Best Practice Case Studies-Case 113 Asset 6 Bone Stress Injuries Ultrasound

Video Transcription

Video Summary

The session is an AMS sports ultrasound case series featuring Stanford sports medicine fellows presenting on sonographic evaluation of medial tibial stress syndrome (bone stress injury continuum). They review bone stress injuries as overuse conditions common in runners, emphasizing early identification to prevent progression. MRI remains the gold standard, using the Fredericson grading scale (0–4), but ultrasound offers point-of-care, low-cost, radiation-free evaluation with dynamic localization of pain. Ultrasound can detect periosteal thickening/elevation, soft tissue edema, hypervascularity on Doppler, cortical irregularity, callus, and occasionally fracture lines, though it cannot assess deeper marrow edema.<br /><br />A case is presented: an 18-year-old female collegiate cross-country runner with one month of right shin pain, increased preseason training, prior stress injury, low BMI, pes planus, and irregular menses. Exam shows focal tibial tenderness, positive hop and fulcrum tests. MRI demonstrates T1/T2 marrow edema consistent with a grade 3 tibial stress injury. The fellows outline an ultrasound scanning protocol (high-frequency linear probe, careful positioning, mark maximal tenderness, optimize depth/gain, scan slowly, confirm in two planes) and cite preliminary data suggesting ~80% sensitivity and ~70% specificity vs MRI, with some features more sensitive and others highly specific.<br /><br />Management includes brief non-weight-bearing boot, graded return-to-run (Alter-G), nutrition/endocrinology referral for oligomenorrhea/RED-S risk, and orthotics for pes planus. Discussion highlights ultrasound’s role as a screening and monitoring tool, Doppler technique pitfalls, and ongoing debate about specificity in runners.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 3

Topic Ankle

Keywords

4th Edition

4th Edition, Case 3

Ankle

sports ultrasound

medial tibial stress syndrome

tibial stress injury

bone stress injury continuum

Fredericson grading scale

point-of-care ultrasound Doppler

runner overuse injury

RED-S oligomenorrhea