CLINICAL TIPS … PASCAL EDOUARD ON BONE PERCUSSION

Posted on by Evert Verhagen

Fortnightly we invite a colleague to share a clinical tip with our community. Today, Pascal Edouard, a BOSEM Associate Editor, is on the stage.

@PascalEdouard42

 

Who are you? 

I am a Medical Doctor, University Professor and Hospital Practitioner in Physiology, focusing on Sports Medicine at the Jean Monnet University and University Hospital of Saint-Etienne in France. Clinically, I have been in charge of our Sports Medicine Unit since 2013, and I have a particular interest in managing track and field athletes and female gymnasts. I am also teaching at the Faculty of Medicine Jacques Lisfranc in Saint-Etienne, where I deliver lectures on Exercise Physiology and Sports Medicine. Finally, my research activities, conducted at the Laboratoire Interuniversitaire de Biologie de la Motricité, focus on injury prevention, particularly for hamstring injuries and track and field athletes.

 

What clinical tip would you like to share with the community?

I would like to share a clinical test that I often use in practice: bone percussion. This test consists in firmly tapping on the bone, searching for pain felt by the patient (see video). The pathophysiological substratum is that bone oedema would be sensitive to vibration. The bone percussion causes a vibration, which, if there is bone oedema, is felt as painful, and in the absence of bone oedema, there is no pain. This test is, for me, instrumental in distinguishing pain in different clinical conditions (e.g., tibial stress fracture or shin splints, foot stress fractures or foot arthropathy, knee bone stress). The bone percussion is part of the systematic approach I use during the physical examination: inspection, palpation, percussion, mobilisation, and stability testing. However, this test applies only to the bones immediately under the skin surface. In my clinical practice, this test helps me manage the patients/athletes load and determine the necessity/relevance of imaging exploration.

 

Where does it come from?

I did not learn it in books or lectures during my academic courses, but from a sports medicine physician Dr Hubert Vidalin. He has immense clinical experience and on a daily basis read sports medicine books and articles. He said that it might be of interest this approach. I did, and I’m continuing to use this test in my daily clinical practice.

 

What is its scientific evidence, if any?

A posteriori, I searched on PubMed (not through a systematic review), and I saw two articles analysing or using this test. The most recent (Nussbaum et al. 2021) does not report high sensitivity or specificity in this test. Current scientific evidence is maybe not strong enough to support it. It is perhaps time to extend this scientific knowledge, and I welcome everybody interested in working with me on this test!

 

References
  • Nussbaum ED, Gatt CJ Jr, Bjornarra J, Yang C. Evaluating the Clinical Tests for Adolescent Tibial Bone Stress Injuries.Sports Health. 2021;13(5):502-510.
  • Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. There is a correlation between clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med. 1995;23(4):472-81.
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