Recurrent Shin Pain In A Runner - Page #1

Author: Melissa Tabor, DO
Co Author #1: Jeffrey Bytomski, DO

Patient Presentation:
22 year old Hispanic male recreational runner presents to clinic for evaluation of left lower extremity pain. He has a know history of chronic tibial stress fractures (five total, one repeat fracture), metatarsal stress fractures, mid-femoral shaft fracture, and Pycnodysostosis.

He developed anterior tibia pain after stepping in a ground depression while running 3-6 weeks prior to clinic visit. Pain is constant, worse in the morning and with walking. There are no alleviating factors. The pain does not wake him from sleep.

Past Medical History: Pycnodysostosis
Past Surgical History:
Left Lower Leg Fracture Repair 1998.
Left Mid-Femoral Shaft Fracture Repair 2001.
Left Foot/Ankle Fracture Repair 2008.

Medications: Somatropin and testosterone gel (prescribed by Endocrine)

Physical Exam:
Vital Signs Stable
General: Patient is awake, alert, and oriented in no acute distress
Musculoskeletal: Left leg exam reveals a prominence distal to the mid-shaft of the tibia with mild tenderness over the prominence. He has a normal gait
Vascular: 2+ peripheral pulses bilaterally.
Neurologic: Sensation intact to light touch, DTRs 2+, gait non-antalgic

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