Question

Sports Residency Program
2008 entrance Questionare

Case #13

A 25yr old Caucasian female, height 67, weight 119lbs, present to the office complaining of right shin psi and general fatigue. she maps out the anteromedial portion of the right shin as being specific location. patient states she had this problem briefly at the end of last season, but it went away during the off-season and started again approximately 4 months ago at the start of her current training season.

Answer 1

Pain is local, 3/10, dull and achy wheb walking, but approaches an 8/10 after several sprinting runs or
or after long distance runs, prevents her from continuing. Rest, Ice, and NSAIDs help to some degree but her condition is getting worse.Her fatigue began approximately the same time as her shin splints , which the patient attributes to lack of exercise due to pain and not getting enough sleep. she is eager to resume her full training.


there is +2 tenderness along the distal length of medial right tibia with +3 tenderness at the upper 1/3rd, +2 tenderness along the soleus medially laterally, and +3 hypertonicity of the soleus and gastrocnemius. patient has pes plants bilaterally, worse on the right, and stands with an externally rotated right leg. there is +2 tenderness throughout the right gluteal muscles. right SI extension and left SI Flexion restrictions are noted with right rotation left lateral flexion restrictions of L4-L5. DTRs, Myotomes,Dermatomes are WNL bilaterally.

Patient's personal and family history is unremarkable.

1.) List 5 differential diagnoses and 1 (one) working diagnosis

2.) List 3 further questions you would ask this patient

3.) What other neuro/pet ho examinations would you perform and why?

4.) what labs and /or studies , if any ,would you order?

5.) what management protocol would you prescribe?