Chronic Lower Leg Pain in Athletes: A Guide for the Differential Diagnosis, Evaluation, and Treatment

Sports Health

Volumn 4, Issue 2, 2012, Pages 121-127

  Biber Brewer, Rachel ^a   Gregory, Andrew J M ^a  

^a VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

chronic exertional compartment syndrome; chronic leg pain; medial tibial stress syndrome; nerve entrapment; popliteal artery entrapment syndrome

Indexed keywords

EID: 84857682171     PISSN: 19417381     EISSN: 19410921     Source Type: Journal    
DOI: 10.1177/1941738111426115     Document Type: Article

References (64)

1. Allen CS,Flynn TW,Kardouni JR, et al.The use of a pneumatic leg brace in soldiers with tibial stress fractures-a randomized clinical trial.Mil Med. 2004;169:880-884.
2. Allen CS,Hemphill NH,Kardouni JR, et al.A randomized controlled trial of a pneumatic leg brace versus traditional treatment in individuals with tibial stress fractures.J Orthop Sports Phys Ther. 2002;32:A3.
3. Anderson M,Ugalde V,Batt M,Gacayan J.Shin splints: MR appearance in a preliminary study.Radiology. 1997;204:177-180.
4. Anil G,Tay KH,Howe TC,Tan BS.Dynamic computed tomography angiography: role in the evaluation of popliteal artery entrapment syndrome.Cardiovasc Intervent Radiol. 2011;34:259-270.
5. Aoki Y,Yasuda K,Tohyama H,Ito H,Minami A.Magnetic resonance imaging in stress fractures and shin splints.Clin Orthop Relat Res. 2004;421:260-267.
6. Baltopoulous P,Filippou DK,Sigala F.Popliteal artery entrapment syndrome: anatomic or functional syndrome?.Clin J Sport Med. 2004;14:8-12.
7. Batt ME,Ugalde V,Anderson MW,Shelton DK.A prospective controlled study of diagnostic imaging for acute shin splints.Med Sci Sports Exerc. 1998;30:1564-1571.
8. Beck B.Tibial stress injuries: an aetiological review for the purposes of guiding management.Sports Med. 1998;26:265-279.
9. Bennell KL,Matheson G,Meeuwisse W, et al.Risk factors for stress fractures.Sports Med. 1999;28:91-122.
10. Blackman PG.A review of chronic exertional compartment syndrome in the lower leg.Med Sci Sports Exerc. 2000;32 (suppl 3): S4-S10.
11. Boden BP,Osbahr DC.High-risk stress fractures: evaluation and treatment.J Am Acad Orthop Surg. 2000;8:344-353.
12. Boden BP,Osbahr DC,Jimenez C.Low-risk stress fractures.Am J Sports Med. 2001;29:100-111.
13. Bradshaw C.Exercise-related lower leg pain: vascular.Med Sci Sports Exerc. 2000;32 (suppl 3): S34-S36.
14. Brennan FH,Kane SF.Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome.Curr Sports Med Rep. 2003;2:247-250.
15. Burne SG,Khan KM,Boudville PB, et al.Risk factors associated with exertional tibial pain: a twelve month prospective clinical study.Br J Sports Med. 2004;38:441-445.
16. Clanton TO,Solcher BW.Chronic leg pain in the athlete.Clin Sports Med. 1994;13:743-759.
17. Detmer D.Chronic shin splints: classification and management of medial tibial stress syndrome.Sports Med. 1986;3:436-446.
18. Edmundsson D,Toolanen G,Thornell L-E,Stal P.Evidence for low muscle capillary supply as a pathogenic factor in chronic compartment syndrome.Scand J Med Sci Sports. 2010;20:805-813.
19. Edwards PH,Wright ML,Hartman JF.A practical approach for the differential diagnosis of chronic leg pain in the athlete.Am J Sports Med. 2005;33:1241-1249.
20. Ehsan O,Darwish A,Edmundson C, et al.Non-traumatic lower limb vascular complications in endurance athletes: review of literature.Eur J Vasc Endovasc Surg. 2004;28:1-8.
21. Fraipont MJ,Adamson GJ.Chronic exertional compartment syndrome.J Am Acad Orthop Surg. 2003;11:268-276.
22. Fredericson M,Bergman G,Hoffman K,Dillingham M.Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.Am J Sports Med. 1995;23:427-481.
23. Fredericson M,Jennings F,Beaulieu C,Matheson GO.Stress fractures in athletes.Top Magn Reson Imaging. 2006;17:309-325.
24. Gaeta M,Minutoli F,Scribano E, et al.CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities.Radiology. 2005;235:553-561.
25. Galbraith RM,Lavallee ME.Medial tibial stress syndrome: conservative treatment options.Curr Rev Musculoskelet Med. 2009;2:127-133.
26. Geslin GE,Thrall JH,Espinosa JL, et al.Early detection of stress fractures using Tc-99m-polyphosphate.Radiology. 1976;121:683-687.
27. Hoch AZ,Pepper M,Akuthota V.Stress fractures and knee injuries in runners.Phys Med Rehabil Clin N Am. 2005;16:749-777.
28. Howard JL.Evaluation of outcomes in patients following surgical treatment of CECS of the leg.Clin J Sport Med. 2000;10:176-184.
29. Hubbard TJ,Carpenter EM,Cordova ML.Contributing factors to medial tibial stress syndrome; a prospective investigation.Med Sci Sports Exerc. 2009;41:490-496.
30. Hutchinson M,Ireland M.Chronic exertional compartment syndrome: gauging pressure.Phys Sportsmed. 1999;27:101.
31. Kaeding CC,Yu JR,Wright R,Amendola A,Spindler KP.Management and return to play of stress fractures.Clin J Sport Med. 2005;15:442-447.
