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Sticks And Stones And Gymnasts’ Bones: Tumbling Through An All-star Case - Page #1
 

Author: Chae Ko, MD, MHSA
Co Author #1: Chae Ko, MD
Co Author #2: Kyle Cassas, MD

Patient Presentation:
Bilateral anterior lower leg pain.

History:
An 18 year-old male high school cheerleader and level 5 gymnast reports a three to four week history of increasing bilateral lower leg pains. Initially, the pain was thought to be shin splints, but his pain worsened and began to interfere with his physical activities. He trains approximately twenty hours per week. The pain began during the last football season with a two month history of anterior lower leg swelling and pain. The pain is described as sharp at times, but at other times it may be dull and throbbing. The pain is constant and there is associated swelling along the anterior lower legs bilaterally. His pain is worsened by weight-bearing activity. He had thus far failed conservative management with rest, ice and NSAIDS. He self-reported "fair" nutritional intake and denied any gastro-intestinal abnormalities. He takes a B-vitamin and Motrin but no other medications. He has never had a previous stress fracture or a bone densitometry performed.

Physical Exam:
He is a well-nourished and well developed male without acute distress. There is visible swelling along the anterior tibia at the junction of the middle and distal third. He has focal tenderness in this area of the tibia. He has good flexibility and has a normal neurovascular exam. There is no leg length discrepancy and the remainder of his examination was unremarkable.

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

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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