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Medial tibial stress syndrome — RACGP Fellowship MCQ

Instant feedback + full explanation. One question, done properly.

HardMusculoskeletal and sportsMedial tibial stress syndromeRACGP Fellowship

A 42-year-old runner has progressively earlier medial tibial pain during training. Tenderness extends over 8 cm of the posteromedial tibial border and there is no night pain or focal swelling. What is the best initial approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Reduce impact load and address training factors, imaging if focal or high-risk features emerge

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

E is correct. Diffuse posteromedial tenderness over more than 5 cm, exercise-related pain and absence of focal or rest pain favour medial tibial stress syndrome rather than a focal stress fracture. Initial care is relative rest from provoking impact, graded return and correction of training load, footwear and biomechanical factors. A analgesia should not be used to mask pain and continue the injurious load. B over-interprets a nonspecific hop test. C risks tissue injury without treating load error. D uses the wrong urgent strategy for a diffuse low-risk presentation. Focal tenderness, night pain, inability to hop or anterior-tibial features should prompt imaging, commonly MRI.

Reference: RACGP AJGP — shin pain in athletes: https://www1.racgp.org.au/getattachment/35bfbc2d-206e-493b-8cd1-4e70354af8fc/Shin-pain-in-athletes.aspx