Evaluation and Diagnosis of Tibial Bone Stress Injuries in Adolescents: Imaging and Nomenclature Current Concept Review

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Eric D. Nussbaum
Bryan Holtzman
Katherine H. Rizzone
Adam S. Tenforde
Mark E. Halstead
Corinna C. Franklin
Kathryn E. Ackerman


Tibial bone stress injuries (BSIs) are common injuries experienced by active adolescent athletes. The current literature lacks consensus of BSI nomenclature and appropriate use of imaging modalities. Injury classification, severity, or grade may differ substantially according to imaging modalities used and location of injury. This leads to inconsistency in understanding prevalence of injury, communication of diagnosis and management, and can cause confusion for patients and their entourages. As such, the purpose of this Current Concept Review was to identify existing classification of atraumatic tibial pain/BSI, propose unifying nomenclature, and review imaging tools available to clinicians caring for young athletes. Limited literature was identified pertaining to adolescent aged athletes. Thus, we expanded our search to included adult literature and identified 32 publications for atraumatic tibial pain. Multiple grading scales and various imaging modalities were used in the literature highlighting a lack of consensus of terminology and imaging for formalizing diagnosis of BSI. Tibial BSI is common in athletes and has large discrepancies in reported incidence. Unified terminology and recommended imaging modalities for the adolescent athlete with these injuries would improve patient care and professional communication. We propose using “Bone Stress Injury” (BSI) to describe overuse injury of the tibia with associated physical examination findings. When needed for guidance of management, imaging can be used to confirm the diagnosis of BSI. Radiography is recommended as the first imaging modality, and MRI should be considered to confirm diagnosis and determine grade of injury.

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How to Cite
Nussbaum, E. D., Holtzman, B., Rizzone, K. H., Tenforde, A. S., Halstead, M. E., Franklin, C. C., & Ackerman, K. E. (2022). Evaluation and Diagnosis of Tibial Bone Stress Injuries in Adolescents: Imaging and Nomenclature: Current Concept Review. Journal of the Pediatric Orthopaedic Society of North America, 4(1). https://doi.org/10.55275/JPOSNA-2022-0015
Lower Extremity