Medial tibial stress syndrome

Medial tibial stress syndrome (MTSS), also known as shin splints, describes a spectrum of stress injury that occurs at the medial tibia. This term is often used to indicate any type of tibial stress injury or the earlier manifestations of a tibial stress lesion before a fracture component can be identified 1.

Typically occurs in athletes (e.g. runners/jumpers) and is characterised by localised pain occuring during exercise at the medial surface of the distal two thirds of the tibial shaft

Clinical tests

A "one-leg hop test" is a functional test can be used to distinguish between MTSS and a stress fracture: a patient with MTSS can hop at least 10 times on the affected leg where a patient with a stress fracture cannot hop without severe pain reference required.

CT

CT is not particularly sensitive (~40%). 3 It may reveal mild osteopaenia as an early sign of fatigue damage of cortical bone in tibial diaphysis 3-4.

MRI

MRI is the most sensitive radiological examination (~88%). 3 It may demonstrate a spectrum of findings ranging from normal to periosteal fluid to marrow oedema to actual stress fracture 5. The anterior cortex (+/- posterior cortex) is most commonly affected 3.

These findings are graded using the Fredericson classification system as follows7:

  • grade 1: periosteal oedema only
  • grade 2: bone marrow oedema appreciated only on T2-weighted sequences
  • grade 3: bone marrow oedema appreciated on both T1 and T2-weighted sequences
  • grade 4
    • 4a: multiple discrete areas of intracortical signal changes
    • 4b: linear area(s) of intracortical signal change correlating with a frank stress fracture
Nuclear medicine

Bone scintigraphy is relatively sensitive (~74%) 3 and may demonstrate high uptake in affected region, characteristically along the posterior tibial aspect on lateral views.

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Article Information

rID: 10776
Section: Pathology
Synonyms or Alternate Spellings:
  • Shin splints
  • Shin splint syndrome
  • MTSS
  • Medial tibial stress syndrome (MTSS)
  • Shin splint

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Cases and Figures

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    Figure 1: illustration - Fredericson classification
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    Case 1
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    Case 2: MTSS grade 3
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    Case 3
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    Delayed bone scan
    Case 4
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    Case 5
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    Case 6: ultrasound
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    Case 7
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    Case 8: ultrasound
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