An army recruit, smoker and 6 months into training staed complaining of pain at postero medial aspect of both legs. There was acute point tenderness and the pain was aggravated on physical activity. The most likely diagnosis is
D i.e. Stress fracture After a prolonged period of repeated stress (6 month of army recruit) presence of acute onset pain and point tenderness , over posteromedial aspect of both legs (i.e. tibia), with aggravation of pain on physical activity is clearly indicative of stress fracture of tibia. Stress Fracture Predisposing/ Risk- Factors Type Clinical Presentation InvestigationX Ray - Predominant risk factor is an increase in trainingfrequency and intensityQ - Predisposed individuals areatheletes, army recruitsQ, dancers and other spos personsinvolved in basket ball rowing, swimming &throwing etc.- Activity that producerepetitive loadingQ- Leg length discrepancyincreases the risk but therisk is not specific to shoeror longer leg.- Female athlete traid i.e.eating disorder, osteopenia,menstrual disturbance. * Fatigue caused by application ofabnormal muscular stress on normal bone* Insufficiency caused by normalmuscular activity on bone that is deficientin minerals. - Load related pain in athletes withgradual onset over a period ofweeks during training oftenoccuring during the first few weeksafter an increase in training volume orintensity, a change in technique orsurface or an alteration of footwearFor non athletes, a recent atypicalincrease in activity (vacation withwalking or aerobic activities) maybe describedIf left unchecked pain may becomepersistent, pain at rest or evennight painThe hallmark physical finding isfocal bone pain (tenderness) withpalpation & stressingQ Percussionof bone typically produces pain butmotion of adjacent joints does not. Three phase bonescintigraphyIf multiple sites of arepossible or x - ray donot suppo thediagnosis. It is mostsensitive test for stressfracture (- 100%) butnot coupled with highspecificity- MRI provide identicalsensitivity and superiorspecificity compared tobone scintigraphy.C T scans* Treatment issymptomatic with castand cessation ofactivityQ
Bearger's disease
Gout
Lumbar canal stenosis
Stress fracture