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Having constant contralateral tibial pain, mid shaft of the medial tibia. Was diagnosed with chronic osteomyelitis. What to do?

Jul 2013
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Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
I am a left BKA secondary to chronic osteomyelitis--five years post amputation. Now I have contralateral tibial pain--mid shaft of the medial tibia. The pain is significant (5+ out of 10). However, no heat, redness, or drainage (thank goodness). I am 90% sure that this is a stress fracture, especially in light of negative plain film x-ray. I ambulate with a prosthesis and no other assistive devices. I cannot get my primary care provider to understand that I do not want narcotics and I do want an MRI or 3-phase bone scan to evaluate. I have great insurance. Other info--I am petite, Caucasian, do not have an eating disorder, and have mild osteopenia. I would appreciate any other differential diagnosis or info that I can pass on to get this checked out. Of additional concern is that the pain is identical to the initial pain when I was first diagnosed with chronic osteomyelitis (Brodie's abscess), which rapidly progressed to acute osteomyelitis.
Posted Thu, 1 Aug 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 55 minutes later
Hi, thanks for writing to XXXXXXX

Before I answer your query, I need some more information on your symptoms to arrive at possible diagnosis.

Please answer the below questions as elaborately as possible -
* What is the duration of pain in your tibial bone?
* onset of pain ? sudden or insidious onset in right tibia
* whether the pain is present continuosly or is associated only with physical activity?
* are you a diabetic patient? any other medical illnesses?
* Is the pain present over a specific area on the bone or is present over the entire tibia?
* Do you have any associated fever?
* Do you have infection in any other parts of the body?

Above answer was peer-reviewed by
Follow-up: Having constant contralateral tibial pain, mid shaft of the medial tibia. Was diagnosed with chronic osteomyelitis. What to do? 22 hours later
Thank you for your followup questions. I am unable to determine if you received my reply answering your questions. Just in case I made an error in sending the reply, here are the answers to your questions.

1. Duration = 2 to 3 weeks.
2. Insidious with rapidly increasing pain.
3. Pain is constant. It worsens with weight bearing.
4. I am not diabetic. No cardiovascular or pulmonary issues, with the exception of mild asthma.
5. Pain is very localized to medial aspect, approximately at mid shaft.
6. No fever or chills.
7. No other infections. Still colonizing MRSA in nasal swab. No areas of redness, heat, or drainage. Plain films of Left BKA stump show no evidence of osteomyelitis.

Thank you for your assistance. Please let me know if you have additional questions.
Answered by Dr. K. Naga Ravi Prasad 2 hours later
Hi, After going through your answers, I would like to consider two conditions that are likely producing symptoms in you -
(1) STRESS or FATIGUE FRACTURE (as you thought of) - Occurs generally due to repetitive overload activities. Commonly seen in weight bearing bones - XXXXXXX BONE (TIBIA). It is tender to palpation (feel) at the fracture site. In the acute setting, Xrays will be negative but over a period of time may show evidence of fracture healing around the site. Also there should be an associated increase in the levels of physical activity in the recent past.

(2) Resurgence of the bacterial infection causing an implantation of the nidus in the tibial bone. Organisms of low virulence will not produce any acute signs of inflammation. A bone scan or MRI rules out this possibility

Lastly (though rare) BENIGN BONE TUMOURS like OSTEOID OSTEOMA also presents with similar symtoms. Usually pain will be more in the NIGHT HOURS.

So, unless you undergo a detailed evaluation, it is hard to make a definitive diagnosis.

Hope I have addressed your issues. Good day
Above answer was peer-reviewed by
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