Bilateral Shin Pain On A 200m Track And Field/Cross Country College Athlete

HISTORY: 20-year-old female Division III 200-meter track student-athlete presented with chronic bilateral shin pain. She had pain since childhood with exacerbation over the last 5 months. She was starting her first cross-country season and noted left greater than right anterior proximal shin pain and bilateral distal posterior medial shin pain. The pain was worse with walking long distances and running with slow improvement over the next few hours after rest. She denied any leg swelling, loss of sensation, or weakness. She also denied any restrictive eating, changes in weight, irregular menstrual cycles, or history of stress fractures. PHYSICAL EXAMINATION: Physical examination showed intact peripheral pulses and no edema. Strength was 5/5 on bilateral lower extremities and sensation was intact and symmetric bilaterally. During Single-leg hop, she had left greater than right anterior tibial pain. She had tenderness on the anterior medial tibia proximally on the left and distal posterior medial pain to palpation bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Medial tibial stress syndrome2. Stress fracture of the tibia 3. Compartment Syndrome TEST AND RESULTS: 1.Bilateral Knee X-rays of bilateral knees are unremarkable.2.Bilateral Tibia/fibula MRI: partial calf strain at the myotendinous junction on the left no signs of any stress edema or fracture 3.Bilateral Pre/post-exertion Anterior and lateral Compartment Testing a.Rest Pressures: i.Right Anterior: 20 mmHg.ii.Right Lateral: 17 mmHg. iii.Left Anterior: 21 mmHg.iv.Left Lateral: 22 mmHg. b.5-min Post-Exertion Pressures: i.Right Anterior: 29 mmHg.ii. Right Lateral: 17 mmHg.iii.Left Anterior: 28 mmHg.iv.Left Lateral: 22 mmHg.c.Rest pressures based on Flick et al are borderline (16-24 mmHg) in all tested compartments. 5-min post-exertion pressures based on Flick et al are abnormal (>20 mmHg) at the left anterior, lateral compartments, right anterior compartment. Final Diagnosis: Chronic Exertional Compartment Syndrome of Bilateral Lower Extremities TREATMENT AND OUTCOMES: Patient deferred fasciotomy/fasciectomy. The patient was referred to running/gait lab for running retraining. A physical therapy program focused on running mechanics and reintegration into competition. She reported a 50% improvement in symptoms with gait training.