Manifestation

Abou-Ghaida¹,

Thapaliya²,

Rua³

2023

Cureus

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Popliteal artery entrapment syndrome (PAES) is a type of arterial obstruction seen in athletic and young patients with no cardiovascular risk factors. It is caused by aberrant anatomy affecting the position of the popliteal artery or gastrocnemius muscle or functional obstruction resulting from a hypertrophied gastrocnemius muscle. Rich's classification has been used to define the various entities. PAES presents as unilateral claudication exacerbated by physical exertion. However, such a clinical presentation is shared amongst not only vascular diseases but also musculoskeletal diseases. Therefore, a wide array of differential diagnoses must be considered when popliteal artery entrapment-induced claudication is suspected.

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Medial tibial stress fracture diagnosis and treatment guidelines

Cited by 21 publications

References 20 publications

Internal Tibial Forces and Moments During Graded Running

Internal Tibial Forces and Moments During Graded Running

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review

Differential Diagnosis of Popliteal Artery Entrapment Syndrome in Light of an Atypical Clinical Manifestation

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