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A 15-year-old female who is an avid runner has started developing increasing pain along her right leg. She indicates that the pain has developed in the past few months and has progressed in the past few weeks to where she cannot tolerate weightbearing on the limb. She runs approximately 10 miles per day and is set on a collegiate running career. She notes that her menses began at age 11, but she has not had a menstrual cycle for 3 months presently. She denies sexual activity. On examination, she is exquisitely tender over the right tibia at the level of the middle to distal third. Radiographs are seen below in Figure A and Figure B. Which of the following should be included as part of this patient’s management?
Observation with continuation of physical activity
Discontinuation of running with weightbearing in CAM walker
Intramedullary nailing of the tibia
Casting of the affected lower extremity
Discussion of eating habits and training regimens
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A 16-year-old gymnast is diagnosed with the female athletic triad. Which of the following treatments is the least appropriate management?
Calcium and Vitamin D
Oral contraceptive pills
Reduced intensity of training
An 18-year-old female cross-country runner presents with right leg pain for 2 months. Her body mass index is 16 and her last menses was 7 months ago. She reports that she had a benign tumor removed from her left ovary 3 years ago. Her urine pregnancy test is negative. She denies constitutional symptoms. She is tender along the tibial crest and is neurovascularly intact in the extremity. A T1 MRI of the tibia is shown in Figure A. What is the most likely etiology for her presentation?
Neurofibromatosis Type 1
Poor caloric intake
Formation of a fusion protein (EWS-FLI1)
Focal fibrocartilaginous dysplasia
A 26-year-old long distance runner presents with insidious onset of hip and groin pain. An MRI of her hip is shown in Figure A. Work-up should include evaluation for which of the following conditions?
Answer 2 and 3
All of the above
The female athlete triad refers to those athletes with: amenorrhea, osteoporosis, and what other entity?
Increased rate of ACL tears
Women athletes have a higher rate of ACL tears than male athletes in the same sport. While the cause is likely multi-factorial, which of the following factors has been shown to contribute most significantly to this observation?
Neuromuscular coordination and training
Intra-articular notch size
Valgus leg alignment