Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review
Abstract Background Numerous conditions are grouped under the generic term exercise‐induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. Methods Three onli...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
|
| Series: | Journal of Foot and Ankle Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13047-023-00680-6 |
| _version_ | 1797321340542255104 |
|---|---|
| author | Fatma Bosnina Nat Padhiar Stuart Miller Krishna Girotra Chrysovalanto Massoura Dylan Morrissey |
| author_facet | Fatma Bosnina Nat Padhiar Stuart Miller Krishna Girotra Chrysovalanto Massoura Dylan Morrissey |
| author_sort | Fatma Bosnina |
| collection | DOAJ |
| description | Abstract Background Numerous conditions are grouped under the generic term exercise‐induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. Methods Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty‐five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. Results One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub‐diagnosis alongside excluding differentials. The details differed markedly for each sub‐diagnosis. Fifty‐nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty‐one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low‐lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). Conclusion Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation. |
| first_indexed | 2024-03-08T04:57:11Z |
| format | Article |
| id | doaj.art-209d113ee64f46a4ad6f499086d12480 |
| institution | Directory Open Access Journal |
| issn | 1757-1146 |
| language | English |
| last_indexed | 2024-03-08T04:57:11Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Foot and Ankle Research |
| spelling | doaj.art-209d113ee64f46a4ad6f499086d124802024-02-07T15:05:47ZengWileyJournal of Foot and Ankle Research1757-11462023-01-01161n/an/a10.1186/s13047-023-00680-6Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping reviewFatma Bosnina0Nat Padhiar1Stuart Miller2Krishna Girotra3Chrysovalanto Massoura4Dylan Morrissey5Sports & Exercise MedicineWilliam Harvey Research InstituteBarts & The London School of Medicine & DentistryQueen Mary University of LondonLondonUKSports & Exercise MedicineWilliam Harvey Research InstituteBarts & The London School of Medicine & DentistryQueen Mary University of LondonLondonUKSports & Exercise MedicineWilliam Harvey Research InstituteBarts & The London School of Medicine & DentistryQueen Mary University of LondonLondonUKSports & Exercise MedicineWilliam Harvey Research InstituteBarts & The London School of Medicine & DentistryQueen Mary University of LondonLondonUKSports & Exercise MedicineWilliam Harvey Research InstituteBarts & The London School of Medicine & DentistryQueen Mary University of LondonLondonUKSports & Exercise MedicineWilliam Harvey Research InstituteBarts & The London School of Medicine & DentistryQueen Mary University of LondonLondonUKAbstract Background Numerous conditions are grouped under the generic term exercise‐induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. Methods Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty‐five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. Results One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub‐diagnosis alongside excluding differentials. The details differed markedly for each sub‐diagnosis. Fifty‐nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty‐one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low‐lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). Conclusion Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation.https://doi.org/10.1186/s13047-023-00680-6Exercise induced leg painChronic exertional compartment syndromeMedial tibial stress syndromeTibial stress fracturesPopliteal artery entrapment syndromeSuperficial peroneal nerve entrapment syndrome |
| spellingShingle | Fatma Bosnina Nat Padhiar Stuart Miller Krishna Girotra Chrysovalanto Massoura Dylan Morrissey Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review Journal of Foot and Ankle Research Exercise induced leg pain Chronic exertional compartment syndrome Medial tibial stress syndrome Tibial stress fractures Popliteal artery entrapment syndrome Superficial peroneal nerve entrapment syndrome |
| title | Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review |
| title_full | Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review |
| title_fullStr | Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review |
| title_full_unstemmed | Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review |
| title_short | Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review |
| title_sort | developing a diagnostic framework for patients presenting with exercise induced leg pain eilp a scoping review |
| topic | Exercise induced leg pain Chronic exertional compartment syndrome Medial tibial stress syndrome Tibial stress fractures Popliteal artery entrapment syndrome Superficial peroneal nerve entrapment syndrome |
| url | https://doi.org/10.1186/s13047-023-00680-6 |
| work_keys_str_mv | AT fatmabosnina developingadiagnosticframeworkforpatientspresentingwithexerciseinducedlegpaineilpascopingreview AT natpadhiar developingadiagnosticframeworkforpatientspresentingwithexerciseinducedlegpaineilpascopingreview AT stuartmiller developingadiagnosticframeworkforpatientspresentingwithexerciseinducedlegpaineilpascopingreview AT krishnagirotra developingadiagnosticframeworkforpatientspresentingwithexerciseinducedlegpaineilpascopingreview AT chrysovalantomassoura developingadiagnosticframeworkforpatientspresentingwithexerciseinducedlegpaineilpascopingreview AT dylanmorrissey developingadiagnosticframeworkforpatientspresentingwithexerciseinducedlegpaineilpascopingreview |