If when you prod your shin you find that you have very focal tenderness that is between 1 mm and 1.5 cm in size, this can be a sign of bone stress injury. Pain which is very well-localised on palpation of your shinĪ tibial bone stress injury often results in marked pain on weight bearing activities, which gets more intense with activity, and NOT better once ‘warmed up’.Pain that worsens specifically on weight bearing activity (e.g.The 3 red flag signs for a bone stress injury are: There are thankfully tell-tale signs associated with each injury. The only iron clad way of differentiating between the two is to have an MRI scan (not an x-ray – which frequently miss stress fractures). Differentiating between shin splints and a bone stress injury A fast engine plus too much mechanical stress to your relatively underdeveloped musculoskeletal chassis can result in injury. If you have recently started running, having come from an established endurance background, such as cycling, then your well-developed cardiovascular engine can sometimes mean that you are more prone to ramping up the mileage quickly. This all adds up where impact and stress on the body is concerned. They are associated with repetitive impact that occurs with regular running – especially when increasing mileage, introducing speed work or even a ‘HIT’ class. These muscles can be felt if you run your fingers down the back of the inside edge of your shin.īone stress injuries range from a bone stress reaction to a complete bone fracture. MTSS is caused by repetitive traction and inflammation of the posterior tibial muscles, which attach to the posterior medial tibial border. There are a number of causes of shin pain, but the two most prevalent are ‘shin splints’ (aka medial tibial periostitis or medial tibial stress syndrome – MTSS) and bone stress injuries (which can culminate in a stress fracture). Please see our publications on tibia fractures, stress fractures, and use of locking plates in fracture treatments.Shin pain is a common complaint amongst distance runners. The HSS Orthopedic Trauma Service has conducted many studies. At 1 year follow-up she was completely asymptomatic.Īnteroposterior and lateral radiographs reveal a stress fracture of the anterior tibial cortex ( arrows).Īnteroposterior and lateral radiographs ( left images) 8 months following surgery revealing a healed tibia stress fracture and CT scan images ( right images) at 8 months illustrate a healed tibial stress fracture. At 4 months postoperatively she had resumed training for competition. At 10 weeks follow up her radiographs illustrated healing of the stress fracture and she resumed full activities. She was surgically treated using an anterior tension band construct with placement of bone graft and a locking plate and screws. Radiographs revealed a radiolucent line involving the anterior cortex of her tibia at the mid-shaft level. At the time of presentation, she was experiencing significant right shin pain that was preventing her from competing in track and field events. Following this treatment she had only temporary improvement in her symptoms and was referred to us. She had also tried a short period of immobilization in a CAM walker boot. One year earlier she had been diagnosed with a stress fracture of her tibia and treated with a bone stimulator and physiotherapy modalities, including ultrasound. Her symptoms were aggravated by activity, especially the long jump. Helfet, MD at the Orthopedic Trauma Service of Hospital for Special Surgery following an 18 month history of insidious onset of right-sided shin pain. A 20-year-old competitive track and field athlete at the collegiate level was referred to the care of David L.
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