Hop test | Tibial Stress Fracture Screening

Medial tibial pain is a very common symptom in athletic and military populations. The presence of pain in this area usually means one of two things: Medial tibial stress syndrome or a medial tibial stress fracture. The latter is by far of most concern to healthcare providers as absolute rest might be indicated to prevent the stress fracture from evolving into a frank fracture of one cortex. While stress fractures and MTSS have commonalities, there are a couple of history items that can be used to distinguish them from each other. Furthermore, orthopedic tests can be used to help with the diagnosis. One such test is the one-legged hop test.

According to a study by Milgrom et al. (2021) the hop test had a sensitivity of 100% and a specificity of 45%. So the hop test is highly effective as a screening test to rule out tibial stress fractures. As the study by Milgrom is the only paper evaluating this test so far, we give it a moderate clinical value as a screening test for now.

To perform the hop test, have the patient stand barefoot on the affected leg. If both tibias are affected, start with the less symptomatic side first. Now ask your patient to hop in place as high as possible.Afterward, the test is conducted on the uninvolved leg.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests to assess for stress fractures are:

• Fulcrum Test (Hip)
• Fulcrum Test (Tibia)

References

Milgrom, C., Zloczower, E., Fleischmann, C., Spitzer, E., Landau, R., Bader, T., & Finestone, A. S. (2021). Medial tibial stress fracture diagnosis and treatment guidelines. Journal of science and medicine in sport, 24(6), 526-530.