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.
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….