sports med 2

Question 1

Differential diagnosis of shin pain

Answer 1

stress fracture
stress reaction
?Shin splints?

Question 2

Examination findings in suspected stress fracture

Answer 2

focal medial tibial tenderness is suggestive of a stress fracture
• linear or segmental tenderness is more likely to relate to a stress reaction.

Question 3

Investigation of shin pain

Answer 3

1. triple phase bone scan and MRI.
   Although bone scanning is considered the gold standard, MRI has also been proven to be a valid imaging modality in stress fractures

Question 4

Management of medial tibial stress fracture

Answer 4

1. fracture resolves well with weight-bearing rest, typically taking 4–8 weeks for complete symptom resolution.
2. ice and simple analgesics
3. Activity modification - limiting walking to essential amounts may be necessary in severe cases, and cross-training

Question 5

Calf pain causes

Answer 5

Deep posterior RECSy. - recurrent exertional compartment syndrome

1. predictable onset of a cramping, tight pressure feeling in the involved muscle groups that comes on at some point into a running-based exercise bout and usually eases within 30 minutes of rest

2.

Question 6

Management of recurrent exertional compartment syndrome (RECSy)

Answer 6

1. diagnosis via intra-compartment pressure testing to confirm the diagnosis.
2. possible surgical release of the relevant compartment fascia (fasciotomy or fasciectomy) is appropriate.

Success rates for fasciotomy are considered good, as the majority of patients achieve good pain relief

Question 7

13 year old with knee pain DDX

Answer 7

1. patellofemoral pain syndrome, also known as patellar maltracking or malalignment, or ‘runners knee’.
2. patellar instability
3. Chondral or osteochondral injury
4. discoid meniscus.

Less common, hip joint pathology and bony tumours

Question 8

Features of patellafemoral pain

Answer 8

1. recent growth spurt
2. onset of knee pain after a change in intensity, volume or type of sporting activity, or after a change in footwear.
3. There may be a history of previous injury to the knee or thigh to cause some quadriceps inhibition

Question 9

Management of patellofemoral pain

Answer 9

1. paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs)
2. decreasing tightness in lateral structures (e.g. iliotibial band)
3. improving VMO (vastus medals oblique) strength and timing. improving hip abductor strength.