BILATERAL TIBIA INJURY-FOOTBALL

Abstract

HISTORY In 10/01, a 19 y/o football player struck his right shin against a weight bench. Within weeks, he did the same on his left. He had little pain, but soon noticed bony protrusions over the tibia and increasing pain with activity. He completed the football season, rested, and the pain subsided. When basketball season began, however, pain returned and became constant. Eventually he had to quit the team. Despite resting, his pain intensified. His first MD visit was in 1/02 and right tibia X-rays diagnosed a fracture. He was told to discontinue all strenuous activities but, thereafter, he left for college and was lost to follow up. In 7/02, pre-season football training began. He saw me in the training room and complained of bilateral tibia “lumps” and pain at these sites, primarily on the right. The shin pain was becoming problematic with daily activities as well as interfering with football practice. PHYSICAL EXAMINATION Healthy 19 y/o male. Deformities over the upper third of the tibiae bilaterally were point tender over about a 2 inch area. No edema, swelling, cyanosis, erythema, or warmth. His gait and stance were normal, as were his hip, knee, ankle and foot exam. DIFFERENTIAL DIAGNOSIS Traumatic tibia fractures. Bilateral stress fractures. Bilateral periostitis/periostial reaction. Metabolic bone disorder. TEST AND RESULTS 1/02 right tibia X-ray-horizontal, 1cm sclerotic line anterolaterally. Thickened, mottled cortex. Read as a right linear cortical fracture of the mid-tibia, incomplete and non-displaced. 7/02 X-rays-bilateral sclerotic, horizontal, anterolateral fractures of the shaft of the tibiae. Neither shows significant callous. No periostial elevation. FINAL WORKING DIAGNOSIS Bilateral Tibia Stress Fractures. TREATMENT AND OUTCOMES Crutches and ice. Old films and new bilateral films requested. Saw orthopedics in 8/02. Treatment and follow-up set for 8 wks. He failed to keep his f/u appt. I contacted him, and currently he has no symptoms with walking, but does still have symptoms with any activity. He is frustrated with his physical limitations and inability to treat the issue, but agreed to come in for follow-up.