Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies.

The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as 'shin splints'. We aimed to review clinical entities that come under the umbrella term 'Exercise-induced leg pain' (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.

[Clinical and experimental assessment of the current treatment of tibial shaft fractures]. / Lábszártörés korszerû kezelésének értékelése klinikai és kísérletes vizsgálatokkal.

Tibial shaft fractures present 15% of all fractures, which means about 2500 cases per year in Hungary. 90% of these fractures are treated surgically. Nowadays, the incidence of tibia fractures is increased, the severity of the fractures is intensified and in spite of new surgical techniques the rate of complications is not dramatically decreased. The treatment of the open tibia fractures has basically changed since the introduction of unreamed intramedullar nails. The unreamed nails turned into the primary method in the treatment of the Grade II and III open fractures and became sufficient for the fixation of the proximal and distal third tibia fractures. In Hungary, we used the Marchetti-Vicenzi nail for the treatment of tibia fractures in first time, with this method the tibial shaft and distal part fractures can be treated safely with low rate of complication. In year 1997 we prepared the treatment concept of the combination of the dynamic brace and the undreamed intramedullar nail. We proved that by the application of this method the advantages of the two treatment form could be attached and the healing period and the rehabilitation of the injured could be shortened. During the clinical exploration of the complications we proved that different pressure levels developed in the muscular compartment around the tibia during the usage of two different surgical techniques, the reamed and unreamed nailing. In the deep compartment we measured statistically higher pressure in the cases of unreamed nailing. In contrast to the literature we can draw the conclusion that there is no relationship between the compartmental pressure changes, the chance of the development of compartment syndrome and the insertion technique of the intramedullar nails. In pursuance of the basic research of the complications we investigated the muscle samples from compartment syndrome and from Volkmann ischemic contracture with differential scanning calorimetry. We proved that there is a difference between thermal features of the intact and ischemic muscles. We demonstrated that there is a close correlation between the compartmental pressure, the structural damage of muscle tissues and thermo-chemic values measured by calorimetry. Due to their sensitivity and specificity, calorimetric examinations can help and support the clinical diagnosis in atypical cases.