Basic principles of nuclear medicine techniques for detection and evaluation of trauma and sports medicine injuries

Tibial Stress Injuries: Aetiology, Classification, Biomechanics and the Failure of Bone

“…The research of Holder and Michael (1984), which was later verified by other studies (e.g. Matin, 1988) is used by most medical imaging specialists as the standard reference for the correct definition and diagnosis of MTSS, and was supported by the British Medical Journal (Macleod, 1999). Holder and Michael (1984) described shin splints to be exercise-induced pain and tenderness to palpation along the posterior medial border of the tibia.…”

“…In the current clinical setting, focal tenderness (due to periosteal swelling and probable attempted bone repair with cortical thickening) is the key for diagnosis of a SF. In the tibia, the whole anteromedial surface of the bone is subcutaneous; hence, there may be overt anteromedial subcutaneous pitting oedema on firm digital palpation reflecting the underlying response of the periosteum to micro-fracture formation (Johnell et al, 1982;Matin, 1988). Additionally, there is sometimes linear tenderness along the whole anterior margin of the tibia to which the deep fascia of the leg has a strong attachment for the anterior compartment.…”

“…Matin (1988) used a five-stage classification, where the initial two stages are defined as MTSS and the final three stages are a SF (Table 2). It is important to note that although there is bone involvement in Stages I and II, MTSS is not considered to be a precursor to a tibial SF in this system.…”

“…Table 2. Classification of a stress fracture and MTSS using nuclear medicine techniques (Matin, 1988).…”

“…This can be observed clinically from distal tibial tenderness, and possibly oedema, over the subcutaneous surface of the tibia. Matin (1988) attributed the bony changes in MTSS to the insertion of Sharpey's fibres. He suggested that abnormal stress on the Sharpey's fibres not only led to the periosteal reaction with an elongated radionucleotide pattern, but also resulted in increased bone remodelling.…”