11/19/2023 0 Comments Tuning fork test was positiveThe point of maximal shin tenderness was located by the provider applying firm pressure along the length of the tibia with a digit of the hand and by asking the patient to identify the point of maximal tenderness. Physical exams were performed by healthcare providers working in the SMART clinic. They were asked additional details of personal exercise, military training, prior lower extremity injuries self-reported tobacco use, supplement use, and prescription medications. Additional data were collected, and participants were asked to report the duration in days of their shin pain. Once identified, eligible participants received a standard history and physical exam including palpation for tenderness along the tibia. The study was approved by the Institutional Review Board at the Naval Medical Center San Diego, and all participants were consented for enrollment into the study. Although women were not excluded from the study directly, the entry level training had not been gender integrated at the time of data collection, so few female patients were evaluated in the SMART clinic and no female patients volunteered from other locations on Camp Pendleton. Potential participants were excluded if they had an established diagnosis of stress fracture, recent lower extremity trauma, bilateral symptoms, or any contraindications to MRI. Inclusion criteria included all active duty service members aged 18 years and older, with a history and physical exam consistent with unilateral stress fracture of the tibia, and who consented to participation. Patients were referred to study personnel if healthcare providers from across Camp Pendleton suspected a unilateral tibial stress fracture. This evaluation included military personnel who sought treatment for shin pain at the Sports Medicine and Reconditioning Team (SMART) clinic at Marine Corps Base Camp Pendleton, California. The goal of this study was to examine the accuracy of the tuning fork test in confirming the diagnosis and location of tibial stress fractures, as compared to the gold standard of MRI, among a cohort of active duty military personnel. 6 The results’ evaluation reported sensitivity and specificity of 75% and 67%, respectively. The first attempt to evaluate the accuracy of the tuning fork was by Lesho in 1997. 5 Since then, the use of a tuning fork has frequently been recommended. Since 1983, when first included in a textbook on sports medicine, the vibration of a tuning fork has been recommended as a way to locate and diagnose a stress fracture by inducing vibratory pain at the site of the injury. However, MRI is expensive and may not be available in the austere environments in which military personnel frequently find themselves. 4 In addition, MRI precisely depicts the location, extent, and severity of bone stress injuries and provides information about adjacent non-osseous tissues that X-ray, bone scan, and CT cannot provide. In recent years, MRI has become the gold standard in the evaluation of stress fractures and has been shown to be superior to both X-ray and bone scintigraphy MRI sensitivity and specificity have been reported as high as 100% and 95%, respectively. 2 Options for radiographic confirmation of stress fractures include X-ray, bone scintigraphy scan, CT, and MRI. Typical physical exam findings are tenderness to palpation, focal temperature increase and pain with various tests like fulcrum, and a hop test. 2 The diagnosis of bone stress injuries can be difficult since physical exam findings are neither sensitive nor specific. 3 A review in 2010 of local data on Marine Corps Base Camp Pendleton revealed one-third of the 1250 stress fractures were tibial stress fractures.Äiagnosis of a tibial stress fracture is made after a history and physical exam and then confirmed with radiologic imaging. The tibia is the most common site for stress fractures. 2 These injuries limit fitness and training abilities. Although there are intrinsic and extrinsic factors causing bone stress injuries, 1 the most likely factors in the military are the rapid increase in physical activity seen in the military as well as a relative energy deficiency. 1 Stress fractures are common injuries among military personnel and are the result of normal healthy bone being subjected to repetitive loading forces, 1 like entry-level military training. Stress fractures result from cumulative microtrauma to the bone caused by repeated mechanical stress.
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