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A Not So Classic Case Of A Tibial Pain In A Distance Runner - Page #1
 

Author: Cameron Allen, B.S.
Co Author #1: Brandon Motzel, B.A. A.T. Still University of Health Sciences Kirksville College of Osteopathic Medicine
Co Author #2: Kevin Marberry, M.D. A.T. Still University of Health Sciences Kirskville College of Osteopathic Medicine, Department of Surgery
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Siobhan Statuta, MD, FAMSSM

Patient Presentation:
A 20 year old male patient presented with left posteromedial calf pain first noticed during running that would resolve spontaneously with rest. The pain was characterized as a sharp, stabbing sensation that was consistent with every run. Additionally, the patient noted a bump on the proximal medial aspect of the tibia. The patient was otherwise healthy and denied joint pain, cramps, stiffness or other associated symptoms.

History:
This patient was a 2nd year student at a local university. He had previously run cross country and track during high school, but had been away from running for 2 years since graduating. However, he recently resumed running several months ago about two or three times per week, and distances up to three miles at a time. His current running shoes were purchased recently and were a model similar to those he had always worn for running.
His past medical history and family history were unremarkable.

Physical Exam:
On physical examination of the knee, there was no extra-articular swelling or effusion noted. Tenderness to palpation was present at the proximal medial tibia and a 2 cm nodule was also noted here, about 7 cm distal to the joint line. Knee range of motion and stability was normal bilaterally. Normal strength was noted and no gait abnormality or joint malalignment was present.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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