Produced by

DIFFERENTIAL DIAGNOSIS ALGORITHM OF MTSS CLINICAL EXAMINATION Diagnostic imaging MRI ? + Linear Focal Atypical MTSS Stress fracture

Extrinsic factors

eg. training errors

DIAGNOSTIC ALGORITHM Diagnostic algorithms have been used exten- sively in the literature to assist the allied health professional in differential diagnosis and guidance in choosing the appropriate test. Above is such an algorithm summarising the findings of this literature review to assist in the differential diagnosis of MTSS.

Possible differential diagnosis ■ Periostitis (tibial and tractional) ■ Tibial bone stress reaction ■ Tibialis posterior tendonitis ■ Soleus tendonitis ■ Flexor hallucis longus tendonitis ■ Flexor digitorum longus tendonitis

AETIOLOGY

Intrinisc factors ■ Abnormal biomechanics ■ Anatomical factors ■ Muscle dysfunction ■ Gender

Plain radiograph Distal Bone scan – – +

After 2-3 weeks of symptoms

1/3 Posteromedial Tibia

Above distal 1/3 Tibia

Possible diagnosis 1. nerve entrapment

Possible diagnosis 1. Chronic ECS 2. PAES

No

pain at rest w/ palpable tenderness

No

pain at rest and no palpable tenderness

Pain

at rest w/ palpable tenderness

Determination of pain at rest and presence of palpable tenderness