A 28-Year-Old with Tibial Pain After Prolonged Exercise

Differential Diagnosis

• Chronic exertional compartment syndrome (CECS)
• Periostitis
• Popliteal artery entrapment syndrome
• Tibial stress fracture

Diagnosis

The images show short segment, ill-defined cortical lucencies of the anterior tibial cortex with associated cortical thickening. This patient was diagnosed with anterior tibial stress fractures.

Learnings/What to Look for

• Stress fracture is an overuse injury, with tibial stress fractures seen often in military recruits and runners after a change in exercise routine
• When enough stress is placed on the bone, it causes an imbalance between osteoclastic and osteoblastic activity and a stress fracture may appear

Pearls for Urgent Care Management

• Treatment is commonly activity restriction with protected weightbearing and pain management
• Surgical intramedullary nailing may be considered for severe situations

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).