Stress fracture shin mri9/15/2023 The pain of shin splints is usually worsened with activity, and eased with rest. an area less than 5cm), with tenderness increased markedly by percussion (ie tapping). Stress fractures do, however, tend to produce a greater localisation of pain (eg. This type of scan is useful in ruling out an actual stress fracture, and the different phases of the scan can help to detect how acute the condition is.Ĭlinically however, the differentiation between shin splints and an actual stress fracture is not always clear. Thus, a bone scan tends to be the most reliable diagnostic indicator, with a ‘Triple Phase Bone Scan’ probably being most sensitive. However, according to some experts, those with chronic shin splints can have a normal MRI. Magnetic Resonance Imaging (MRI) is often a good indicator of bone marrow oedema, which in turn may relate to this bone stress response. Acute shin splints usually show patterns of periosteal changes and bone marrow oedema (ie swelling). Whilst the stress reaction is involving bone, X-rays are in fact poor in regards to indicating this periosteal reaction. ie If not treated or rested and you continue to run with pain, this may result in an actual stress fracture. Shin Splints can be thought of as an early stress fracture. Other muscles sometimes thought to be implicated in shin splints are Tibialis Posterior, Flexor Digitorum Longus or Flexor Hallicus Longus, all with attachment along the inner aspect of the tibia. The overload can take numerous forms eg excessive mileage (particularly on hard training surfaces), excessive ankle pronation or tight calf muscles (in particular the soleus muscle) causing excessive tractional (pulling) forces where the muscles meet the bone. This stress reaction takes the form of an inflammation of the involved area in response to overloading. What many experts do agree upon is that ‘shin splints’ are often most likely a stress reaction involving the periosteal (ie outer layer) bone of the distal (or lower) tibia. This pain is usually located postero-medially (ie toward the back and inside of the lower shin bone), or antero-laterally (ie toward the frontal and outer part of the lower shin) depending on the muscles involved. However, for the purposes of this article, ‘shin splints’ are usually associated with pain along the tibia (or shin bone) of the lower leg. Some prefer the term ‘ medial tibial stress syndrome’. The involved anatomy can indeed vary and thus opinions differ on what a more appropriate generic term may be. A diagnosis of ‘shin splints’ may, for example, actually be describing a stress fracture, compartment syndrome or tibial periostitis. It is inappropriate because the term can often be describing differing clinical problems involving the lower leg, such as an inflammatory reaction of muscle and tendon or a bone stress response. Most medical experts agree that the term ‘Shin Splints’ is probably inappropriate.
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