Often, they present with sudden onset of pain aggravated by activity and relieved by rest 6. Patients with stress fractures of the proximal tibia may present without any preceding event of trauma. MTX and prednisolone usage may account for a weakened bone in our patient, predisposing the proximal tibia to stress fracture on the background of a mild osteoarthritis. In addition, our patient was on long-term prednisolone, which may have contributed to osteoporosis. Prolonged usage of MTX can result in osteopathy 4. MTX is postulated to affect osteoblastic activity and may enhance osteoclastic bone resorption. MTX is an anti-metabolite that inhibits RNA and DNA synthesis 3. In our case, we believe that the stress fractures occurred in association with methotrexate osteopathy due to prolonged usage of methotrexate (MTX). However, it is rare for stress fractures of the proximal tibia to occur in cases of mild osteoarthritis of the knee, where there is minimal mal alignment. If the proper training principles and regimen are performed many of these injuries can be avoided.Proximal tibia stress fractures may occur on the background of osteoarthritis, due to the inherent mal alignment of the knee joint. Runners, military personnel and others that walk, march, jog or run constantly are the most susceptible for this type of injury. Stress fractures in the Tibia are common injuries in people that experience a constant pounding in their lower extremities. You will be evaluated and treated and if they assess the need for more testing they can help you with the process. If you do not need a referral, simply call your Physical Therapist’s office and make an appointment. If your insurance company requires that you have a referral for a specialist’s visit, then you will have to get it from your doctor. Seeing a Physical Therapist is easy and does not require a visit to a doctor. In the absence of enough strength, the force and stress through the bone might be too great and a stress fracture might occur. The muscles are responsible for moving the joints, but have a secondary function of absorbing some of the stress and forces that are placed through the bone when the injured person is weight bearing. When appropriate, the Physical Therapist will increase the intensity of the exercise regimen to help to increase the strength of the musculature that surrounds the injury. Weight bearing and non-weight bearing exercises might be prescribed to accomplish the same thing. The Physical Therapist will use a variety of modalities to enhance blood flow to the injury site and help to decrease the pain level. The use of ice on a regular basis will reduce the pain by slowing down the nerve conduction of the pain signal and reduce the heat in the tissue which acts as a catalyst to the inflammatory process. An active inflammation process causes the pain, and this can be best addressed with an icing program. The use of anti-inflammatory medications is not recommended because they can inhibit bone healing. The Physical Therapist implements a multifaceted treatment program, beginning by controlling the inflammation and pain. Treatment for a Tibial Stress FractureĪfter the orthopaedic doctor makes the formal diagnosis via the MRI, the patient is usually referred to Physical Therapy. The most accurate way to diagnose a stress fracture is via a MRI. ![]() Regular x-rays are usually performed, but they might not be accurate in the acute phase of the injury. It might be hot to the touch and will cause the patient to limp when they are attempting to walk or run. Healthcare professionals will conduct special tests to positively confirm the existence of the fracture site. ![]() The stress fracture is an example of this situation. If the degradation of the bone due to stresses and forces is greater than the ability of Osteoclast to produce more bone and “remodel” it the bone will be compromised and can suffer a break. The Osteoblast is a bone cell that is responsible for “making” more bone. The Tibia is a living connective tissue capable of “remodeling” or repairing itself. It has a hard outer shell, it is compact, and has a sponge-like inner portion or cancellous bone. Sometimes called the shinbone or shankbone, the Tibia is a long bone that is one of the strongest weight-bearing bones in the body. Long distance runners, military personnel and other activities that “over-load” the lower extremities can cause a stress fracture over time. If the amount of force is too great for the Tibia to handle, a person may develop a tibial stress fracture. This causes instability in the bone, severe pain and difficulty walking without a severe limp. A tibial stress fracture is a crack or micro-fracture in the lower shinbone.
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