Medial tibial stress syndrome can be diagnosed reliably using history and physical examination.
BACKGROUND
The majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS).


OBJECTIVE
Our aim was to assess if MTSS can be diagnosed reliably, using history and physical examination. We also investigated if clinicians were able to reliably identify concurrent lower leg injuries.


METHODS
A clinical reliability study was performed at multiple sports medicine sites in The Netherlands. Athletes with non-traumatic lower leg pain were assessed for having MTSS by two clinicians, who were blinded to each others' diagnoses. We calculated the prevalence, percentage of agreement, observed percentage of positive agreement (Ppos), observed percentage of negative agreement (Pneg) and Kappa-statistic with 95%CI.


RESULTS
Forty-nine athletes participated in this study, of whom 46 completed both assessments. The prevalence of MTSS was 74%. The percentage of agreement was 96%, with Ppos and Pneg of 97% and 92%, respectively. The inter-rater reliability was almost perfect; k=0.89 (95% CI 0.74 to 1.00), p<0.000001. Of the 34 athletes with MTSS, 11 (32%) had a concurrent lower leg injury, which was reliably noted by our clinicians, k=0.73, 95% CI 0.48 to 0.98, p<0.0001.


CONCLUSIONS
Our findings show that MTSS can be reliably diagnosed clinically using history and physical examination, in clinical practice and research settings. We also found that concurrent lower leg injuries are common in athletes with MTSS.
Department of Rehabilitation, Nursing Science & Sports, University Medical Centre Utrecht, Utrecht, The Netherlands.
M
M
Winters
Division of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
E W P
EWP
Bakker
Bergman Clinics, Naarden, The Netherlands.|The Sport Physician Group, OLVG West, Amsterdam, The Netherlands.|Department of Elite Sports, National Olympic Committee and National Sports Federation, Arnhem, The Netherlands.
M H
MH
Moen
Academic Physical Education, The Hague, The Netherlands.
C C
CC
Barten
Physiotherapy and Rehabilitation Diepeveen, Haarlem, The Netherlands.
R
R
Teeuwen
Orthopaedic and Sports Medicine Hospital, Aspetar, Doha, Qatar.|Amsterdam Centre for Evidence Based Sports Medicine (ACES), Academic Medical Centre, Amsterdam, The Netherlands.
A
A
Weir
D000293:Adolescent; D056352:Athletes; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007869:Leg Injuries; D008297:Male; D058923:Medial Tibial Stress Syndrome / Q000175:diagnosis*; D008487:Medical History Taking; D009426:Netherlands; D010808:Physical Examination; D015203:Reproducibility of Results; D055815:Young Adult
diagnosis; history; medial tibial stress syndrome; physical examination; reliability