Today a show you the case of a young football player  that came to my observation for a persistent pain on his postero-medial compartment of the leg; as you can see from the dynamic ultrasound examination, a gross irregularity of the cortical tibial surface was evident with intense periostal hypervascularity.

The tibia is the most common site of a stress fracture in the lower body, especially in young athletes. Don’t forget that sensibility of the ultrasound scan with bone-like structures is 100% but 0% specificity. The integration with other imaging modalities is always needed; Mri exam is essential.

Sagittal Stir-3D Shark-T1w Mri scans 0.3 Tesla (from left to right)

Axial Stir (left) and T2w (right) Mri scans (0.3 Tesla); intense periostal reaction is evident.

With plain radiograph positive findings may take months to appear; don’t be surprised if during the first few weeks after the onset of symptoms, x-rays of the damaged area may look normal; not in this case….

Plain radiographs of the same patient: acute phase (left) and two months after (right).