Another hip region imaging application of potential interest to physiatrists involves the use of technetium bone scanning to evaluate recently described “thigh splints” caused by exaggerated stride length by short female basic trainees in the unisex-oriented military (34). Seven cases of thigh pain in female recruits at one military base were imaged after administration of technetium-99, with the expectation of finding stress fractures. Instead, the scans showed longitudinal linear accentuation sites in the upper or middle femur that were consistent with periosteal elevation and corresponded with the sites of insertion of one or more of the adductor muscles (Fig. 6-21). The reason these findings occur only in female trainees is explained by a Saunders and colleagues’ classic description of pelvic rotation as the first of their six determinants of gait (35). Because the shorter female recruits had to march with taller males, their stride had to be lengthened to maintain straight lines of march, and exaggerating the normal pelvic rotation lengthens stride. The adductor muscles are important pelvic rotators, and their overuse apparently produced avulsion and elevation of the periosteum adjacent to their femoral insertions.

FIGURE 6-21. Thigh splint sites demonstrated by technetium-99 scintigraphy. The accentuation sites (arrowheads) correspond to the insertions of the adductor longus and magnus muscles.


Source: Physical Medicine and Rehabilitation - Principles and Practice

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