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

Abstract

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. The purpose of this Current Concept Review is to identify existing classification of atraumatic tibial pain/BSI, propose unifying nomenclature, and review imaging tools available to clinicians caring for young athletes. 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. Radiography is recommended as the first imaging modality, and MRI should be considered to confirm diagnosis and determine grade of injury. Key Concepts: • Atraumatic tibial pain is a common injury experienced by pediatric and adolescent athletes, but no uniform diagnostic terminology currently exists for appropriate identification and management. • “Bone stress injury” should be used as a unifying term for “stress fracture,” “stress reaction,” and other phrases that are inconsistently used to define overuse injuries of the bone. • MRI is the gold-standard by which bone stress injuries of the tibia can be graded for severity. • Physicians are encouraged to maintain a broad differential diagnosis when treating tibial pain to avoid missing a catastrophic diagnosis (e.g., sarcoma) in a young athlete.