(2-4) The Talar Bump Test may help differentiate tibial stress fracture from MTSS. (1) Single leg hopping is painful in about half of MTSS cases (and 70-100% of stress fractures). Applying a vibrating tuning fork over the tibia may help detect stress fracture with 75% sensitivity. More focal tenderness, the presence of anterior tibial tenderness, or any significant swelling suggests stress fracture. Tenderness from MTSS should involve at least 5 cm of the tibial border. The 256-Hz tuning fork performed best, with a sensitivity of about 90, but unfortunately, the test had very poor specificity: only around 20. Prolonged stress may generate a periosteal reaction detectable as a “rough” or “bumpy” feel upon palpation. 1 However, it is important to understand that the findings from this single test alone, isn’t sufficient to rule in or out a fracture. The tuning fork test is an acceptable method for identifying fractures. Pain that persists more than five minutes post-activity carries a higher suspicion of stress fracture.Ĭlinical evaluation demonstrates diffuse tenderness over the posteromedial tibial border. Tuning forks can be used to help determine if someone has a potential fracture. Initially, symptoms may subside during training, but as the condition progresses (toward stress fracture), symptoms may linger throughout activity or even at rest. Symptoms are often worse with exertion – particularly at the beginning of a workout. The clinical presentation of MTSS includes vague, diffuse pain over the middle to distal posteromedial tibia. Prolonged insult may lead to a tibial stress fracture, and many authors now believe that MTSS and stress fracture represent two different points along a continuum of bony stress reaction. Stress reactions occur when the normal adaptive remodeling response cannot keep pace with excessive training loads, i.e., high demands with inadequate recovery times. Healthy bone responds to this stress by remodeling itself more densely. The stress of exercise can temporarily weaken bone. Research suggests that traction periostitis may be an inflammatory precursor to a tibial stress fracture. This research article, The Ability of Clinical Tests to Diagnose Stress Fractures: A systematic Review and Meta-analysis, assesses the reliability of both therapeutic ultrasound and the tuning fork test. Early etiological theories focused on myofascial strain, but current evidence shows that a bony stress reaction is the most likely cause of MTSS. In this method, the examiner placed a stethoscope over a boney prominence at the end of a long bone and a vibrating 128 Hz tuning fork at the opposite end of.
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