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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (medial-tibial-stress-syndrome.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Medial Tibial Stress Syndrome Cheat Sheet)
}

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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Medial Tibial Stress Syndrome Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/26421/}}}
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
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\begin{tabulary}{5.8cm}{L}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 3rd February, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
\raggedright
\raggedcolumns

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% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.


\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{MTSS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Exercise induced pain along posteromedial border of the tibia} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Eccentric contraction of deep flexors (running/jumping on hard surfaces)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Repetitive traction on medial tibial crest causes muscle pain, periosteal inflammation and bony stress} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Inflammatory precursor to tibial stress f\#} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Bone responds to stress by remodelling itself more densely (occurs when remodelling cannot keep up with excessive/improper training -terrible toos - too much, too fast, too long)} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Demographics/Risk factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Females more than males} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Prior Hx} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Increased BMI} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Foot hyperpronation} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vague diffuse pain over middle to distal posteromedial tibia} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Worse with exertion (increase in activity \seqsplit{intensity/duration/beginning} of a workout)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pain \textgreater{}5 mins post activity {\bf{Consider Stress F\#}}} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Assess for numbness/paresthesia (compartment syndrome)} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Diffuse tenderness over posteromedial tibial border (at least 5cm)} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Might feel a periosteal reaction of roughness/bumpiness} \tn 
% Row Count 12 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Focal \& anterior tibial tenderness = Consider stress f\# (tuning fork test)} \tn 
% Row Count 14 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Single leg hop = painful most of the time} \tn 
% Row Count 15 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Tenderness over FDL and tibialis posterior} \tn 
% Row Count 16 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Talar bump test (if +ve strong suspicion of stress f\#)} \tn 
% Row Count 18 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Assess for hypertonicity of gastrosoleus} \tn 
% Row Count 19 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Navicular drop test (hyperpronation)} \tn 
% Row Count 20 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Assess for postural risk factors: \{\{nl\}\} Inflexability or imbalance of the hamstrings, quads \{\{nl\}\} Genu varus/valgus \{\{nl\}\} Tibial Torsion \{\{nl\}\} Femoral anteversion \{\{nl\}\} Leg length discrepancies \{\{nl\}\} Hip abductor weakness \{\{nl\}\} Excessive ext rot of the hip} \tn 
% Row Count 26 (+ 6)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Assess gait/running patterns/joint mobility of LL} \tn 
% Row Count 28 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Imaging}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Often unnecessary unless red flags, focal tenderness, +ve vibration testing, pain at rest, fail to improve with con care} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Radiographs taken \textgreater{}2-3 weeks unlikely to show findings} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{MRI better than x-ray for stress f\# and to grade them as follows: \{\{nl\}\} {\bf{Grade 1:}} Periosteal odema \{\{nl\}\} {\bf{Grade 2-3}} Bone marrow oedema \{\{nl\}\} {\bf{Grade 4:}} Cortical stress f\#} \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{X-ray findings of stress f\# = periosteal elevation/calus formation/cortical lucency} \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Stress f\#} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- External compartment syndrome} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Peripheral vascular disease} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Muscle strain} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Occult f\#} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Infection} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Neoplasm} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- DVT} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Peripheral neuropathy} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Popliteal artery entrapment syndrome} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- LS Radiculopathy} \tn 
% Row Count 11 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Vascular claudication} \tn 
% Row Count 12 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Remove risk factors - identify training errors and biomechanical risk factors} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Consider non-weight bearing activities (swimming, stationary cycling, pool running)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Ultrasound, electrical stimulation} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Ice/home ice massage} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Stretching and myofascial release of gastro, soleu, hip ext rots, tibialis posterior and anterior} \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Strengthening of tibialis posterior and hip abductors} \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- SMT/EMT of Spine, SI , pelvis, LL} \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Arch supports for pronation} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Return to activity should start slowly (lower intensity and distance then increasing by 10-15\% per week)} \tn 
% Row Count 15 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Avoid running on hard/uneven surfaces} \tn 
% Row Count 16 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Wider step width if narrow gait} \tn 
% Row Count 17 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Assess running shoes} \tn 
% Row Count 18 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Surgery is rarely indicated (posterior fasciotomy)} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}