title: Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test.
abstract: OBJECTIVE
  To examine the relationship between two clinical test results and future diagnosis of (Medial Tibial Stress Syndrome) MTSS in personnel at a military trainee establishment.
  
  
  METHODS
  Data from a preparticipation musculoskeletal screening test performed on 384 Australian Defence Force Academy Officer Cadets were compared against 693 injuries reported by 326 of the Officer Cadets in the following 16 months. Data were held in an Injury Surveillance database and analysed using χ² and Fisher's Exact tests, and Receiver Operating Characteristic Curve analysis.
  
  
  METHODS
  Diagnosis of MTSS, confirmed by an independent blinded health practitioner.
  
  
  RESULTS
  Both the palpation and oedema clinical tests were each found to be significant predictors for later onset of MTSS. Specifically: Shin palpation test OR 4.63, 95% CI 2.5 to 8.5, Positive Likelihood Ratio 3.38, Negative Likelihood Ratio 0.732, Pearson χ² p<0.001; Shin oedema test OR 76.1 95% CI 9.6 to 602.7, Positive Likelihood Ratio 7.26, Negative Likelihood Ratio 0.095, Fisher's Exact p<0.001; Combined Shin Palpation Test and Shin Oedema Test Positive Likelihood Ratio 7.94, Negative Likelihood Ratio <0.001, Fisher's Exact p<0.001. Female gender was found to be an independent risk factor (OR 2.97, 95% CI 1.66 to 5.31, Positive Likelihood Ratio 2.09, Negative Likelihood Ratio 0.703, Pearson χ² p<0.001) for developing MTSS.
  
  
  CONCLUSIONS
  The tests for MTSS employed here are components of a normal clinical examination used to diagnose MTSS. This paper confirms that these tests and female gender can also be confidently applied in predicting those in an asymptomatic population who are at greater risk of developing MTSS symptoms with activity at some point in the future.
authors.affiliation: Department of Physiotherapy, University of Canberra, Australia. phillip.newman@canberra.edu.au
authors.forename: Phil
authors.initials: P
authors.lastname: Newman
authors.forename: Roger
authors.initials: R
authors.lastname: Adams
authors.forename: Gordon
authors.initials: G
authors.lastname: Waddington
mesh_terms: D000293:Adolescent; D001315:Australia; D004487:Edema / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D058923:Medial Tibial Stress Syndrome / Q000517:prevention & control*; D008889:Military Personnel; D010173:Palpation / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D055815:Young Adult