II. Pathophysiology

  1. Tightness in Tibialis Posterior and Soleus Muscles predisposes to Shin Splints
  2. Tibial periostitis with anterior tibia micro-Fractures

III. Risk Factors

  1. Poor flexibility
  2. Over-pronation or increased internal tibial rotation
  3. Worn or improper shoes
  4. Running on Hard surfaces
  5. Early season hill training
  6. Increased training intensity, pace or distance
  7. Miserable Malalignment Syndrome

IV. Signs

  1. Localized pain (and mild swelling) at middle to distal third of postero-medial tibia
  2. Pes Planus associated with over pronation

V. Differential Diagnosis

VI. Imaging

  1. Tibia XRay
    1. Evaluate for Stress Fracture
  2. Tibia MRI
    1. Most accurate test for occult Stress Fracture (perform if high level of suspicion and negative XRay)

VII. Management

  1. Calf Stretching
    1. Alphabet writing range of motion Exercises with foot
  2. Local measures and Analgesics
    1. NSAIDs
    2. Ice massage
    3. Transverse friction massage (TFM)
    4. Local Ultrasound with Phonophoresis
  3. Orthotics
    1. Cushioned anti-pronation inserts (CAPI)
    2. Sleeve, strapping, brace
  4. Relative rest
    1. Decrease training and avoid hills
    2. Consider cross training activities
    3. Limit activity to soft surfaces

VIII. Management: Algorithm based on severity

  1. Mild Shin Splints
    1. Implement above measures
  2. Moderate Shin Splints
    1. Implement above measures
    2. Replace Running with non-provocative activity
    3. Consider evaluation for Tibial Stress Fracture
  3. Severe Shin Splints
    1. Implement above measures
    2. Long air cast
    3. Evaluate for Tibial Stress Fracture
    4. No weight bearing sports until
      1. Two weeks of rest and
      2. Negative Hop Test

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Ontology: Medial Tibial Stress Syndrome (C1696469)

Definition (MSH) SKELETAL MUSCLE pain and tenderness along the posteromedial TIBIA resulting from exercise such as running and other physical activity.
Concepts Injury or Poisoning (T037)
MSH D058923
Dutch mediale tibia stress-syndroom, shin splints
German mediales Tibia-Stress-Syndrom, Schienbeinkantensyndrom, Mediales Tibiakantensyndrom
Italian Sindrome da stress medio-tibiale, Stecche per stinchi, Sindrome da stress tibiale mediale, MTSS
Portuguese Síndrome de stress da tíbia interna, Aparelho para a tíbia, Síndrome da Tensão Tibial Medial, Síndrome do Estresse Tibial Medial
Spanish Síndrome de estrés de la tibia medial, Síndrome de dolor crónico en la espinilla, Síndrome de Estrés Medial de la Tibia, Síndrome del Estrés Medial de la Tibia
English Shin splints, shin splint, shin splint (diagnosis), Shin Splint, Medial Tibial Stress Syndrome (MTSS), Shin Splints, Medial Tibial Stress Syndrome, injury shin splints, shin splint injury, shin splints, splints shin, Medial Tibial Stress Syndrome [Disease/Finding], Medial tibial stress syndrome
French Entorse du muscle fléchisseur commun des orteils, Périostite tibiale, Syndrome de stress du tibia interne, Syndrome de stress tibial, Syndrome de stress du tibia médial, Périostite tibiale du sportif, Syndrome douloureux tibial
Japanese 脛骨内側過労性症候群, シンスプリント, ケイコツナイソクカロウセイショウコウグン, シンスプリント
Czech Holenní dlahy, Syndrom středního holenního stresu, mediální tibiální stresový syndrom
Russian МЕДИАЛЬНЫЙ ТИБИАЛЬНЫЙ СТРЕСС-СИНДРОМ, MEDIAL'NYI STRESSOVYI SINDROM BOL'SHEBERTSOVOI KOSTI, MEDIAL'NYI TIBIAL'NYI STRESS-SINDROM, МЕДИАЛЬНЫЙ СТРЕССОВЫЙ СИНДРОМ БОЛЬШЕБЕРЦОВОЙ КОСТИ
Hungarian Lábszár túlzott megterhelése, Medialis tibialis stress syndroma
Polish Zespół przeciążenia przyśrodkowej części piszczeli
Norwegian Beinhinnebetennelse, Shin splint, Benhinnebetennelse, Medialt tibialt stresssyndrom, Medialt tibiasyndrom