32. Korpelainen R,Orava S,Karpakka J,Siira P,Hulkko A.Risk factors for recurrent stress fractures in athletes.Am J Sports Med. 2001;29:304-310.
33. Kortebein PM,Kaufman KR,Basford JR,Stuart MJ.Medial tibial stress syndrome.Med Sci Sports Exerc. 2000;32 (suppl 3): 27S-33S.
34. Leach RE,Purnell MB,Saito A.Peroneal nerve entrapment in runners.Am J Sports Med. 1989;17:287-291.
35. MacIntyre JG,Taunton JE,Clement DB, et al.Running Injuries: a clinical study of 4,173 cases.Clin J Sport Med. 1991;1:81-87.
36. Matsen FA,Mayo KA,Sheridan GW,Krugmire RB.Monitoring of intramuscular pressure.Surgery. 1976;79:702-709.
37. McCrory P,Bell S,Bradshaw C.Nerve entrapment of the lower leg, ankle and foot in sport.Sports Med. 2002;32:371-391.
38. McDermott MM,Criqui MH,Liu K, et al.Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial arterial pressures, and association with leg functioning in peripheral arterial disease.J Vasc Surg. 2000;32:1164-1171.
39. Meier TO,Schneider E,Amann-Vesti B.Long-term follow-up of patients with popliteal artery entrapment syndrome treated by endoluminal revascularization.Vasa. 2010;39:189-195.
40. Moen MH,Bongers T,Bakker EWP, et al.The additional value of a pneumatic brace in the treatment of recruits with medial tibial stress syndrome; a randomized study.JR Army Med Corps. 2010;156:236-240.
41. Moen MH,Bongers T,Bakker W, et al.Risk factors and prognostic indicators for medial tibial stress syndrome.Scand J Med Sci Sports.
42. Moen MH,Rayer S,Schipper M, et al.Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study.Br J Sports Med.
43. Moen MH,Tol JL,Weir A,Steunebrink M,De Winter TC.Medial tibial stress syndrome: a critical review.Sports Med. 2009;39:523-546.
44. Murphy DF,Connolly DAJ,Beynnon BD.Risk factors for lower extremity injury: a review of the literature.Br J Sports Med. 2003;37:13-29.
45. Peck E, Finnoff JT, Smith J, Curtiss H, Muir J, Hollman JH. Accuracy of palpation-guided needle tip placement into deep and superficial posterior leg compartments [published online ahead of print May 26, 2011]. Am J Sports Med.
46. Pedowitz RA,Hargens AR,Mubarak SJ,Gershuni DH.Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg.Am J Sports Med. 1990;18:35-40.
47. Pham TT,Kapur R,Harwood MI.Exertional leg pain: teasing out arterial entrapments.Curr Sports Med Rep. 2007;6:371-375.
48. Plisky MS,Rauh MJ,Heiderscheit B,Underwood FB,Tank RT.Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors.J Orthop Sports Phys Ther. 2007;37:40-47.
49. Rome K,Handoll HH,Ashford RL.Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults.Cochrane Database Syst Rev. 2005;2:.
50. Rompe JD,Cacchio A,Furia JP,Maffulli N.Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome.Am J Sports Med. 2010;38:125-132.
51. Schon LC.Nerve entrapment, neuropathy, and nerve dysfunction in athletes.Orthop Clin North Am. 1994;25:47-59.
52. Schubert AG.Exertional compartment syndrome: review of the literature and proposed rehabilitation guidelines following surgical release.Int J Sports Phys Ther. 2011;6:126-141.
53. Sterling JC,Edelstein DW,Calvo RD,Webb R.Stress fractures in the athlete: diagnosis and management.Sports Med. 1992;14:336-346.
54. Stickley CD,Hetzler RK,Kimura IF,Lozanoff S.Crural fascia and muscle origins related to medial tibial stress syndrome symptom location.Med Sci Sports Exerc. 2009;41:1991-1996.
55. Touliopolous S,Hershman EB.Lower leg pain: diagnosis and treatment of compartment syndromes and other pain syndromes of the leg.Sports Med. 1999;27:193-204.
56. Turnipseed WD.Functional popliteal artery entrapment syndrome: a poorly understood and often missed diagnosis that is frequently mistreated.J Vasc Surg. 2009;49:1189-1195.
57. Van Gent RN,Siem D,van Middlekoop M,van Os AG,Bierma-Zeinstra SMA,Koes BW.Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.Br J Sports Med. 2007;41:469-480.
58. Verma RB,Sherman O.Athletic stress fractures, part I: history, epidemiology, physiology, risk factors, radiography, diagnosis, and treatment.Am J Orthop (Belle Mead NJ). 2001;30:798-806.
59. Wen DY.Risk factors for overuse injuries in runners.Curr Sports Med Rep. 2007;6:307-313.
60. Wilbourne A.Electrodiagnostic testing of neurologic injuries in athletes.Clin Sports Med. 1990;9:229-245.
61. Wilcox JR,Moniot AL,Green JP.Bone scanning in the evaluation of exercise related stress injuries.Radiology. 1977;123:699-703.
62. Wilder RP,Sethi S.Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints.Clin Sports Med. 2004;23:55-81.
63. Yates B,White S.The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.Am J Sports Med. 2004;32:722-780.
64. Zwas ST,Elkanovitch R,Frank G.Interpretation and classification of bone scintigraphic findings in stress fractures.J Nucl Med. 1987;28:452-457.