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shin splints; anterior tibial syndrome; medial tibial stress syndrome

Etiology: 1) periostitis 2) tibial stress fracture 3) risk factors - pes planus - excessive pronation - increase in training intensity [4] Clinical manifestations: 1) pain along the medial, distal 2/3 of the tibia a) initially painful with running & after exercise b) progressively becomes painful at rest c) pain during exercise, improves with rest, & is associated 2) tenderness of distal medial tibia - tenderness over the distal 2/3 of posterior-medial tibia 3) tenderness of periosteal attachment of posterior tibial or soleus muscle [6] Radiology: 1) radiograph is normal unless a stress fracture is present 2) bone scan may demonstrate stress fracture in 2-3 weeks 3) bone densitometry for female runners with amenorrhea & low BMI [6] Differential diagnosis: - stress fracture of distal 1/3 of tibia - delayed-onset muscle soreness - muscle pain (mylagias) that develops 24-48 hours after exercise - weakness, tenderness, stiffness & swelling may be noted - pain peaks 1-3 days after inciting activity with resolution in 7 days - tibialis anterior muscle strain - pain at the time of injury or soon ater - pain localized to tibialis anterior muscle Management: 1) non-steroidal anti-inflammatory drugs (NSAIDs) 2) rest from weight-bearing exercise 3) ice massage to painful area for 15 minutes several times per day 4) full leg air splint & a brief period of restricted weight bearing if pain interferes with activities of daily living 5) gait evaluation by a biomechanist 6) advance running mileage slowly after control of pain

Related

stress fracture (fatigue fracture)

General

leg pain

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 19 American College of Physicians, Philadelphia 1998, 2021
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 809
  3. Grunwald A and Silberman Z Anterior Tibial Syndrome JAMA. 1959;171(16):2210-2213 http://jama.jamanetwork.com/article.aspx?articleid=327269
  4. NEJM knowledge+ Rheumatology
  5. Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012 Apr;31(2):273-90 PMID: 22341017 Review.
  6. NEJM Knowledge+ Endocrinology