Tibial Stress Fractures: Specificity of Focal Tenderness to Palpation
Abstract
Introduction: Stress fractures are common among military recruits and athletes. When involving the leg, they are typically characterized by tenderness in the medial tibial region. The inconsistency and imprecision of previously described clinical examination maneuvers highlight the need for this study, which aims to evaluate the sensitivity and specificity of tibial palpatory pain patterns. Materials and Methods: A series of 19 patients presenting with 31 painful episodes in the leg between 2012 and 2014 was analyzed. Patients experiencing tibial pain during military training were included, while those with a history of trauma were excluded. A physical examination was performed, mapping painful tibial points using a grid divided into nine zones and classifying them into three patterns: vertical, transverse, and focal (single point). All patients underwent radiographic and scintigraphic imaging. Results: Of the total patients, 63% were women and 36.8% were men. A total of 31 lesions were identified (64.5% in women, 35.5% in men). Radiographs were negative in all cases, whereas scintigraphy confirmed 22 (71%) stress fractures and 9 (29%) cases of periostitis. The transverse and focal pain patterns were the most sensitive (40.91%). The focal pattern was observed in 29% of cases and was exclusively associated with stress fractures. Conclusions: Focal tenderness to palpation was present in 100% of cases with stress fractures, demonstrating its high specificity as a clinical sign. This finding highlights its diagnostic value in evaluating tibial stress fractures.Downloads
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