Pain In The Left Shin - Page #4
 

Working Diagnosis:
Left Tibia Stress Fracture

Treatment:
The patient was advised to decrease intensity at practice and to use ibuprofen as needed. She was also given a Velcro walking boot to wear that allowed support while weight bearing.

Outcome:
On three weeks follow up patient was doing well with very minimal pain upon jumping and running

Author's Comments:
This case emphasizes the message that in cases where there is suspicion of stress fracture, diagnostic ultrasound can provide a good alternative to more costly, poorly accessible, and invasive techniques such as MRI or bone scan scintigraphy.

Editor's Comments:
This is a great case of the benefits of sports ultrasound for immediate diagnosis in patients presenting with musculoskeletal complaints. As the author stated a high index of suspicion is often needed in these cases. In any athlete with a stress fracture, menstrual cycle regularity (for females) and screening for eating disorders should be assessed.

References:
1. Dobrindt O, Hoffmeyer B, Ruf J, et al. Blinded-read of bone scintigraphy: the impact on diagnosis and healing time for stress injuries with emphasis on the foot. Clin Nucl Med. 2011; 36(3):186-191.
2. Bianchi S, Luong DH. Stress fractures of the ankle malleoli diagnosed by ultrasound: a report of 6 cases. Skeletal Radiol 2014; 43:813–818

3. Reeder MT, Dick BH, Atkins JK, Pribis AB, Martinez JM. Stress fractures: current concepts of diagnosis and treatment. Sports Med. 1996;22(3):198-212.

4. Krestan C, Hojreh A. Imaging of insufficiency fractures. Eur J Radiol. 2009;71:398-405.

5. Ishibashi Y, Okamura Y, Otsuka H, Nishizawa K, Sasaki T, Toh S. Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med. 2002; 12:79–84

6. Stafford SA, Rosenthal DI, Gebhardt MC, Brady TJ, Scott JA MRI in stress fracture. Am J Roentgenol. 1986;147:553–556

7. Sofka CM. Imaging of stress fractures. Clin Sports Med. 2006;25:53-62.

8. Bodner G, Stöckl B, Fierlinger A, Schocke M, Bernathova M. Sonographic findings in stress fractures of the lower limb: preliminary findings. Eur Radiol. 2005; 15:356–359.

9. Banal F, Gandjbakhch F, Foltz V, et. al. Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients. J Rheumatol. 2009; 36(8):1715-9.

10. V. Khy, B. Wyssa, S. Bianchi. Bilateral stress fracture of the tibia diagnosed by ultrasound. A case report. J Ultrasound. Jun 2012; 15(2): 130–134.

11. Jones SL, Phillips M. Early Identification of Foot and Lower Limb Stress Fractures using Diagnostic Ultrasonography: A review of three cases. The Foot and Ankle Online Journal. 2010 3 (4): 3.

12. Greaney RB, Gerber FH, Laughlin RL, et al. Distribution and natural history of stress fractures in U.S. Marine recruits. Radiology. 1983; 146:339-46.

13. Arni D, Lambert V, Delmi M, Bianchi S. Insufficiency fracture of the calcaneum: sonographic findings. J Clin Ultrasound 2009; 37:424-7.

14. Pohl M, Mullineaux D, Milner C, Hamill J, Davis I. Biochemical predictors of retrospective tibial stress fractures in runners. J Biomech 2008; 41:1160-5.

15. Warden S, Burr D, Brukner P. Stress fractures: pathophysiology, epidemiology and risk factors. Curr Osteoporos Rep 2006;4(3):103-9.

16. Patel DS, Roth M, Kapil N. Stress fracture: diagnosis, treatment and prevention. Am Fam Physician. 2011; 83(1): 39-46.

17. Papalada A, Malliaropoulos N, Tsitas K, et al. Ultrasound as a primary evaluation tool of bone stress injuries in elite track and field athletes. Am J Sports Med. 2012;40(4):915-9.

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