Diagnosis of medial tibial stress syndrome
This 2017 cross-sectional study found medial tibial stress syndrome (MTSS) can be diagnosed with almost perfect reliability within clinical practice, using history and physical examination. Concurrent lower leg injuries were found to be present (32%) in athletes with MTSS and could also be identified reliably.
46 athletes who presented with a gradual onset of any lower leg pain for at least 1 week completed the study with 8 blinded assessors. Six steps were used for the confirmation of the diagnosis MTSS, based on the previous work by Yates & White (2004) and Edwards et al. (2005). This included questions on the onset and location of the pain, where MTSS was defined as exercise induced pain along the posteromedial tibial border and recognisable pain on palpation of the posteromedial tibial over a length of ≥5 consecutive centimetres.
Where the pathogenesis of sports injuries is unclear, there is a need for a shift in the diagnostic paradigm away from medical imaging techniques. The pathogenesis of MTSS remains equivocal with bony overload and periosteal traction inflammation being reported. Currently, the history and clinical examination is the gold standard of the diagnostic process in MTSS. The role of imaging in MTSS may be to rule out other entities with a known pathogenesis such as stress fractures, or suspicion of other rare conditions like osteosarcoma.
> From: Winters et al., Br J Sports Med (2017) (Epub ahead of print). All rights reserved to Winters et al.. Click here for the online summary.