Nature Vs Nurture: A Stressful Situation - Page #1

Author: Sydney Asselstine, MD
Co Author #1: Sydney Asselstine, MD
Co Author #2: Robert Kim, MD Rutgers RWJMS at CentraState Family Medicine Residency
Co Author #3: Steve Weintraub, MD Rutgers RWJMS at CentraState Family Medicine Residency
Senior Editor: Adam Lewno, DO
Editor: Sara Raiser, MD

Patient Presentation:
An 18-year-old male high school football player with a history of asthma and spondylolysis presented with several months of bilateral anterior medial shin and knee pain.

The patient was concerned about his shin pain since his older brother, also a star football player, had experienced a nearly identical injury at the same age that was attributed to tibial stress fractures. The patient had been increasing his training in preparation for his NCAA Division I career. With this he had increased weight gain and increased frequency of running and weightlifting sessions. His pain was exacerbated by running and would linger after exercise. He also endorsed medial arch and ankle pain occasionally as well. He denied any inciting trauma, numbness, or weakness.

Physical Exam:
On presentation, his vitals were stable and he was not in any distress. BMI was 32.2. Cardiovascular and respiratory exams were benign. He did not have an antalgic gait, and no pes planus was noted but he did have a pronated stance. Knee exam revealed no effusion or deformity. There was tenderness over the medial tibial plateaus bilaterally and the mid to distal third of the tibias, right more than left. He had full range of motion in the lower extremity with negative instability tests. He was neurologically intact and had good pulses symmetrically.

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Phone: 913.327.1415

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