Abstract:High-resolution CT has high diagnostic accuracy in depicting medial tibial stress syndrome. Cortical abnormalities can also be seen in some asymptomatic distance runners.
“…Although symptoms of MTSS are located at the interface of the crural fascia and bone, there is evidence that MTSS is associated with specific bone changes. 10,11,20,21 …”
Context:Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.Objective:To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.Data Sources:Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.Study Selection:Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.Study Design:Systematic review with meta-analysis.Level of evidence:Level 4.Data Extraction:Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.Results:Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.Conclusion:Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.
“…Although symptoms of MTSS are located at the interface of the crural fascia and bone, there is evidence that MTSS is associated with specific bone changes. 10,11,20,21 …”
Context:Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.Objective:To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.Data Sources:Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.Study Selection:Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.Study Design:Systematic review with meta-analysis.Level of evidence:Level 4.Data Extraction:Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.Results:Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.Conclusion:Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.
“…The role of plain x-ray is early but MRI is required if patient fails to respond to the conservative management. Plain radiograph and NCCT can show focal increased cortical thickening or exostosis in long standing cases [6,7]. MRI has replaced bone scan which used to pick up early signs.…”
Background: Medial tibial stress syndrome (MTSS) or shin splints is the result of soft tissue injuries surrounding the tibial shaft. The most common causative factor is that of repetitive trauma while doing exertional exercises and maneuvers. These injuries cause pain in the lower leg and affects the lower part of the tibia shaft. This is frequently encountered in athletes and dancers.
“…3) as well as linear stress fractures that may occur in the tibia [4, 27, 30, 31]. CT scanning is useful for demonstrating evidence of healing by clearly demonstrating the periosteal reaction and the absence of a discrete lucency or sclerotic fracture line [4, 27, 31]. It is also helpful in determining if the fracture is complete or incomplete.Fig.…”
Stress fractures and other bony stress injuries occur along a spectrum of severity which can impact treatment and prognosis. When treating these injuries, it should be borne in mind that no two stress fractures behave exactly alike. Given that they are not a consistent injury, standardized treatment protocols can be challenging to develop. Treatment should be individualized to the patient or athlete, the causative activity, the anatomical site, and the severity of the injury. A holistic approach to the treatment of the most difficult stress fractures should be taken by orthopedists and sports medicine specialists. This approach is necessary to obtain optimal outcomes, minimize loss of fitness and time away from sports participation, and decrease the risk of recurrence.
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